Handbook of Multicultural Assessment: Clinical, Psychological, and Educational Applications

Handbook of Multicultural Assessment Clinical, Psychological, and Educational Applications Third Edition

Lisa A. Suzuki and Joseph G. Ponterotto, Editors

John Wiley & Sons, Inc.

Copyright  2008 by John Wiley & Sons, Inc. All rights reserved. Published by Jossey-Bass. A Wiley Imprint 989 Market Street, San Francisco, CA 94103-1741 www.josseybass.com Wiley Bicentennial logo: Richard J. Pacifico No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, or on the Web at www.copyright.com. Requests to the publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, 201-748-6011, fax 201-748-6008, or online at http://www.wiley.com/go/permissions. Readers should be aware that Internet Web sites offered as citations and/or sources for further information may have changed or disappeared between the time this was written and when it is read. Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Neither the publisher nor author shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages. Jossey-Bass books and products are available through most bookstores. To contact Jossey-Bass directly call our Customer Care Department within the U.S. at 800-956-7739, outside the U.S. at 317-572-3986, or fax 317-572-4002. Jossey-Bass also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Library of Congress Cataloging-in-Publication Data Handbook of multicultural assessment : clinical, psychological, and educational applications.—3rd ed. / Lisa A. Suzuki and Joseph G. Ponterotto, editors. p. cm. Includes bibliographical references and index. ISBN-13: 978-0-7879-8703-9 (cloth) 1. Psychological tests—Social aspects. 2. Psychometrics—Social aspects. 3. Educational tests and measurements—Social aspects. 4. Multiculturalism. I. Suzuki, Lisa A., date. II. Ponterotto, Joseph G. BF176.H36 2008 150.28
7—dc22 2007028794 Printed in the United States of America THIRD EDITION

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CONTENTS

Preface

ix

The Editors

xiii

The Contributors

xv

PART ONE: GENERAL ASSESSMENT ISSUES 1 SECTION ONE: GENERAL MULTICULTURAL ASSESSMENT ISSUES 3 1 Issues in Culturally Appropriate Psychoeducational Assessment 5 Amado M. Padilla, Graciela N. Borsato

2 Multicultural Assessment Validity: The Preeminent Ethical Issue in Psychological Assessment 22 Charles R. Ridley, Michael L. Tracy, Laura Pruitt-Stephens, Mary K. Wimsatt, Jacquelyn Beard

3 Building Community Test Norms: Considerations for Ethnic Minority Populations 34 Robert G. Malgady, Gerardita Colon-Malgady

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iv Contents 4 Cultural Identity, Racial Identity, and the Multicultural Personality

52

Alan W. Burkard, Joseph G. Ponterotto

5 Acculturation and Multicultural Assessment: Issues, Trends, and Practice 73 Lourdes M. Rivera

6 Multicultural Issues in Computer-Based Assessment 92 Muninder K. Ahluwalia

7 Clinical Diagnosis in Multicultural Populations

107

Richard H. Dana

8 A Cultural Assessment Framework and Interview Protocol

132

Ingrid Grieger

SECTION TWO: ASSESSING IMMIGRANTS AND REFUGEES 163 9 Considerations for the Cross-Cultural Evaluation of Refugees and Asylum Seekers 165 Judy B. Okawa

10 Cultural Adaptation and Translation of Assessment Instruments for Diverse Populations: The Use of the Harvard Trauma Questionnaire in Rwanda 195 Mary Fabri

11 Delivering Quality Mental Health Services to Immigrants and Refugees Through an Interpreter 220 Maria Prendes-Lintel, Francisca Peterson

SECTION THREE: DAILY LIVING ASSESSMENT 245 12 Assessment of Diverse Family Systems

247

Daniel T. Sciarra, George M. Simon

13 Culturally Competent Vocational Assessment with At-Risk Adolescents in Middle and High School 273 Margo A. Jackson, Aisha M. B. Holder, Morgan T. Ramage

14 Cross-Cultural Considerations in Quality-of-Life Assessment 299 Shawn O. Utsey, Mark A. Bolden

CONTENTS

PART TWO: TESTING ISSUES 319 SECTION ONE: PERSONALITY ASSESSMENT 321 15 TEMAS: A Multicultural Test and Its Place in an Assessment Battery Rosemary Flanagan, Giuseppe Costantino, Elsa Cardalda, Erminia Costantino

16 Multicultural Issues in Projective Assessment 346 Giselle B. Esquivel, Geraldine V. Oades-Sese, Sarah Littman Olitzky

17 On the Multicultural Utility of the 16PF and the CPI-434 in the United States 375 Kristen M. Strack, Marcella H. Dunaway, Stefan E. Schulenberg

18 Multicultural Applications of the Myers-Briggs Type Indicator

402

Mary H. McCaulley, Raymond A. Moody

19 MMPI-2 and MCMI-III Performances of Non-White People in the United States: What We (Don’t) Know and Where We Go from Here 425 Kwong-Liem Karl Kwan, Michael Lynch Maestas

SECTION TWO: ASSESSMENT OF COGNITIVE ABILITIES 447 20 Ability Testing Across Cultures

449

Robert J. Sternberg, Elena L. Grigorenko

21 Educational Assessment of English-Language Learners 471 Graciela N. Borsato, Amado M. Padilla

22 Multicultural Issues and the Assessment of Aptitude

490

Lisa A. Suzuki, Lorelei Prevost, Ellen L. Short

23 Academic Achievement Testing for Culturally Diverse Groups Craig L. Frisby

24 Neuropsychological Assessment in a Multicultural Context: Past, Present, and Future 542 Arthur MacNeill Horton Jr.

25 Family-Oriented, Culturally Sensitive (FOCUS) Assessment of Young Children 565 Paul J. Meller, Phyllis S. Ohr

520

323

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vi Contents 26 Assessment Issues for Working with Diverse Populations of Elderly: Multiculturally Sensitive Perspectives 594 Amanda L. Baden, Grace Wong

SECTION THREE: FORENSIC ASSESSMENT 625 27 Assessing for Child Maltreatment in Culturally Diverse Families Lisa A. Fontes, Margarita R. O’Neill-Arana

28 Competency to Stand Trial: A Multicultural Perspective

651

Sergei V. Tsytsarev, Amanda Landes

29 Multicultural Assessment: Trends and Future Directions Lisa A. Suzuki, Joseph G. Ponterotto

Name Index Subject Index

672 694

666

627

To my wonderful, supportive, and loving husband, John, and to someone who brings great joy to us: our daughter, Kaitlyn L.A.S.

To my loving, brilliant, caring, beautiful, and fun wife, Ingrid; and to our wonderful cousins in Frankfurt: Dalia, Merlin, and Thomas J.G.P.

PREFACE

I

t has been six years since the second edition of the Handbook of Multicultural Assessment was published. During this time, the landscape of assessment practice has grown in complexity, and the challenges facing clinicians, educators, and researchers using various modes of evaluation have increased. This third edition addresses these challenges with updated and newly conceptualized chapters regarding contemporary issues in assessment, cultural examination of the most popular psychological measures, and two new innovative sections. In accordance with earlier editions, this Handbook brings together an outstanding group of authors from academic and clinical settings whose expertise makes this text one that will be useful to clinicians, researchers, educators, and graduate students. Although the authors were asked to revise their work for this new edition, many of them decided to rework their entire chapters based on new developments in the field. We have also invited a number of new contributors because of their outstanding work on relevant multicultural topics. In addition, we are pleased to introduce some new chapters and sections, which we describe in the following paragraphs. Part One focuses on general assessment issues that cut across the different testing areas. The chapters in Section One focus on appropriate practices, ethics, community norms, identity, interviewing, and clinical diagnosis. A new chapter (Six) has been added given the increased presence of technology in current

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x PREFACE assessment practices. Also, Chapter Four, on identity, now includes attention to innovative work being done with respect to the multicultural personality. Section Two, ‘‘Assessing Refugees and Immigrants,’’ is new to this edition. Given the increase in globalization, assessment practices must take into account important historical, social, and political contexts when assessing newcomers such as refugees and immigrants as they arrive and adjust to life in the United States. Each chapter contains anecdotal accounts that draw readers into the harsh realities facing immigrants and refugees. Use of translators and interpreters is more commonplace as members of the mental health profession are increasingly called on to assess individuals who do not speak English. We extend our welcome to the authors of the chapters in this section, who are actively working within refugee and immigrant communities. Section Three contains chapters focusing on the assessment of diverse family systems, vocational issues, and quality of life. The focus of the vocational chapter (Chapter Thirteen) has changed from the previous edition to encompass contemporary work being done with at-risk middle school and high school adolescents. Part Two focuses on the assessment of personality, cognitive ability, and our new section on forensic assessment. The chapters in Section One highlight the use of the Tell-Me-a-Story, projective tests (such as drawings, TAT, and Rorschach), and the most recent versions of the 16PF, CPI, MBTI, MMPI, and MCMI. This section once again includes attention to various methods of assessing cognitive ability, as well as neuropsychological assessment and the evaluation of young children and the elderly. We also examine the educational assessment of English-language learners, an important area new to this edition. Forensic assessment, the topic of Section Three, is a new area of coverage for the Handbook. It provides information regarding multicultural issues as they bear on the assessment of child abuse and criminal competency. We are aware that certain topics such as cultural equivalence, acculturation, and language are mentioned repeatedly throughout the text. These are conceptually relevant topics to a number of testing areas, and their impact should be understood within multiple contexts. Although a number of outstanding books have been published focusing on the multicultural use of psychological measures, we believe that this Handbook continues to provide the greatest breadth of coverage in assessment. Chapter authors refer readers to major sources for more complete discussion of particular measures. In addition to adding new areas, we have consolidated topics (for example, Chapter Sixteen now covers drawing tests, Rorschach, and TAT) and included reference to Web sites that will assist readers in accessing more information.

PREFACE

We are pleased to offer this new edition to meet the challenges that researchers, educators, and clinicians face in serving diverse communities. And we hope that it will continue to stimulate interest and ongoing debate regarding best practices in multicultural assessment.

ACKNOWLEDGMENTS We acknowledge the support and assistance of Alan Rinzler, Jossey-Bass executive editor, who contributed to the conceptualization of this third edition. In addition, we thank Seth Schwartz, Carol Hartland, and Susan Geraghty of Jossey-Bass for their understanding, patience, and support in the completion of the Handbook. Completion of this book often took us away from our families and significant others for extended periods of time. We will always be grateful for their support, love, and understanding. Lisa A. Suzuki New York University

Joseph G. Ponterotto Fordham University

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THE EDITORS

Lisa A. Suzuki is an associate professor in the Department of Applied Psychology at New York University. Prior to this appointment, she was on faculty at Fordham University and the University of Oregon. Her main research interests have been in the areas of multicultural assessment, training, and qualitative research methods. She is coeditor of the Handbook of Multicultural Counseling (1995, 2001) with J. G. Ponterotto, J. M. Casas, and C. M. Alexander; Using Qualitative Methods in Psychology (1999) with M. Kopala; and coauthor of Intelligence Testing and Minority Students: Foundations, Performance Factors, and Assessment Issues (2001) with R. R. Valencia. She served as the vice president for diversity and public interest for the Society of Counseling Psychology (Division 17) of the American Psychological Association and received the Distinguished Contribution Award from the Asian American Psychological Association in 2006. She is an associate editor for The Counseling Psychologist and editorial consultant for the Asian Journal of Counselling. She received her Ph.D. in counseling psychology from the University of Nebraska–Lincoln. Joseph G. Ponterotto is professor of education and coordinator of the master’s degree programs in mental health and school counseling at Fordham University’s Graduate School of Education. His primary research and teaching interests are in the areas of multicultural counseling and assessment, psychological measurement, and research methods, particularly qualitative and mixed-method designs. He coedited the often-cited April 2005 special issue

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xiv THE EDITORS of the Journal of Counseling Psychology on qualitative research methods with B. Haverkamp and S. Morrow. He is coeditor of the Handbook of Multicultural Counseling (1995, 2001) with J. M. Casas, L. A. Suzuki, and C. M. Alexander. His most recent book is Preventing Prejudice: A Guide for Counselors, Educators, and Parents (2nd edition, 2006), coauthored with S. Utsey and P. Pedersen. In 2007 he was awarded the Seventeenth Annual Janet E. Helms Award for Mentoring and Scholarship. He received his Ph.D. in counseling psychology from the University of California at Santa Barbara.

THE CONTRIBUTORS

Muninder K. Ahluwalia is an associate professor in the Department of Counseling, Human Development, and Educational Leadership at Montclair State University. She currently serves on the executive board of the Asian American Psychological Association. Her primary research interests are in multicultural counseling, issues of identity and self among Asian Americans, racism and discrimination, and methodological issues in qualitative research. She received her doctorate in counseling psychology from New York University. Amanda L. Baden is an associate professor and the graduate adviser in the counseling program at Montclair State University in Montclair, New Jersey. Her research interests focus on adoption triad members, transracial and international adoption issues, racial and cultural identity, and multicultural counseling competence. Her clinical training took place in community mental health and large urban hospital centers in New York City, including Gouverneur Hospital and Bellevue Hospital, both of which serve diverse clinical populations. Baden has written extensively on adoption issues and is one of the editors of The Handbook of Adoption: Implications for Researchers, Practitioners, and Families (2007). Her clinical specializations include counseling adoption triad members, transracial adoptees, and individuals with multiracial backgrounds. She is also a licensed psychologist in New York State. She received her doctorate in counseling psychology from Michigan State University.

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xvi THE CONTRIBUTORS Jacquelyn Beard is a first-year master’s student in the Counseling and Educational Psychology Department at Indiana University. Her primary research interest is multicultural counseling. She holds a B.S. from the University of Illinois, Urbana-Champaign. Mark A. Bolden is a research fellow with the DC Baltimore Research Center on Child Health Disparities, where he investigates the impact of stress and structural violence on substance use and coping among populations of African descent. He is a member of the Association of Black Psychologists, the founder of the National Black Counseling Psychologists Conference, and a cofounder of ACTIVE! (African-Centered Trauma Initiative). He is a doctoral candidate in counseling psychology at Howard University. Graciela N. Borsato is a doctoral candidate in child and adolescent development at Stanford University. Her research is concerned with the schooling experiences and psychosocial adjustment of immigrant children. She has a special interest on issues of equity and access for language-minority students. She has been a teaching fellow at the Stanford Center in Comparative Studies in Race and Ethnicity and is a lecturer at San Jos´e State University. She also serves as a member of the Student and Early Career Council of the Society for Research in Child Development. She received her M.A. in psychology at San Jos´e State University. Alan W. Burkard is an associate professor in the Department of Counseling and Educational Psychology at Marquette University, where he is also director of the school counseling program. His primary research and teaching interests are multicultural counseling and assessment, clinical supervision, and counselor and psychologist training and development. He received his doctorate in counseling psychology from Fordham University in New York. Elsa Cardalda is associate professor and director of the doctoral clinical psychology program at Carlos Albizu University, San Juan, Puerto Rico. She has been director of the department for several years, achieving with her fellow professors the prestigious American Psychological Association accreditation, for which she developed the existing scholarship on culturally competent clinical training. Her publications span her diverse research interests. She has been working for the past fifteen years with Giuseppe Costantino on issues related to the cross-cultural validation and cultural competence of the TEMAS instrument, with populations in Puerto Rico and New York City. Among her significant findings are the relevant use of TEMAS as a problem-solving device, the adaptation of the group method technology, exploration of gender issues,

THE CONTRIBUTORS

and protective factors for children at risk. Other research interests include the analyses of murals as social representations of breastfeeding practices and egalitarian and authoritarian attitudes. She received her doctorate from the New School University and is an APA member. Erminia Costantino is director for the American Multicultural Institute, a multimedia organization, with a mission of promoting multicultural competence through articles, presentations, shows, and documentary films. She also works as a research associate consultant at the Lutheran Family Health Centers (LFHC). Costantino has directed, edited, and produced a culturally competent promotional video for the SAMHSA-funded Primary Care Research in Mental Health/Substance Abuse for the Elderly project, a multisite national study that resulted in the largest enrollment increase for the LFHC site. She has contributed to numerous national and international TEMAS presentations and the latest book: TEMAS (Tell-Me-A-Story) Assessment in Multicultural Societies. She received her bachelor of science degree in communication and psychology from St. John’s University and a certificate from UCLA, Anderson School of Management, Entertainment Media Management Institute. Giuseppe Costantino is director of training and new programs at Lutheran Medical Center Lutheran Family Health Centers, Brooklyn, New York. He created the TEMAS test rationale and pictures prior to the collaborative publication of the 1998 manual. He is also the originator of cuento therapy, hero/heroine modeling therapy, and TEMAS narrative therapy. His work on culturally competent assessment and treatment was recognized by the surgeon general (2001), the American Psychological Association (2003), and the Society for Personality Assessment (2003). He is an APA member and recipient of several National Institutes of Health research project grants; grants from Substance Abuse and Mental Health Services Administration/Human Resources and Services Administration; on mental health in primary care for the elderly and on the effects of the terrorist attacks of September 11, 2001, on children; and grants from the AVON Foundation and New York State Department of Health, Office of Minority Health, on cancer prevention. He was consulting editor of Journal of Personality Assessment, Hispanic Journal of Behavioral Sciences, and Buros Institute Eighth and Ninth Mental Measurements Yearbooks. He has written three books and more than forty book chapters and articles on culturally competent assessment and treatment of culturally diverse individuals. He received his doctorate from New York University. Richard H. Dana is research professor (Honorary) at the Regional Research Institute, Portland State University. Since retirement in 1988 as University

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xviii THE CONTRIBUTORS Professor Emeritus, University of Arkansas, his research has focused on the multicultural assessment-intervention process model. He is the author of sixteen books, thirty book chapters and monographs, seventeen reviews, and approximately two hundred journal publications. He has a diplomate in clinical psychology and has been licensed in seven states. His awards include Sigma Xi Associate (1949) and Member (1963); Society for Personality Assessment-Bruno Klopfer (1984); Mayman (2004); Oregon Graduate School of Professional Psychology-Walter Klopfer (1987); and Arkansas Psychological Association-Distinguished Psychologist (1988). His most recent books are Multicultural Assessment Principles, Applications, and Examples (2005), Tell-Me-A-Story Assessment of Multicultural Populations (with G. Costantino and R. Malgady, 2007), and Cultural Competency Training (with J. Allen, in preparation). He received his doctorate from the University of Illinois. Marcella H. Dunaway is a doctoral candidate in clinical psychology at the University of Mississippi. Her research interests include the assessment of attention deficit hyperactivity disorder and other disruptive behaviors, serious emotional disturbances, intimate partner violence, and multicultural assessment issues. She earned her master of arts degree in clinical psychology at East Tennessee State University. Giselle B. Esquivel is professor in the school psychology program, Division of Psychological and Educational Services, Graduate School of Education at Fordham University. She is a nationally certified school psychologist, a licensed psychologist, a diplomate of the American Board of Professional Psychology, and a fellow of the American Academy of School Psychology and of the American Psychological Association. Her research publications and professional presentations are in the areas of multicultural school psychology, creativity, resilience, spirituality, and the use of narrative methods with culturally diverse children and adolescents. She has been influential in the development of a multicultural perspective in school psychology through her academic work and leadership in professional organizations. She received her Psy.D. from Yeshiva University in New York. Mary Fabri is a clinical psychologist and director of Torture Treatment Services and International Training at the Marjorie Kovler Center of Heartland Alliance in Chicago. She is the current president of the National Consortium of Torture Treatment Programs. Fabri provides consultation and training internationally on the impact of trauma, cross-cultural issues, and secondary traumatization. She is a primary investigator for the Rwandan Women’s Inter-association Study and Assessment, examining the long-term effects of

THE CONTRIBUTORS

trauma, and a psychological consultant for Women’s Equity in Access to Care and Treatment in Rwanda. She is also a guest lecturer at the National University of Rwanda in Butare. She has worked in public health settings and with multicultural issues and published on topics pertaining to refugee mental health and cross-cultural treatment. Fabri received her Psy.D. from Argosy University (originally the Illinois School of Professional Psychology). Rosemary Flanagan is an associate professor at Touro College, New York, New York. Previously she was full-time faculty and director of the school psychology program at Gordon F. Derner Institute for Advanced Psychological Studies, Adelphi University, Garden City, New York. Prior to coming to Adelphi, she was a practicing school psychologist for eighteen years, while serving as adjunct faculty at St. Johns and Hofstra Universities. She has taught personality assessment for fifteen years, and has over twenty publications on assessment and professional issues in school psychology. She recently served as a guest editor (with Hedwig Teglasi) of an issue of Psychology in the Schools that was devoted to personality assessment and school psychology. Flanagan is a fellow of the Society for Personality Assessment and a diplomate of the American Board of Professional Psychology (ABPP). Active in professional associations, she is a past president of the American Board of School Psychology and currently serves on the board of trustees of the ABPP. She maintains an independent practice of psychology. She received her Ph.D. from Hofstra University. Lisa A. Fontes is a core faculty member at Union Institute and University’s Psy.D. program in clinical psychology in Brattleboro, Vermont. She has dedicated fifteen years to making the social service and mental health systems more responsive to culturally diverse people harmed by family violence. She is the author of Child Abuse and Culture: Working with Diverse Families (2005) and editor of Sexual Abuse in Nine North American Cultures: Treatment and Prevention (1995) and has written extensively on related topics. Fontes has worked as a family, individual, and group therapist in a variety of settings. She has conducted research in Santiago, Chile, and with Puerto Ricans, African Americans, and European Americans in the United States. She is fluent in Spanish and Portuguese. She is a popular conference speaker, consultant. and trainer. She received her Ph.D. from the University of Massachusetts. Craig L. Frisby is an associate professor of school psychology and director of the school psychology program at the University of Missouri, Columbia. He is a member of the National Association of School Psychologists and the Society for the Study of School Psychology. He is a former associate editor of School

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xx THE CONTRIBUTORS Psychology Review, coeditor of Test Interpretation and Diversity: Achieving Equity in Assessment (1998), and lead editor for The Comprehensive Handbook of Multicultural School Psychology (2005). His research interests include the measurement of test session behavior, multidimensional scaling applications, and cultural issues in professional school psychology. He earned his doctorate from the University of California, Berkeley. Ingrid Grieger is director of the Counseling Center at Iona College in New Rochelle, New York, and adjunct professor of counseling at Fordham University’s Graduate School of Education. She has strong clinical, teaching, and research interests in rational emotive behavior therapy, women’s issues in counseling, multicultural counseling and assessment, multicultural organizational development, and mental health and wellness issues for college student populations. A frequent presenter and writer regarding these topics, Grieger was coeditor of Cognition and Emotional Disturbance (1982) and has authored chapters in such books as Handbook on Counseling Women (2003), Handbook of Multicultural Counseling (1995, 2001), and Counseling Across Cultures (2007). She received her doctorate in counselor education from the University of Virginia. Elena L. Grigorenko is associate professor of child studies and psychology at Yale University and associate professor of psychology at Moscow State University. She has published more than two hundred peer-reviewed articles, book chapters, and books. She has received awards for her work from five divisions of the American Psychological Association and won the APA Distinguished Award for an Early Career Contribution to Developmental Psychology. Her research has been funded by the National Institutes of Health, the National Science Foundation, the U.S. Department of Education, Cure Autism Now, the Foundation for Child Development, the American Psychological Foundation, and other federal and private sponsoring organizations. She received her doctorate in general psychology from Moscow State University, Russia, and her doctorate in developmental psychology and genetics from Yale University. Aisha M. B. Holder is a doctoral student in the counseling psychology program at Fordham University. She also works in the Career Advancement Program (CAP) at JPMorgan Chase (JPMC), a global financial services company, where she provides career counseling to JPMC employees with diverse backgrounds. Prior to her role in CAP, she served as a human resources generalist in the retail and investment banking business divisions at JPMC for six years. Her research interests are career development, racial microaggressions, and

THE CONTRIBUTORS

multicultural counseling. She earned a master of arts degree in psychological counseling at Teachers College, Columbia University. Arthur MacNeill Horton Jr. has been a faculty member at the University of Virginia, the Johns Hopkins University, West Virginia University, the University of Baltimore, the University of Maryland Medical School, Department of Psychiatry, among other academic institutions. He holds diplomates in clinical psychology and behavioral psychology from the American Board of Professional Psychology and in neuropsychiatry from the American Board of Professional Neuropsychology. He is the author or editor of over 15 books, more than 30 book chapters, and over 150 journal articles. His most recent book is Handbook of Forensic Neuropsychology (2003), edited with Lawrence C. Hartlage. Neuropsychology, the Coalition of Clinical Practitioners of Neuropsychology, and the National Academy of Neuropsychology. He received his doctoral degree from the University of Virginia. He also recently coauthored the Test of Verbal Conceptualization and Fluency (2006) with Cecil R. Reynolds. He is a past president of the American Board of Professional. Margo A. Jackson is an associate professor and training director of the counseling psychology programs in the Division of Psychological and Educational Services of the Graduate School of Education at Fordham University. Before joining the Fordham faculty, she completed postdoctoral psychology fellowships in research (complex instruction at Stanford University) and in clinical supervision (at the Palo Alto Veterans Affairs Health Care System); taught at San Jose State University and Stanford University; served as a career counselor and professional development consultant in private practice; was director of the Career Development Center, D’Youville College; served as president of the board of directors at the Greater Buffalo Counseling Centers. Her clinical, research, and teaching interests are in multicultural career counseling and psychotherapy training and supervision, and her focus is on examining methods to assess and constructively address hidden biases of counselors and educators. She earned her Ph.D. in counseling psychology at Stanford University, Ed.M. in counseling at the University of Buffalo, and B.A. in psychology and Spanish at the State University of New York at Binghamton. Kwong-Liem Karl Kwan is an associate professor in the Department of Educational, School, and Counseling Psychology at the University of Missouri at Columbia. He earned his Ph.D. (1996) from the counseling psychology program at the University of Nebraska. He was a tenured faculty in the Department of Educational Studies at Purdue University (1996–2005). During his doctoral years in Nebraska, he was a research assistant at the Buros Institute of Mental Measurements. Prior to pursuing his psychology studies in the United

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xxii THE CONTRIBUTORS States, he worked as a research interviewer at the Psychiatric Epidemiology Research Unit in the Department of Psychiatry at the Chinese University of Hong Kong. His research focus is on the development and assessment of culture-specific counseling constructs. He serves on the editorial boards of the Journal of Counseling Psychology, Asian Journal of Counselling, and as editor of the International Forum of The Counseling Psychologist. Amanda Landes is currently a doctoral student at the Psy.D. program in school/community psychology at Hofstra University. Previously she interned in an adult male inpatient forensic facility and is now working with children with behavior problems. Upon graduation she hopes to combine her knowledge of psychology and the law with her experience with children to work with incarcerated adolescents and children who have experienced severe trauma. She received her B.S. in communication studies from New York University and her M.A. in forensic psychology from the John Jay College of Criminal Justice of the City University of New York. Michael Lynch Maestas is the director of Counseling and Psychological Services at the University of Kansas and a licensed psychologist. He received his Ph.D. from the University of Nebraska-Lincoln in 2000. He has taught psychopathology, clinical interviewing, and personality, intellectual, and neuropsychological assessment. His professional interests focus on psychological evaluation and assessment, intellectual assessment, and neuropsychological assessment. Additional important interest areas include American ethnic minority issues, acculturation, ethnic identity development and retention, multicultural therapy and assessment competencies, and supervision and training in professional psychology. Robert G. Malgady is professor of educational statistics at New York University, where he has taught in the Steinhardt School of Education for the past twenty-seven years. He recently retired from his academic position to pursue research at Touro College. Dr. Malgady received a B.A. in psychology from Rutgers University and a Ph.D. in psychology/statistics from the University of Tennessee. He is the author or coauthor of five books and over ninety book chapters and journal articles in a variety of areas of psychology, including statistics, psychometrics, cross-cultural assessment, and culturally sensitive psychotherapy for Hispanic youngsters. He serves regularly on NIMH grant review panels and American Psychological Association editorial boards. Having written one fiction novel, he recently completed a screenplay currently under review by HBO cablevision.

THE CONTRIBUTORS

Gerardita Colon-Malgady has been director of risk management and medical credentialing at Beth Israel Medical Center in New York City for the past eight years. She is coauthor of journal articles on assessment of attention deficit disorder among Hispanic children, as well as articles on basic statistical methods. She is a frequent presenter at the annual meetings of the American Psychological Association. She received a B.A. in psychology from Boricua College and an M.S. in bilingual school psychology from Fordham University at Lincoln Center. Mary H. McCaulley was president of the Center for Applications of Psychological Type (CAPT) in Gainesville, Florida. She and Isabel Briggs Myers founded CAPT in 1975 as a nonprofit organization for research, training, and practical applications of the Myers-Briggs Type Indicator. She earned her doctorate in clinical psychology at Temple University in Philadelphia. From 1964 to 1985 she served on the graduate faculty of the Department of Clinical Psychology at the University of Florida. After meeting Isabel Myers in 1969, she focused her energies on the Myers-Briggs Type Indicator. McCaulley created the first MBTI newsletter, the first MBTI computer scoring, and the first MBTI professional training program and trained thousands of type practitioners around the world. She followed up Isabel Myers’s longitudinal medical sample and wrote a state-of-the-art monograph on the MBTI in the health professions. After Isabel Myers’s death in 1980, she revised the MBTI Manual (1985, 1998). She was a founding member of the Association for Psychological Type in 1979 and a member of the APA, the American Counseling Association, and the American Educational Research Foundation. McCaulley died in 2003. Paul J. Meller is an associate professor and assistant director of the doctoral training program in school/community psychology at Hofstra University. His research has focused on the promotion of social competence in young children, as well as the nature and reduction of conflict in high-risk and divorcing families. He has served as a consultant to over a hundred school districts and is the founder and executive director of Turning Points, a community-based agency that provides court-referred services to highly conflicted and distressed families. He received his doctorate in school psychology from Syracuse University. Raymond A. Moody taught at several universities: UCLA, Indiana, Wisconsin, Iberoamericana in Mexico City, the Universidad de Guadalajara, and the University of Hawaii retiring after forty years of teaching. He spent two sabbaticals at the Center for Applications of Psychological Type (CAPT) working with Mary McCaulley. His publications deal with type, language teaching, and

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xxiv THE CONTRIBUTORS motivation. His most recent research has focused on type and cultural values, with collaborators in Bulgaria, Finland, Japan, Korea, and New Zealand. With CAPT support, in 1993, he organized the International Conference on Psychological Type and Culture—East and West in Honolulu, which draws contributors from Europe, the Americas, and Asia. The sixth conference will be held in 2008. He has served as president of the Hawaii Association of Language Teachers and is a founding member of the Hawaii chapter of the Association for Psychological type. He is the multicultural and international interest coordinator for the Association for Psychological Type International. He earned his doctorate in Spanish and Portuguese from UCLA. Geraldine V. Oades-Sese is an assistant professor at Rutgers University, Graduate School of Applied Professional Psychology, and a nationally certified school psychologist. Her professional experiences include providing assessment and intervention services for gifted children, as well as developmentally delayed, multiply handicapped, and medically fragile infants, children, and adolescents. She is conducting research on resilience among at-risk preschool children and adolescents from culturally and linguistically diverse backgrounds. She is first author of a number of published articles and book chapters in the area of multicultural school psychology and has presented her research on resilience at professional organizations, including the New York Academy of Sciences. She received her doctorate in school psychology from Fordham University at Lincoln Center. Phyllis S. Ohr is an associate professor and assistant clinical director of the doctoral program in combined clinical and school psychology at Hofstra University, Hempstead, New York. She has previously worked as a psychologist at Schneider Children’s Hospital, Lake Success, New York, in an early intervention program for young children with special needs and their parents. Ohr’s clinical and research specialty is the cognitive-behavioral assessment of stressed parent-child dyads. She has also investigated early precursors of later psychopathology, with her latest findings presented in ‘‘Predicting Adolescent Anxiety Ratings from Infant Behavioral Style in Response to Expectancy Violation,’’ published in 2006 in Applied Developmental Science. She received her doctorate in clinical child psychology from St. John’s University, Jamaica, New York. Judy B. Okawa is a licensed clinical psychologist and founder of the Center for Traumatic Stress Studies (CTSS) in Washington, D.C. She is nationally recognized for her expertise in working with refugee and immigrant survivors of torture and refugee trauma. Prior to establishing CTSS, she founded and

THE CONTRIBUTORS

directed the Program for Survivors of Torture and Severe Trauma at the Center for Multicultural Human Services in Falls Church, Virginia. Okawa is well known for her expertise in the psychological evaluation of asylum seekers and frequently provides expert witness testimony on the impact of torture and war trauma. She has testified before congressional committees on the impact of torture on numerous occasions and has received a Human Rights Award for her work with torture survivors. She received her Ph.D. in clinical psychology from George Washington University, an M.A., in Latin American studies from Stanford, and an M.A. in English from Georgetown University. Sarah Littman Olitzky is a doctoral candidate in the school psychology program at Fordham University, concentrating in the psychology of bilingual students. She has contributed as research assistant to a number of studies in the areas of acculturation, language development, multicultural parenting beliefs, and resilience. Several of these investigations have been conducted in Nicaragua, Spain, and Israel. Her primary professional interests include school-based interventions for at-risk Latino students, as well as the assessment of linguistically diverse children. Toward this end, she has participated in clinical and research externships at major New York City institutions such as the New York University Child Study Center, New York Presbyterian, and Bellevue Hospital. She received a B.A. in psychology and Spanish from Barnard College, Columbia University. Margarita R. O’Neill-Arana is a psychologist and director of clinical training of the Psy.D. program at Union Institute and University in Cincinnati, Ohio, where she serves on the faculty. She has taught, counseled, supervised, and collaborated with individuals of diverse backgrounds in educational and clinical settings for over twenty-five years. She has also developed and managed clinical programs for disenfranchised populations. She has served as cochair of the Multicultural Advisory Committee of the Massachusetts Department of Mental Health, director of Culture-Specific Services at Worcester Youth Guidance Center, president of the Women’s Fund of Western Massachusetts, and director of a demonstration project to develop mental health services for the Vietnamese community in Springfield, Massachusetts. Her interests include child and family psychology, child abuse, cultural competence, Latino mental health and adolescent girls’ development. She received her doctoral degree from the University of Massachusetts. Amado M. Padilla is professor and chairman of the program in psychological studies in education at Stanford University. A fellow of the American Psychological Association, he has published more than 180 articles and chapters

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xxvi THE CONTRIBUTORS on numerous topics, including psychological assessment, ethnic identity, acculturation, second-language learning and teaching, and the education of immigrant students. He is the founding editor of the Hispanic Journal of Behavioral Sciences, currently in its twenty-ninth year of publication. He has served as a consultant to numerous regional and national organizations, as well as governmental agencies, that work with immigrant children and their families. He received his doctorate in experimental psychology from the University of New Mexico. Francisca Peterson is a therapist at For Immigrants and Refugees Surviving Torture (FIRST Project), located in Lincoln, Nebraska. She was an international student counselor for five years at Moorhead State University. In her role as a school psychologist with the Lincoln Public Schools, she is assigned to the gifted program. She also served as the team leader for the English-language learners’ special needs assessment team for five years. Peterson has specialized training in trauma. She received her interpreter training through various legal and mental health workshops. She has taught mental health workshops for FIRST Project for six years and presented mental health interpretation workshops for the Nebraska Association for Translators and Interpreters as well as the Texas A&M School Psychology Department. She received her master’s degree in counseling from Moorhead State University, is a licensed mental health professional and certified school psychologist in Nebraska, and holds a National School Psychologist Certification. Maria Prendes-Lintel, a founder and director of FIRST Project (For Immigrants and Refugees Surviving Torture), which opened its doors in Lincoln, Nebraska, in 2000, and has worked with refugees and immigrants in various capacities since 1977. She has presented internationally, nationally, regionally, and locally in working with multicultural populations, immigrants and refugee needs, psychosocial and physiological impact of stress, working with interpreters, treatment of immigrant and refugee trauma and torture, depression, and areas related to behavioral health and multicultural populations. She is also the president of a private practice, The Wellness Center. She received her bachelor’s and master’s degrees in social work and completed her doctorate in counseling psychology from University of Nebraska Lincoln. Lorelei A. Prevost is a doctoral student in the counseling psychology program at New York University. Her research concerns survivors of trauma and recovery with a focus on resilience. Other research interests are immigrant and refugee acculturation and identity development, and the racial and cultural experiences of transracially adopted children. Her clinical work has focused on

THE CONTRIBUTORS

populations recovering from trauma, including immigrants and refugees who have survived torture, as well as combat veterans. She earned her Ed.M. and M.A. in psychological counseling from Teachers College, Columbia University, and an M.A. in international relations from the Fletcher School of Law and Diplomacy, Tufts University. Laura Pruitt-Stephens is a first-year doctoral student in the Counseling and Educational Psychology Department at Indiana University. Her primary research interest is multicultural competency and training issues. She holds a B.S. from Utah State University. Morgan T. Ramage is a director at the SCORE! Educational Center in Huntington, New York, where she works to enhance student motivation, confidence, and academic performance through direct academic coaching and by developing partnerships with schools and parents. Her clinical and research interests include the development and use of metacognitive strategies in children, the effectiveness of supplemental education programs, and body image disturbances. She earned her M.S.Ed. in educational psychology at Fordham University with a concentration in education evaluation. Charles R. Ridley is a professor and codirector of training of the counseling psychology program at Indiana University. He has published extensively in the areas of multicultural counseling, assessment, and training, as well as on topics related to therapeutic change, organizational consultation, and the use of religious resources in counseling and psychotherapy. A licensed psychologist, he is a fellow of Divisions 17 and 45 of the American Psychological Association. He is author of Overcoming Unintentional Racism in Counseling and Therapy: A Practitioner’s Guide to Intentional Intervention (2005) and coauthor with W. Brad Johnson of The Elements of Mentoring (2004). He received his doctorate from the University of Minnesota. Lourdes M. Rivera is an assistant professor of counselor education in the Department of Educational and Community Programs at Queens College of the City University of New York. She teaches courses in counseling techniques, counseling theories, multicultural counseling, and career development. Prior to joining the faculty at Queens College, she worked as a college counselor providing personal, career, and academic counseling to a diverse community college population. Her predoctoral internship was completed in an urban hospital setting where she worked with culturally diverse children, adolescents, and adults in the inpatient and outpatient departments. Her research interests include issues in multicultural counseling and career development, particularly

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xxviii THE CONTRIBUTORS as relates to diverse populations. Rivera received her doctorate in counseling psychology from Fordham University at Lincoln Center. Stefan E. Schulenberg is a licensed psychologist in the state of Mississippi, an assistant professor in the Department of Psychology at the University of Mississippi, and director of the department’s Psychological Assessment Clinic. He teaches the doctoral clinical training program’s cognitive and personality assessment sequence, as well as graduate and undergraduate courses in tests and measurements. His research interests include computer use in psychological assessment and psychotherapy, psychological test construction, multicultural issues in psychological assessment, clinical disaster psychology, and logotherapy. He is a diplomate in Logotherapy through the Viktor Frankl Institute of Logotherapy. He received his doctorate in clinical psychology from the University of South Dakota, where he also specialized in clinical disaster psychology. Daniel T. Sciarra is professor of counselor education at Hofstra University in Hempstead, New York. Fluently bilingual in Spanish, he sees Latino children, adolescents, and families through the Stamford Child Guidance Center in Stamford, Connecticut. In addition to numerous articles and book chapters on the subject of multicultural counseling, Sciarra is the author of two books, Multiculturalism in Counseling (1999) and School Counseling: Foundations and Contemporary Issues (2004), and he is currently writing a third book, Emotional Disorders in the Classroom. A former school counselor with the New York City Board of Education, Sciarra holds a doctorate in counseling psychology from Fordham University, a master’s degree in counseling from Boston College, and a bachelor’s degree in English education from Fairfield University. He is a licensed psychologist, a licensed clinical mental health counselor (LCMHC), and a national certified counselor (NCC). Ellen L. Short is an assistant professor at Long Island University in the Department of Human Development and Leadership, Counseling Programs. Her areas of specialization in practice, teaching, scholarly research, and publishing are group dynamics focusing on race, ethnicity, gender, and culture; HIV; substance abuse and high-risk behavior among heterosexual populations; and multicultural assessment of intelligence. She received her M.A. in counseling psychology from Northwestern University and her Ph.D. from New York University.

THE CONTRIBUTORS

George M. Simon is a member of the faculty of the Minuchin Center for the Family and an adjunct assistant professor in the Department of Health Professions and Family Studies of Hofstra University. He sees couples and families in his therapeutic practice in Deer Park, New York. In addition to numerous articles published in leading peer-reviewed journals, Simon is the author of Beyond Technique in Family Therapy: Finding Your Therapeutic Voice (2003) and coauthor, with Salvador Minuchin and Wai-Yung Lee, of the second edition of Mastering Family Therapy: Journeys of Growth and Transformation (2006). Simon holds a bachelor’s degree in meteorology from New York University, a master’s degree in philosophy from Fordham University, and a master’s degree in counseling, also from Fordham University. He was trained in structural family therapy by Salvador Minuchin, the chief architect of this therapeutic approach. He is a licensed marriage and family therapist (LMFT). Robert J. Sternberg is dean of the School of Arts and Sciences and professor of psychology at Tufts University. Previously he was IBM Professor of Psychology and Education and Professor of Management at Yale University. In 2003, he was president of the American Psychological Association and currently is president of the Eastern Psychological Association. Sternberg’s main interests are intelligence, creativity, wisdom, and leadership. He received his doctorate from Stanford and has received eight honorary doctorates. Kristen M. Strack is a doctoral student in the clinical psychology program at the University of Mississippi, where she earned her M.A. degree in clinical psychology. Her research interests include treatment of individuals with serious mental illness, empowerment, psychological assessment, and multicultural issues in applied psychology. Michael L. Tracy is an associate professor in the Counseling and Educational Psychology Department and supervisor within the Center for Human Growth at Indiana University and a licensed psychologist who has also been a family therapist. His specialty is the area of assessment and exceptionality. He received his doctorate from the University of Michigan. Sergei V. Tsytsarev is professor of psychology at Hofstra University in Hempstead, New York. He was a professor of law and psychology at St. Petersburg (formerly Leningrad) State University from 1983 to 1991 and in 1988–1989 was a visiting scholar at the Faculty of Law at Osaka City University, Japan. Since 1991 he has been an associate professor at John Jay College of Criminal Justice in New York City and then at Hofstra University.

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xxx THE CONTRIBUTORS He teaches and conducts research in cross-cultural psychopathology and psychotherapy, forensic (criminal) psychology, and psychology of addictions. In 1977, he graduated from Leningrad State University and in 1982, he earned his doctorate in clinical psychology from the V. M. Bekhterev Psychoneurological Research Institute. Shawn O. Utsey is an associate professor of counseling psychology in the Department of Psychology at Virginia Commonwealth University. He is currently the editor-in-chief for the Journal of Black Psychology and has served in this capacity since 2001. Utsey has published on African American psychology in a number of journals, including the Journal of Black Psychology, Journal of African American Men, Journal of Personality Assessment, Journal of Cross-Cultural Psychology, Cultural Diversity and Ethnic Minority Psychology, and the Journal of Counseling Psychology. More recently, he has examined the influence of African American culture on indicators of health and well-being. He is a leading scholar in the area of race and racism and, with Joseph Ponterotto and Paul Pedersen, wrote the recently published second edition of Preventing Prejudice. Utsey is the 2004 recipient of the Emerging Professional Award from Division 45 of the American Psychological Association and the 2004 Kenneth and Mamie Clark Mentoring Award from APAGS, the student division of the American Psychological Association. He received his doctorate in counseling psychology from Fordham University in New York City. Mary K. Wimsatt is a first-year doctoral student in the Counseling and Educational Psychology Department at Indiana University. Her primary research interests are multicultural counseling competency and diversity issues. She holds an M.S. from the University of Kentucky. Grace Wong is a psychologist at South Beach Psychiatric Center (Staten Island, New York) working with monolingual Chinese-speaking patients. She worked extensively with the elderly when she worked for the Center for Older Adults at Gouverneur Hospital in Manhattan. She maintains an active private practice and is the president of the Division of Culture, Race, and Ethnicity for the New York State Psychological Association. She received her doctorate in clinical psychology from Fuller Graduate School of Psychology.

PART ONE

GENERAL ASSESSMENT ISSUES

SECTION ONE

GENERAL MULTICULTURAL ASSESSMENT ISSUES

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art One focuses on general issues pertaining to assessing people from diverse racial and ethnic backgrounds and gathering appropriate clinical data. The topics explored in this section are culturally appropriate psychoeducational assessment, cultural validity, community test norms, identity, acculturation, computer-based assessment, clinical diagnosis, and interviewing. Chapter One, by Amado M. Padilla and Graciela N. Borsato, highlights current issues pertaining to the role of culture in test construction, administration, and overall use. The authors also set out consequences of poor testing practices and recommendations for culturally sensitive assessment practices. This chapter is based in part on earlier versions that appeared in the first and second editions of the Handbook. Chapter Two, by Charles R. Ridley, Michael L. Tracy, Laura Pruitt-Stephens, Mary K. Wimsatt, and Jacquelyn Beard, examines multicultural validity as a preeminent ethical issue in assessment. The authors note that all ethical considerations hinge on multicultural assessment validity that focuses on making accurate, comprehensive, and culturally appropriate assessments of clients. Chapter Three, by Robert G. Malgady and Gerardita Colon-Malgady, is a new addition to the Handbook. This chapter provides information about norm-referenced testing and the special circumstances that evolve in the

4 HANDBOOK OF MULTICULTURAL ASSESSMENT psychological and educational testing of ethnic and racial minority children and adolescents. Chapter Four, by Alan W. Burkard and Joseph G. Ponterotto, address theoretical and assessment advances in the assessment of racial identity and ethnic identity. In addition, the authors provide information regarding the relatively newer construct of multicultural personality, which holds promise in relation to assessment practices internationally and across disciplines in psychology. Chapter Five, by Lourdes M. Rivera, presents an overview of the current status of and issues related to conceptualizing and assessing acculturation. The author addresses bidimensional conceptualization, overlap with other related constructs, and measurement issues. Chapter Six, new to the Handbook, addresses the impact of technology in assessment. Muninder K. Ahluwalia explores the use of computers in testing, application to multicultural populations, and the use of computer-based testing in educational and clinical settings. Chapter Seven, by Richard H. Dana, looks at clinical diagnosis in multicultural populations. The author critiques the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders and discusses the medical-psychiatric illness paradigm and current assessment and intervention practices. In addition, he integrates information from research guidelines and emphasizes a new conceptual model based on multicultural research guidelines, linguistic skills, culturally competent assessments, and interventions. Chapter Eight, by Ingrid Grieger, highlights the creation of a cultural assessment framework and interview protocol. The author illustrates the importance of gathering relevant information on a wide range of variables, including one’s multiple identities (for example, racial identity, ethnic identity, sexual identity). The interview is conceptualized as the foundation for subsequent quantitative assessments and clinical activities. The author introduces the Cultural Assessment Interview Protocol, a semistructured, field-tested cultural assessment tool.

CHAPTER ONE

Issues in Culturally Appropriate Psychoeducational Assessment Amado M. Padilla Graciela N. Borsato

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here is a long-standing debate regarding appropriate assessment strategies for use with women, the economically disadvantaged, racial/ethnic minorities, language minorities, and individuals with disabilities. Indeed, psychoeducational assessment is an area of professional practice that has been often criticized for its contribution to the perpetuation of social, economic, and political barriers confronting these various groups (Gregory and Lee, 1986; Mensh and Mensh, 1991). It has also been argued (Stobart, 2005) that fairness in assessment is, above all, a sociocultural rather than a technical issue and that the consideration of the curriculum and educational opportunities of students should therefore be included in discussions about fair assessment. The recognition that no knowledge is acultural warrants close examination of the content we choose to assess and the extent to which it privileges the dominant culture’s values, beliefs, and interests over those of other groups. In terms of educational opportunities, it is necessary to examine whether there are differences in the resources available for different groups. For example, that there is a shortage of well-qualified teachers in schools serving low-income communities is well known. Given the importance of teacher expertise to student achievement (Darling-Hammond, 2004a), it should not be surprising that students attending schools with a high proportion of underqualified teachers do not perform as well on academic achievement tests as do students from more privileged socioeconomic backgrounds. The critical issue at hand is that standardized tests are extensively used for selecting and screening. Thus,

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6 HANDBOOK OF MULTICULTURAL ASSESSMENT if these tests are biased against particular groups because of curricular issues or unequal access to the knowledge the tests assess, such groups are unfairly denied access to educational and career opportunities. We fully acknowledge in this chapter that ‘‘fair assessment is inseparable from fairness in access opportunities and in what the curriculum offers’’ (Stobart, 2005, p. 278). Neglect of the role of the sociocultural context in which testing takes place absolutely collides with the ideal of equity in assessment. This chapter is based on the one authored by Amado Padilla and Antonio Medina that appeared in the first edition of the Handbook of Multicultural Assessment and was subsequently updated by Amado Padilla for the second edition of the Handbook. In this third edition, we have incorporated more recent materials, but the arguments are essentially the same since issues of culturally appropriate assessment have not changed since the original chapter was written. What has evolved from the first edition is the increased importance of high-stakes testing and concerns about accountability. Together these conditions make the challenges of culturally appropriate testing more relevant than ever before. In what follows, we discuss the role of culture in test construction, administration, and use. We also highlight the consequences of poor testing practices and offer recommendations for using assessment instruments and procedures in ways that are culturally sensitive.

TEST CONSTRUCTION We take the position in this chapter that psychoeducational assessment is made culturally appropriate through a continuing and open-ended series of substantive and methodological insertions and adaptations designed to mesh the process of assessment and evaluation with the cultural characteristics of the group being studied. The insertions and adaptations must span the entire assessment and evaluation process, from the development or adaptation of instruments, including translation, to the administration of the measure, and ultimately to the appropriate scoring and interpretation of the outcomes. Thus, assessment is made culturally appropriate through a continuing, intentional, and active preoccupation with the culture of the group or individual being assessed. The search for culturally fair assessment strategies has long been hampered by the lack of consensus on the definition of culture. As Frisby (1998) points out, the common practice of equating culture with geographical, racial, and ethnic differences, albeit expedient, is entirely arbitrary. There are other culturally relevant constructs, such as English-language proficiency, age of migration, generational status, length of residence in the United States, ethnic identity, and extent of acculturation, that have not traditionally been viewed

ISSUES IN CULTURALLY APPROPRIATE PSYCHOEDUCATIONAL ASSESSMENT

as significant concerns in test theory or development and yet are likely to function as moderators of psychoeducational assessment. In terms of extent of acculturation, the more acculturated the person is to the host society, the greater the likelihood is that standardized norms can be applied with confidence to that individual (Cu´ellar, 2000). With regard to language proficiency, Geisinger (2003) argues that when nonnative English speakers are tested, each individual’s relative language abilities in the first and second languages need to be considered before deciding whether to test in English or the first language. Sometimes the markers to guide test selection are not readily apparent, however. Consider a Latino adolescent who to a majority group test examiner appears acculturated but who nonetheless is more adept in Spanish than in English (Padilla, 1992). Such an adolescent will likely have more difficulty on a speed test (limited time) if it is administered in English than in an assessment situation where time is not a critical element in the test administration. At the very least, if it is not possible to eliminate cultural influences on standardized test scores, specific cultural variables should be considered in order to interpret findings from these tests (Anastasi, 1988, as cited in Cu´ellar, 1998). Consistent with Anastasi’s recommendation and noting that the impact of acculturation on performance in standardized intelligence measures is well documented in the psychological assessment literature, Gopaul-McNicol and Armour-Thomas (2002) suggest using an acculturation instrument in conjunction with psychometric tests of intelligence so as to obtain a more appropriate measure of cognitive ability. This is a sensible recommendation, yet there is to date no consensus as to how most effectively to measure acculturation (Cabassa, 2003).

PSYCHOMETRIC CONSIDERATIONS Many tests used in education are norm referenced. In norm-referenced testing, a person’s test score is compared to the scores of a group of people who have already taken the same test, called the norming group. As Sireci (2005) points out, the utility of norm-referenced tests depends on how recent the norms are and the extent to which the norm group is representative of the population with which the test is currently being used. Psychologists have long argued that instruments normed on majority group populations cannot be indiscriminately used with individuals who differ from the normative population. The reason is that the validity (the extent to which the test measures what it claims to measure) and reliability (the extent to which the test is internally consistent or gives consistent results over time) of a norm-referenced test when used with individuals whose cultural or linguistic backgrounds were not adequately represented in the norming group are questionable. The implication is that the

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8 HANDBOOK OF MULTICULTURAL ASSESSMENT test performance of an individual who comes from a nondominant cultural background or is lower in social status may be affected in ways not intended by the test creator, unless this individual’s group was included in the norming of the test. Whereas in norm-referenced tests a student’s test score is compared to the performance of similar students, in criterion-referenced tests a student’s test performance is compared with carefully designed standards of expected performance (Sireci, 2005). The issue is that those standards often reflect the values of the dominant culture as to what constitutes acceptable language, behavior, and valued knowledge. As Scheuneman and Oakland (1998) point out, the competencies and cognitive abilities of children raised in a minority culture are often different from those required by the tests, and therefore these children may not perform as well in those tests as children from the dominant culture. Scheuneman and Oakland add that in general, ‘‘observed performance differences suggest that the greater the similarity of an individual’s socioeconomic and cultural background to that of the majority population, the better the test performance will be’’ (p. 86). Although this is a well-established fact in the psychometric literature, the pressure associated with accountability and test use often results in failure to acknowledge it when interpreting differences in test outcomes. Questions about the reliability and validity of aptitude and achievement tests were discussed by a Latino psychologist more than seventy years ago (Sanchez, 1932a, 1932b), but little attention was given to Sanchez’s critique at that time despite his intimate knowledge of Latino culture and the fact that he published his critiques in reputable journals of the day. We might ask why, if Sanchez raised questions about the lack of cultural sensitivity of tests over seventy years ago and such concerns have continued to the present, so little attention has been given to these problems. The answer to this rhetorical question probably is that people of color have not had the political clout, in either society generally or the field of psychological assessment specifically, to insist that their concerns be taken seriously (Padilla, 1992).

TRANSLATION AND ADAPTATION OF TESTS Over the years, numerous scholars have criticized the administration of tests in English to language-minority children because of issues of validity. Indeed, research results indicate that test scores of English learners are substantially lower than those of native English speakers and that as the language demands of individual test items decrease, so does the achievement gap between English-learning and English-proficient students (Abedi, Hofstetter, and Lord, 2004). Given the pitfalls of testing language-minority individuals in English,

ISSUES IN CULTURALLY APPROPRIATE PSYCHOEDUCATIONAL ASSESSMENT

consideration has been given to translating tests from a source language (English) into a second target language. However, as Sandoval and Dur´an (1998, p. 195) point out, this practice is ‘‘fraught with hazards and issues,’’ the most salient of which is the difficulty of maintaining construct equivalence when tests are translated (Abedi et al., 2004). Geisinger (1994) advanced a set of guidelines for translating and adapting a test to a new culture and language population: • Individuals translating or adapting an assessment instrument should not only be fluent in the two languages, but also fully knowledgeable about both cultures, the content that the instrument purports to assess, and the uses to which the instrument will be put. • A group of individuals who meet the same rigorous requirements as the translators should review the quality of the translation or adaptation, and any recommendations for change should be incorporated subsequently. • The instrument should be pilot- and field-tested. • Scores need to be standardized and necessary validation research conducted. As these guidelines suggest, if done appropriately, translating tests can be difficult, time-consuming, and very expensive. These are likely the reasons that wholesale translation of tests has not generally been found to be an acceptable solution to the pervasive problem of inappropriate assessment of English-language learners. Furthermore, research indicates that assessments using students’ first language should be used only when students have received the corresponding content instruction in their first language. In other words, the language of testing should be the same as the language of instruction (Abedi et al., 2004), but proficiency in English must match the linguistic proficiency demands of the content instruction in English. The mismatch between the two proficiencies is what frequently leads to misinterpretation of test outcomes.

TEST ADMINISTRATION: ASSESSMENT ACCOMMODATIONS In the past, students with disabilities and English-language learners were frequently excluded from participation in large-scale assessment programs (Abedi et al., 2004; Thurlow, Lazarus, Thompson, and Morse, 2005). In the case of English-language learners, the concern was of course that poor English-language proficiency could be a confounding influence in the measurement of academic achievement. As for students with disabilities, several factors have accounted for their exclusion, but a major reason has been that the highly standardized ways in which tests need to be administered in order to

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10 HANDBOOK OF MULTICULTURAL ASSESSMENT be meaningful are not always accessible to these students (Bolt and Thurlow, 2004). Recently we have seen an increased emphasis on accountability to improve student performance. Because of the 2001 No Child Left Behind (NCLB) Act, states’ educational agencies are responsible for developing high academic standards and implementing assessment systems to monitor whether students are meeting those high standards (Abedi et al., 2004). The exclusion of English-language learners or students with disabilities from assessment programs would prevent these students from taking advantage of the potential positive effect of accountability practices. Therefore, under the NCLB Act, it is no longer acceptable to exclude them from mandated testing. States must include all students in their accountability systems and provide adaptations or accommodations for students with disabilities and students with limited English proficiency so the inclusion requirements can be met (Thurlow et al., 2005; Abedi et al. 2005). Test accommodations refer to changes in test format or administration that allow students with disabilities and English-language learners to demonstrate their content knowledge without giving them an advantage over students who are not receiving the accommodated assessments (Abedi et al., 2004). In a recent review of research on test accommodation strategies for English learners, Abedi et al. (2004) cautioned against a one-size-fits-all approach given that some accommodations are more effective with some students than with others, depending on factors such as length of time in the United States and English reading proficiency. In addition, Abedi et al. found that modifying the language of test items to reduce low-frequency vocabulary and complex language structures that are incidental to the content knowledge being assessed and allowing the use of customized dictionaries constitute effective accommodation strategies. Moreover, these strategies have been found to help English-language learners while not affecting the scores of English-proficient students. As Abedi et al. point out, there is no reason, then, that these strategies cannot be used with all students. A parallel review of research conducted by Bolt and Thurlow (2004) on five frequently allowed test accommodations used with students with disabilities (dictated response, large print, braille, extended time, and sign language interpreter for instructions) revealed ‘‘mixed support and nonsupport’’ for providing these accommodations to students with disabilities. Reviews of literature by Abedi et al. (2004) and Bolt and Thurlow (2004) reveal that empirical research on test accommodations is scarce. Given the emphasis on testing and accountability and the mandate to include all students in assessment programs, the urgency for research examining the appropriateness and effectiveness of accommodation strategies cannot be overstated. In the meantime, as Abedi et al. point out, ‘‘for any group of students, accommodations must be administered, used, and interpreted cautiously’’ (p. 8).

ISSUES IN CULTURALLY APPROPRIATE PSYCHOEDUCATIONAL ASSESSMENT

HIGH-STAKES DECISIONS In today’s test-conscious environment where tests have acquired such prominence for diagnosis, selection, certification, and accountability, it is vitally important to contextualize our discussion in the language of low- and high-stakes decision making. In low-stakes testing, there are typically no consequences associated with performance. For example, weekly classroom quizzes to determine what the student knows are low-stakes testing. Results from these quizzes are used to inform subsequent instructional practices to promote and support learning. High-stakes testing carries important and often long-term consequences for the individuals being assessed. Scores from high-stakes tests play an important role in decisions made with regard to academic placement, scholarship awards, certification, and professional and graduate school entry. An example of high-stakes testing is the use of a test outcome to determine whether a student will receive a diploma following thirteen years of public school attendance. High school exit exams have received considerable public attention and best illustrate what is meant by a high-stakes test. Identical treatment, the condition most consonant with accurate prediction, presupposes access to the same experiences; this is especially true of cognitive type testing (Williams, 1983). It can be argued that this prerequisite is not met in our educational system or in most aspects of daily life where minority individuals are concerned. For example, although attendance of early education programs has increased significantly in the United States, enrollment rates vary substantially by race/ethnicity, poverty status, and maternal education (Karoly and Bigelow, 2005). This enrollment disparity is of great concern given the benefits to children’s academic outcomes associated with participation in high-quality preschool programs (Magnuson, Meyers, Ruhm, and Waldfogel, 2004). It is important to keep in mind that once test scores become numbers in a file, they provide the basis for high-stakes decisions concerning selection, placement, and promotion that are made without consideration of potential inequities imposed by the original testing situation (Lam, 1993). Notwithstanding the criticism that their use is incompatible with the goal of equity, standardized tests are used regularly to make key educational decisions, such as placement in special education classes, assignment to low-track or high-track classes, and grade retention (Gopaul-McNicol and Armour-Thomas, 2002). With regard to special education, Losen and Orfield (2002) cite ‘‘unjustifiable reliance on IQ and other evaluation tools’’ (p. xviii) as one of the factors contributing to the overrepresentation of minority children in special education classes. Padilla (1988) warned against the use of assessment instruments in English to diagnose learning disabilities of English-language learners. Of note is that numerous lawsuits centered on this issue were brought

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12 HANDBOOK OF MULTICULTURAL ASSESSMENT against the educational establishment. In one of the early legal cases, Diana v. California State Board of Education (1970), the suit questioned the practice of testing children in English when this was not their first or dominant language. Padilla noted that although this case was settled out of court and in favor of the student, the ruling has had little impact on professional practice and placement decisions. Indeed, recent results (Artiles, Rueda, Salazar, and Higareda, 2002) indicate that Hispanic students identified as English-language learners are still disproportionably placed in special education in the upper grades. The overrepresentation of minority students in special education is troubling, especially taking into account that students in special education are more likely to experience lower teacher expectations and to drop out of school at higher rates than their nondisabled peers (Ferri and Connor, 2005). Standardized tests are also used to make decisions about grade retention (Gopaul-McNicol and Armour-Thomas, 2002). The use of high-stakes testing in grade retention has been called into question by some educational specialists. For example, Darling-Hammond (2004b) reports that in 1997 and 1998, more than twenty thousand students were retained in grade in Chicago under a policy requiring test passage at grades 3, 6, and 8. Darling-Hammond also points out that an evaluation of the subsequent academic performance of these students confirmed past research findings indicating that retaining students not only does not help them to catch up with their peers, but also contributes to high rates of academic failure and behavioral problems. It is common practice in education to use assessment procedures to track students into vocationally or academically oriented classes (Oakes, 1985). Not surprisingly, high school minority students are disproportionably found in lower academic, non-college-oriented tracks (Mickelson, 2003). Proponents of tracking argue that achievement tests are necessary for determining which students have the relevant knowledge and to what degree, and who is thus adequately prepared to complete college-oriented, high-track classes (Loveless, 1999). Critics of tracking (such as Heubert, 2001) contend that as tracking is currently practiced, the emphasis in lower class tracks is on basic skills, and these classes are often taught by the least qualified teachers. Oakes (2000) further argues that minority and White children are exposed to different curricula through the practice of ability tracking, which begins as early as elementary school. Thus, poor learning environments lead directly to poor performance on achievement tests, which are used in turn to make other high-stakes decisions, such as high school graduation and admission to college. In the area of college admissions, scores on a test of scholastic achievement measuring developed ability to reason with words and numbers to solve college-like problems inform the user about how much trouble a student may expect to have in moving immediately into college work (Samuda, 1998). However, as Samuda points out, these instruments and their outcomes say

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nothing about the odds against which the student has had to struggle in developing those particular abilities or about the energy and determination the individual will put into college work. A student’s ability to solve problems posed in a different language or sociocultural context may or may not be reflected in the scores, depending on how widely divergent the two cultures at issue may be. Equally important from a psychometric perspective is that the predictability of success in college as determined by grades and completion based on tests such as the Scholastic Assessment Test (SAT) is rarely above 0.2 to 0.3 (Zwick and Sklar, 2005). Nonetheless, the importance of the SAT over many decades has taken on a life of its own, as witnessed by the uproar when the president of the University of California, Richard Atkinson, a distinguished psychologist and a member of the National Academy of Science, challenged the utility of the SAT (see Cloud, 2001). For a student whose schooling has been of lower quality or whose home and perhaps predominant community language is other than English, a mediocre score on a test may represent a triumph of ability, devotion to study, and persistence. The test scores are not designed to reflect these characteristics, not because these qualities themselves are unimportant but because testing has not yet produced ways to measure them. In educational assessment and selection practices, the student’s holistic profile, including biographical record, demonstrated interest, and long-term perseverance as reflected in school grades, and especially as illuminated by the comments of those who know his or her history, are the indispensable bases for understanding the meaning of the scores resulting from standardized tests. One other aspect that deserves consideration is that for members of any group about whom a negative academic stereotype exists, assessment situations make them vulnerable to stereotype threat: ‘‘the event of a negative stereotype about a group to which one belongs becoming self-relevant, usually as a plausible interpretation for something one is doing, for an experience one is having, or for a situation one is in, that has relevance to one’s self-definition’’ (Steele, 1997, p. 616). Stereotype threat affects students who have gained skills and confidence in a particular domain for which their group is negatively stereotyped, such as school-identified African Americans or math-identified women. Steele and Aronson (1995) showed that inducing stereotype threat, by asking students to indicate their race before a test or by telling them that the test is a measure of intellectual ability, can undermine the test performance of African Americans, even though they have demonstrated their competency in numerous other ways prior to the test. Subsequent research extended these results to other groups, such as students from low socioeconomic backgrounds (Croizet and Claire, 1998) and female students in the domain of math (Spencer, Steele, & Quinn, 1999). Steele (1997) offers some general strategies to reduce stereotype threat, including teacher-student relationships that contribute to

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14 HANDBOOK OF MULTICULTURAL ASSESSMENT discredit negative stereotypes, offering challenging school work rather than remediation, and stressing the expandability of intelligence in response to experience and training. Testing environments such as Advanced Placement examinations, the SAT, and the Graduate Record Exams are characterized by the two conditions that contribute to stereotype threat: evaluative scrutiny and identity salience (Good, Aronson, and Inzlicht, 2003). Indeed, students without a doubt recognize that their performance in these tests can have important and long-term implications for their future. Also, they are often asked to indicate their gender and race/ethnicity prior to taking the test, and they take the test in the presence of White students and males. Students’ group identity is therefore made salient in these test situations. As Natriello and Pallas (2001) point out, the threat of conforming to race-based stereotypes about academic ability may depress the academic performance of racial/ethnic minorities and other stigmatized groups. In this sense, high-stakes tests can potentially contribute to ‘‘exacerbate already substantial inequities in schooling outcomes’’ (p. 37). High-stakes tests are prominent not only in the field of education but also in other arenas, such as mental health, forensics, and employment. Gray-Little and Kaplan (1998) point out that in clinical settings, misdiagnoses, whether based on interview or psychological testing, can have serious consequences for the client. Indeed, misdiagnosed clients are not likely to receive appropriate treatment, and if psychotropics are prescribed, such individuals are exposed to needless risks. Also according to Gray-Little and Kaplan, a review of the literature on the psychiatric diagnosis of ethnic minorities indicates that sometimes race and ethnicity are predictive of diagnosis independent of symptoms and that diagnosticians are subject to bias in clinical judgments. Furthermore, the expression of distress and psychopathology varies among racial and ethnic groups in the United States, and these variations may affect the interpretation of psychological tests and the accuracy of diagnosis. In the area of forensic assessment, decisions based on testing instruments can have a large impact on matters such as legal responsibility and personal freedom. The consideration of sociocultural factors when interpreting the results of forensic tests is therefore crucial. As an example, in the context of urban Black families, a biological parent’s deficits in resources or skills may be compensated for by the availability of an extended kinship network very much invested in caring for the child. As Gray-Little and Kaplan (1998) point out, a lack of cultural awareness in this case could potentially lead to the child’s being removed without cause from a functional and nurturing family. Employment tests are frequently used for purposes of selection and promotion. As Sireci and Geisinger (1998) point out, ‘‘The decisions made on the basis of scores derived on employment tests often mean the difference between work and unemployment or between upward mobility and stagnation’’

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(p. 105). Latinos are becoming more prominent in the workforce due to their youthfulness relative to the aging majority population, higher fertility rates, and increased immigration levels (Toossi, 2004). According to Toossi, Asians are also expected to have a large increase in the labor force participation rate over the next few years, reflecting especially the increasing number of Asian women entering the workforce. These demographic trends highlight the need to consider seriously issues inherent in the psychological assessment and evaluation of Latinos and Asian Americans in order to ensure their educational and occupational opportunity and success. In so doing, the social well-being of all Americans will be fostered.

RECOMMENDATIONS FOR NONBIASED ASSESSMENT PRACTICES There are several ways in which tests may be biased. For example, the very content or language of test items may be biased in the sense that they give unfair advantage to one group over another. Several methods for detecting differential item functioning (DIF) across contrasting groups of test takers have been devised. As Kristjansson, Aylesworth, McDowell, and Zumbo (2005) point out, systematic application of DIF detection methods followed by expert review contributes to validity and equity in testing. These should therefore be key steps in test development and validation. Another type of bias, called construct bias, occurs when the construct being measured does not have the same meaning across groups. The standard method to identify construct bias is to examine the factor structure of the test under consideration with different subgroups. The presence of items that have different meanings and relationships with other items for different groups signals construct bias (Skiba, Knesting, and Bush, 2002). To prevent construct bias, extensive knowledge of the different populations with whom a test is to be used is crucial during test development and test adaptation or translation. Bias can also result from incidental features such as mode of test administration or even examiner personality factors that favor one group of examinees over another. This type of bias, commonly referred to as method bias, can be prevented, or at least ameliorated, through extensive training of test administrators (van de Vijver and Phalet, 2004). Finally, bias may occur due to inappropriate application, which results in the identification of one set of applicants over others. This type of bias is present when tests that are not valid for tracking or promotion are nonetheless used for those purposes or when students do not have the opportunity to learn the knowledge and skills that the high school exit exam measures. It is important to remember that use of a test is appropriate only to the extent to which the inferences derived from the test scores and the actions that follow are appropriate (Heubert, 2001).

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16 HANDBOOK OF MULTICULTURAL ASSESSMENT One of the most publicized approaches to nonbiased assessment was the use of differential norms, such as in the System of Multicultural Pluralistic Assessment (SOMPA; Mercer, 1979). In this system, a child’s score on the Wechsler Intelligence Scale for Children (WISC) is ‘‘corrected’’ based on acculturation and other sociocultural variables. Typically scores of European American children are shifted downward, while the scores of Mexican American and African American children are shifted upward (van de Vijver and Phalet, 2004). Although SOMPA constitutes a valuable attempt to deal with the issue of acculturation in assessment, it has been criticized for its poor performance in predicting future academic performance (Sandoval and Dur´an, 1998; van de Vijver and Phalet, 2004). Additional approaches to address acculturation in multicultural assessment, including cutoff scores, acculturation as moderator, standardization or centering, item response theory, method factors, and ‘‘person-fit tradition,’’ are discussed in detail by van de Vijver and Phalet. We agree with these researchers that given the increasingly multicultural nature of our society and the pervasive influence of acculturation on behavior, the need to consider the extent of acculturation in assessment situations can no longer be ignored. Having the competence necessary for becoming culturally sensitive in assessment procedures is not an easy task. Psychologists who employ tests as part of their professional responsibility may be unaware of how their ethnic and cultural experiences and position in mainstream society influence their selection of particular tests and the interpretations they derive from psychological instruments. Although the situation is improving, many psychologists are not trained in nonbiased assessment, and as a result, they know little about procedures for evaluating students from diverse backgrounds. Geisinger and Carlson (1998) contend that to assess members of diverse groups, it is necessary to understand psychometric concepts such as test bias and test fairness. They add that during their training to use psychological assessment, students must read test manuals carefully and determine whether and how a test may be properly used with members of different groups. This is especially critical if the person or group to be tested is not similar to the group on which the test was normed. Future psychologists should also be encouraged to consult with others when assessing an individual from a cultural group with which they have limited or no experience. In order for test examiners to increase their cross-cultural assessment competency, they must become knowledgeable and comfortable with the traditional customs and communicative styles of many individuals who do not represent the prototypical middle-class person on whom most assessment instruments are based. We recommend that test users involve minority community members

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in selecting instruments to be used in a school, employment venue, placement center, and so forth. This practice increases the minority community’s trust and rapport regarding testing practices and results in more appropriate assessment measures, practices, and decision making. Ultimately complex judgments concerning appropriate and equitable test use can best be made by users who are familiar with those being assessed and the environment in which the test is administered (Lam, 1993). Research emphasis is usually placed on a comparative approach that uses similar measures to compare groups of people who differ in culture, language, or social class. We believe that a paradigm shift is required whereby the study of a specific group is valued for its own sake and need not be compared to another group, especially if the comparison is likely to be biased. Instruments that are biased and favor a particular group should not be used to evaluate differences between culturally distinct groups of people. Furthermore, instruments must also be appropriate for accurately assessing changes in learning or behavior that are due to a treatment or educational program. However, if assessment devices are inappropriate in a pretest context, they will also be poor measures of postintervention learning or behavior changes. Test makers and users need to be aware of how test performance is influenced by inequality in educational and economic opportunity, parents’ educational attainment, cultural orientation, language spoken at home, proficiency in English, socialization experiences, occupational status and income of wage earners, and level of motivation to do well. When sufficient information is given beforehand about possible confounding variables in deciding to test a particular individual or group, a more informed decision can be made about the suitability of the test to be used.

CONCLUSION It is important to sensitize professionals to discriminatory practices while broadening assessment methods. In advocating for a systems approach that is culturally sensitive, it is crucial that we redouble our efforts to increase the pool of qualified minority psychologists who are trained in psychometric theory and test construction. Furthermore, we need to train individuals who are expert in psychological assessment to assume leadership positions in the field. There are too few psychologists with the expertise necessary to advance the discussion of culturally sensitive assessment beyond that which has prevailed for the past three decades. In this new millennium, we look forward to assessment practices that better reflect the cultural face of America.

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References Abedi, J., Hofstetter, C. H., & Lord, C. (2004). Assessment accommodations for English language learners: Implications for policy-based empirical research. Review of Educational Research, 74(1), 1–28. Artiles, A. J., Rueda, R., Salazar, J. J., & Higareda, I. (2002). English language learner representation in special education in California urban school districts. In D. J. Losen & G. Orfield (Eds.), Racial inequity in special education (pp. 117–136). Cambridge, MA: Harvard Education Press. Bolt, S. E., & Thurlow, M. L. (2004). Five of the most frequently allowed testing accommodations in state policy. Remedial and Special Education, 25(3), 141–152. Cabassa, L. J. (2003). Measuring acculturation: Where we are and where we need to go. Hispanic Journal of Behavioral Sciences, 25(2), 127–146. Cloud, J. (2001). Should SATs matter? Time Magazine. Retrieved June 27, 2006, from http://www.time.com/time/nation/article/0,8599,101321–1,00.html. Croizet, J., & Claire, T. (1998). Extending the concept of stereotype and threat to social class: The intellectual underperformance of students from low socioeconomic backgrounds. Personality and Social Psychology Bulletin, 24(6), 588–594. Cu´ellar, I. (1998). Cross-cultural clinical psychological assessment of Hispanic Americans. Journal of Personality Assessment, 70(1), 71–86. Cu´ellar, I. (2000). Acculturation as a moderator of personality and psychosocial assessment. In R. H. Dana (Ed.), Handbook of cross-cultural and multicultural personality assessment (pp. 113–129). Mahwah, NJ: Erlbaum. Darling-Hammond, L. (2004a). Inequality and the right to learn: Access to qualified teachers in California’s public schools. Teachers College Record, 106(10), 1936–1966. Darling-Hammond, L. (2004b). Standards, accountability, and school reform. Teachers College Record, 106(6), 1047–1085. Ferri, B. A., & Connor, D. J. (2005). In the shadow of Brown: Special education and overrepresentation of students of color. Remedial and Special Education, 26(2), 93–100. Frisby, C. L. (1998). Culture and cultural differences. In J. Sandoval, C. L. Frisby, K. F. Geisinger, J. D. Scheuneman, & J. R. Grenier (Eds.), Test interpretation and diversity: Achieving equity in assessment (pp. 3–16). Washington, DC: American Psychological Association. Geisinger, K. F. (1994). Cross-cultural normative assessment: Translation and adaptation issues influencing the normative interpretation of assessment instruments. Psychological Assessment, 6, 304–312. Geisinger, K. F. (2003). Testing students with limited English proficiency. In J. E. Wall & G. H. Walz (Eds.), Measuring up: Assessment issues for teachers, counselors, and administrators (pp. 147–159). Greensboro, NC: CAPS Press. Geisinger, K. F., & Carlson, J. F. (1998). Training psychologist to assess members of a diverse society. In J. Sandoval, C. L. Frisby, K. F. Geisinger, J. D. Scheuneman, &

ISSUES IN CULTURALLY APPROPRIATE PSYCHOEDUCATIONAL ASSESSMENT J. R. Grenier (Eds.), Test interpretation and diversity: Achieving equity in assessment (pp. 375–386). Washington, DC: American Psychological Association. Good, C., Aronson, J., & Inzlicht, M. (2003). Improving adolescents’ standardized test performance: An intervention to reduce the effects of stereotype threat. Applied Developmental Psychology, 24, 645–662. Gopaul-McNicol, S., & Armour-Thomas, E. (2002). Assessment and culture: Psychological tests with minority populations. Orlando, FL: Academic Press. Gray-Little, B., & Kaplan, D. A. (1998). Interpretation of psychological tests in clinical and forensic evaluations. In J. Sandoval, C. L. Frisby, K. F. Geisinger, J. D. Scheuneman, & J. R. Grenier (Eds.), Test interpretation and diversity: Achieving equity in assessment (pp. 141–178). Washington, DC: American Psychological Association. Gregory, S., & Lee, S. (1986). Psychoeducational assessment of racial and ethnic minority groups: Professional implications. Journal of Counseling Psychology and Development, 64(10), 635–637. Heubert, J. P. (2001). High-stakes testing and civil rights: Standards of appropriate test use and a strategy for enforcing them. In G. Orfield & M. L. Kornhaber (Eds.), Raising standards or raising barriers? Inequality and high-stakes testing in public education (pp. 179–194). New York: Century Foundation Press. Karoly, L. A., & Bigelow, J. H. (2005). The economics of investing in universal preschool education in California. Santa Monica, CA: RAND Corporation. Kristjansson, E., Aylesworth, R., McDowell, I., & Zumbo, B. D. (2005). A comparison of four methods for detecting differential item functioning in ordered response items. Educational and Psychological Measurement, 65(6), 935–953. Lam, T.C.M. (1993). Testability: A critical issue in testing language minority students with standardized achievement tests. Measurement and Evaluation in Counseling and Development, 26, 179–191. Losen, D. J., & Orfield, G. (2002). Introduction. In D. J. Losen & G. Orfield (Eds.), Racial inequity in special education (pp. xv–xxxvii). Cambridge, MA: Harvard Education Press. Loveless, T. (1999). The tracking wars: State reform meets school policy. Washington, DC: Brookings Institution Press. Magnuson, K. A., Meyers, M. K., Ruhm, C. J., & Waldfogel, J. (2004). Inequality in preschool education and school readiness. American Educational Research Journal, 41(1), 115–157. Mensh, E., & Mensh, H. (1991). The IQ mythology: Class, race, gender, and inequality. Carbondale: Southern Illinois University Press. Mercer, J. R. (1979). Technical manual: System of Multicultural Pluralistic Assessment (SOMPA). New York: Psychological Corporation. Mickelson, R. A. (2003). When are racial disparities in education the result of racial discrimination? A social science perspective. Teachers College Record, 105(6), 1052–1086.

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20 HANDBOOK OF MULTICULTURAL ASSESSMENT Natriello, G., & Pallas, A. M. (2001). The development and impact of high-stakes testing. In G. Orfield & M. L. Kornhaber (Eds.), Raising standards or raising barriers? Inequality and high-stakes testing in public education (p. 38). New York: Century Foundation Press. Oakes, J. (1985). Keeping track: How schools structure inequality. New Haven, CT: Yale University Press. Oakes, J. (2000). Grouping and tracking. In A. E. Kazdin (Ed.), Encyclopedia of psychology. Washington, DC: American Psychological Association. Padilla, A. M. (1988). Early psychological assessment of Mexican-American children. Journal of the History of the Behavioral Sciences, 24, 113–115. Padilla, A. M. (1992). Reflections on testing: Emerging trends and new possibilities. In K. F. Geisinger (Ed.), Psychological testing of Hispanics (pp. 271–284). Washington, DC: American Psychological Association. Samuda, R. J. (Ed.). (1998). Psychological testing of American minorities: Issues and consequences (2nd ed.). Thousand Oaks, CA: Sage. Sanchez, G. I. (1932a). Group differences in Spanish-speaking children: A critical review. Journal of Applied Psychology, 40, 223–231. Sanchez, G. I. (1932b). Scores of Spanish-speaking children on repeated tests. Journal of Genetic Psychology, 40, 223–231. Sandoval, J., & Dur´an, R. (1998). Language. In J. Sandoval, C. L. Frisby, K. F. Geisinger, J. D. Scheuneman, & J. R. Grenier (Eds.), Test interpretation and diversity: Achieving equity in assessment (pp. 181–211). Washington, DC: American Psychological Association. Scheuneman, J. D., & Oakland, T. (1998). High-stakes testing in education. In J. Sandoval, C. L. Frisby, K. F. Geisinger, J. D. Scheuneman, & J. R. Grenier (Eds.), Test interpretation and diversity: Achieving equity in assessment (pp. 77–103). Washington, DC: American Psychological Association. Sireci, S. G. (2005). The most frequently unasked questions about testing. In R. P. Phelps (Ed.), Defending standardized testing (pp. 111–121). Mahwah, NJ: Erlbaum. Sireci, S. G., & Geisinger, K. F. (1998). Equity issues in employment testing. In J. Sandoval, C. L. Frisby, K. F. Geisinger, J. D. Scheuneman, & J. R. Grenier (Eds.), Test interpretation and diversity: Achieving equity in assessment (pp. 105–140). Washington, DC: American Psychological Association. Skiba, R. J., Knesting, K., & Bush, L. D. (2002). Culturally competent assessment: More than nonbiased tests. Journal of Child and Family Studies, 11(1), 61–78. Spencer, S., Steele, C. M., & Quinn, D. M. (1999). Stereotype threat and women’s math performance. Journal of Experimental Social Psychology, 35, 4–28. Steele, C. M. (1997). A threat in the air: How stereotypes shape intellectual identity and performance. American Psychologist, 52(6), 613–629.

ISSUES IN CULTURALLY APPROPRIATE PSYCHOEDUCATIONAL ASSESSMENT Steele, C. M., & Aronson, J. (1995). Stereotype threat and the intellectual test performance of African Americans. Journal of Personality and Social Psychology, 69(5), 797–811. Stobart, G. (2005). Fairness in multicultural assessment systems. Assessment in Education, 12(3), 275–287. Thurlow, M. L., Lazarus, S. S., Thompson, S. J., & Morse, A. B. (2005). State policies on assessment participation for students with disabilities. Journal of Special Education, 38(4), 232–240. Toossi, M. (2004). Labor force projections to 2012: The graying of the U.S. workforce. Monthly Labor Review, 127(2), 37–57. van de Vijver, F.J.R., & Phalet, K. (2004). Assessment in multicultural groups: The role of acculturation. Applied Psychology: An International Review, 53(2), 215–236. Williams, T. S. (1983). Some issues in the standardized testing of minority students. Journal of Education, 165, 192–208. Zwick, R., & Sklar, J. C. (2005). Predicting college grades and degree completion using high school grades and SAT scores: The role of student ethnicity and first language. American Educational Research Journal, 42, 439–464.

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CHAPTER TWO

Multicultural Assessment Validity The Preeminent Ethical Issue in Psychological Assessment Charles R. Ridley Michael L. Tracy Laura Pruitt-Stephens Mary K. Wimsatt Jacquelyn Beard

A

plethora of ethical issues are relevant to multicultural assessment. Among the more prominent of these are the selection of culturally appropriate instruments, the culturally sensitive interpretation of test profiles, the use of interpreters, the adequacy of training for conducting multicultural assessments, and the extent to which confidentiality serves the best interests of clients from collectivistic cultures. These and a host of other issues suggest that multicultural assessment is a challenging and delicate clinical endeavor. Despite the critical nature of the ethical issues we have noted, they are subordinate in importance to multicultural assessment validity. No other ethical issue compares in importance to making an accurate, sound, and comprehensive assessment of clients—one that takes simultaneously into account their cultural experiences and unique idiographic experiences. Furthermore, all other ethical considerations in the area of assessment hinge on multicultural assessment validity. Consider the following statements from the official documents of two mental health associations. The reiterated theme highlights the importance of clinicians’ making valid assessments, and with consideration of the populations they serve: Psychologists use assessment instruments whose validity and reliability have been established for use with members of the population tested. When such validity or reliability has not been established, psychologists describe the strengths and limitations of test results and interpretation [American Psychological Association, 2002, p. 1071].

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MULTICULTURAL ASSESSMENT VALIDITY When interpreting assessment results, including automated interpretations, psychologists take into account the purpose of the assessment as well as the various test factors, test-taking abilities, and other characteristics of the person being assessed, such as situational, personal, linguistic, and cultural differences, that might affect psychologists’ judgments or reduce the accuracy of their interpretations [American Psychological Association, 2002, p. 1072]. Counselors recognize that culture affects the manner in which clients’ problems are defined. Clients’ socioeconomic and cultural experiences are considered when diagnosing mental disorders [American Counseling Association, 2006, p. 245]. Counselors are cautious when selecting assessments for culturally diverse populations to avoid the use of instruments that lack appropriate psychometric properties for the client population [American Counseling Association, 2006, p. 246]. Counselors use with caution assessment techniques that were normed on populations other than that of the client. Counselors recognize the effects of age, color, culture, disability, ethnic group, gender, race, language preference, religion, spirituality, sexual orientation, and socioeconomic status on test administration and interpretation, and place test results in proper perspective with other relevant factors [American Counseling Association, 2006, p. 246].

The twofold purpose of this chapter is to introduce and define the concept of multicultural assessment validity (MAV) and demonstrate why this relatively unexamined concept is the most critical ethical issue in psychological assessment. We argue that much of the conduct of psychological assessment is culturally invalid and therefore an ethical problem. We further argue that this is largely a problem of the mental health professions and not simply a problem of individual practitioners. In making our argument, we unpack implications for conducting culturally valid assessments and consequently engaging in ethically appropriate behavior. The chapter is organized into five major sections: we discuss the ubiquity of invalid assessment, explain why invalid assessment is the preeminent ethical problem in multicultural assessment, describe the influence of culture on assessment, operationalize multicultural assessment validity by defining the construct and pointing out its various components, and explain the ultimate test of multicultural assessment validity.

THE UBIQUITY OF INVALID ASSESSMENT Psychological assessment ought to be impartial, fair, and sound. This premise rests on the clinical integrity of the assessment process and the competence of mental health professionals to execute the process. Identifiable realities of a client’s psychological presentation should determine the nature of the

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24 HANDBOOK OF MULTICULTURAL ASSESSMENT assessment, including any assigned diagnosis. Therefore, competent practitioners should be able to formulate similar conceptions of a client’s psychological presentation, regardless of their own backgrounds, the client’s background, or the complexity and nature of the client’s psychological presentation. In spite of this acknowledgment of the need for accuracy and impartiality, psychological assessment is a complex decision-making process, influenced by subtle sociopsychological variables often not accounted for in the process. For instance, an enduring and disturbing pattern of misdiagnosis of minority clients, especially African Americans, has been found (Bell and Mehta, 1980; Snowden and Cheung, 1990; Strakowski et al., 1995). These consumers are underrepresented with diagnoses of affective disorders and overrepresented with diagnoses of schizophrenic disorders. These consistent findings, reported in numerous studies, suggest considerable inaccuracy and partiality in assessment, compelling Ridley (2005) to label the problem as race-based misdiagnosis. Inaccurate and partial assessments, result from four types of judgmental errors: (1) overlooking or minimizing the influence of culture on clients’ psychological presentations, (2) overemphasizing the influence of culture on clients’ psychological presentations, (3) overlooking or minimizing clients’ idiographic experience, and (4) overemphasizing clients’ unique idiographic experience. Culturally valid assessment overcomes the problems of inaccuracy and partiality. This type of assessment formulates a clinical picture of clients that is idiographic in the sense of reflecting the uniqueness of individuals and also normative in the sense of reflecting the individuals as cultural beings. Both perspectives are integral to MAV.

THE PREEMINENT ETHICAL PROBLEM The Codes of Ethics of the American Counseling Association (2006) and the American Psychological Association (2002) provide principles and standards of professional conduct, and they are intended to hold professionals accountable for their actions (Cottone and Tarvydas, 1998). To understand how professionals might be held accountable, Ridley, Liddle, Hill, and Li (2001) proposed the use of the terms ethical concern and ethical problem. An ethical concern refers to questionable professional conduct or possible conflicts of ethics. A process of discernment is required to determine the seriousness of the concern. An ethical problem is a concern that has been determined to be serious. Consequently it compromises the integrity of clinical treatment. It also requires problem solving to achieve ethically appropriate behavior.

MULTICULTURAL ASSESSMENT VALIDITY

In the light of the distinction between ethical problems and ethical concerns, we argue that the preeminent ethical problem in psychological assessment is invalid multicultural assessments. Unless this problem is resolved, the mental health professions are faced with another ethical problem that is the direct consequence of invalid multicultural assessments: invalid and inappropriate clinical intervention. Clearly, valid interventions depend on clinicians’ conducting valid assessments of clients. The problem of invalid assessment rests on several unresolved clinical difficulties. Three stand out in particular: the gathering of clinical data is wrought with invalid approaches, clinicians fail to account adequately for culture’s role in assessment, and clinicians make premature clinical interventions by moving from instrumentation in assessment to clinical intervention, bypassing the task of making valid multicultural assessment.

CULTURE’S INFLUENCE ON ASSESSMENT Culture exerts a powerful but often overlooked or misunderstood influence on psychological assessment. For instance, Fish (2000) noted that clinicians may base their conceptions of clients’ culture on obvious factors such as physical appearance, race, ethnicity, national origin, or sexual orientation. Certainly these important influences should be integral to conducting an assessment. However, clinicians’ oversight or misunderstandings stem largely from their failure to realize the ubiquity of culture and its less obvious manifestations in all areas of human functioning. As Draguns (1989) pointed out, culture is a silent participant in the clinical enterprise. But how is culture a participant in psychological assessment? What do clinicians need to understand about culture to make sound assessments? We begin with a discussion of the nature of culture. Goodenough (1996) postulates that it is necessary to think of culture in the sense that it has both phenomenal and ideational order. He argues that the phenomenal order is what an observer sees as patterns in the ongoing conduct of affairs—the actual enactment of activities—in a society or community. These patterns are manifested in the recurring regularities of modality and discontinuity that give apparent structure to events and human interactions and, taken together, constitute what is often referred to as a people’s ‘‘way of life.’’ These patterns differ from one society to the next and the term ‘‘culture’’ is often used in reference to them [p. 293].

In this sense, culture is owned by its group members, community, or society. However, it is essential to state that depending on the area under discussion, there may be considerable variation among families, communities,

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26 HANDBOOK OF MULTICULTURAL ASSESSMENT or other subgroups within a larger society as to how various activities are conducted, perceived, evaluated, and believed (Goodenough, 1996). Observers may recognize obvious or subtle patterns, such as those found in speech, clothing, foods, artifacts, and styles of communication. They may then use this information as a basis for forming opinions, beliefs, and attitudes about a group or individual. Therefore, it is necessary for clinicians to understand their own phenomenal order and how it affects their views of others. Goodenough (1996) also discusses ideational order: Culture in the ideational sense . . . consists of what the members of a human group have to know in order to function acceptably as members of that group in the activities in which they engage. In this sense culture is not necessarily shared by all the members of a group; but in the process of learning from one another, people attribute what they learn to one another, and, to the extent that these attributions enable them to accomplish their purposes with one another, they create the illusion of shared understandings and a common culture [p. 293].

Goodenough (1981) coined the term propriospect to refer to one’s ‘‘private, subjective view of the world and of its content’’ (p. 98). So while a group, community, or society may be said to have customary practices, activities, or rituals, its members may not ascribe to them in the same manner or connect the same meaning to their knowledge (Goodenough, 1996). As a consequence, group members may have different standards for perceiving, evaluating, believing, and doing that are attributed to their interactions with others (Goodenough, 1981). In this sense, a group member’s reality of culture is individually created and maintained. Clinicians face the ethical challenge of adequately balancing and integrating in their assessments clients’ private and ecological experience. On the one hand, individuals have a private subjective experience of the world. This is the anthropological view. Because of their subjectivity, as noted by the concept of propriospect, individuals select practices and ways of behaving from their cultures that are personally meaningful. Therefore, within every culture, there is a considerable range of ways that people behave. Certainly there are norms within every culture that define acceptable and unacceptable behavior, and large segments of a culture fall within the range of acceptable behavior. Nevertheless, within-group variability is always larger than between-group variability. Oversight of within-group variability leads to stereotyping, and in assessment, this means the failure to conceptualize clients in terms of their unique idiographic experience. This suggests the need to respect, appreciate, and evaluate clients’ behavior against cultural norms; however, clinicians never should limit their assessments to those norms.

MULTICULTURAL ASSESSMENT VALIDITY

On the other hand, sound psychological assessments cannot be made without clinicians’ taking into account clients’ social ecology (Bronfenbrenner, 1977; Neville and Mobley, 2001). This is the ecological view, suggesting that no one lives in a vacuum. In clarifying this point, Watzlawick, Beavin, and Jackson (1967) stated: A phenomenon remains unexplainable as long as the range of observation is not wide enough to include the context in which the phenomenon occurs. Failure to realize the intricacies of the relationships between an event and the matrix in which it takes place, between an organism and its environment, either confronts the observer with something ‘‘mysterious’’ or induces him to attribute to his object of study certain properties the object may not possess [pp. 20–21].

This description implies a relevant point about social ecologies: they are complex and multilayered systems. Therefore, explaining the behavior of an individual necessitates more complexity than is typical of many oversimplified explanations, which fail to account for all aspects of a client’s reality. The critical challenge in assessment is to simultaneously account for both the ecology of the client and the client’s subjective experience, but clinicians must do so without overemphasizing or underemphasizing either consideration. They must ascertain how clients pick and choose meaning from their experiences in their social ecology, as well as the influence of their social ecology on their behavior. The result is an understanding of both clients’ propriospect and interaction with their ecology.

MULTICULTURAL ASSESSMENT VALIDITY Multicultural assessment validity is the process by which clinicians arrive at an accurate, sound, and comprehensive description of clients’ psychological presentations. The process entails a number of relevant clinical activities. Each activity is oriented to accomplishing a specific task, but the incorporation of cultural data is an essential component of all of these activities. Without the incorporation of cultural data across these activities, MAV is impossible. The soundness of case conceptualizations also requires that the clinical activities used to formulate the conceptualizations are based on scientific principles. For without having scientific underpinnings, clinical applications lack treatment integrity. In the light of these propositions, we construe MAV as a two-dimensional process: (1) the essential activities of the process and (2) the attainment of positive therapeutic outcomes. Ultimately MAV yields a clinical picture of clients that accounts for both cultural influences on their psychological functioning and their private, subjective experiences as individuals and members of their respective cultures.

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Foundational Principles Six principles underlie the conceptualization of multicultural assessment validity: 1. MAV involves a process of progressive decision making. MAV involves a series of actions or operations marked by gradual changes in clinicians’ understanding of clients (Ridley, Li, and Hill, 1998). As the process unfolds, clinicians move from having an initial uninformed and vague conceptualization to eventually achieving the intended outcome of having an accurate, sound, and comprehensive picture of the client. 2. To engage competently in the process of progressive decision making, clinicians need a conceptual framework to guide the process. The framework must be coherent and scientifically based. The guidance provided by the framework is reflected in the thinking tools clinicians need to move the process forward. These thinking tools differentiate MAV from other assessment protocols, which typically provide only the behavioral tools to move the assessment process forward. By having a conceptual framework, clinicians can see the overall process of assessment while simultaneously seeing the discrete components of the process. 3. To be valid, the process of assessment must include every relevant decision. The actions or operations in MAV are essentially microdecisions, each serving a particular role in increasing clinicians’ insight and helping them gain a clearer understanding of clients. Making quick decisions or short-circuiting this process normally leads to inaccurate, unsound, and incomplete case conceptualizations. It is in the interest of clinicians to slow the action down by carefully working through each microdecision. In this era of managed care, with its pressure to rush to quick decisions, clinicians are reminded of their ethical responsibility of making valid, carefully thought out assessment decisions. 4. The process unfolds in a spiral rather than a linear fashion. Inherent in the process of progressive decision making is the reality that assessment is a human endeavor. Although clinicians’ understanding of clients becomes clearer through the process, the clarity does not occur automatically and does not always take place without missteps along the way. Consider the wide range of problem presentations among clients and the number of clients who present with challenging problems to understand. Then consider the varying levels of self-awareness and capabilities of clients to self-disclose. Next consider the wide range of abilities among clinicians in collecting and interpreting client data. Finally consider that even with highly competent clinicians, new information and insight about clients emerge over time. These considerations suggest that the retracing of microdecisions is integral to the formulation of a sound, accurate, and comprehensive case conceptualization.

MULTICULTURAL ASSESSMENT VALIDITY

5. Culture’s influence must be accounted for in all aspects of the process. Because of two established premises—clinicians and clients are cultural beings, and culture participates in all clinical endeavors—the process of progressive decision making is inevitably invalid without accounting for culture. The inability of clinicians to recognize the influence of culture (both their own culture and that of their clients) on assessment and to incorporate these influences in their case conceptualizations does not negate the influences. Furthermore, the inability of clinicians to incorporate culture into every microdecision does not make culture any less influential. Incorporating culture into every microdecision is essential. 6. The ultimate criterion of establishing MAV is a client’s attainment of positive therapeutic outcomes. Unless clients attain positive therapeutic outcomes, the assessment protocol and its attending microdecisions are pointless. Since the overall goal of assessment is to provide insight into clients and the overall purpose of obtaining insight is to facilitate positive therapeutic change, any other purpose would be pointless as well as a waste of client and clinician time, energy, and resources. In the light of the principles of beneficence and nonmalfeasance, pointless clinical activities are unethical.

Description of the Process We conceptualize MAV as consisting of eight clinical activities (Figure 2.1). These activities are a series of microdecisions and action steps, each integral to the process. In our opinion, clinicians often overlook several of the activities in this comprehensive process, thereby rendering many assessments invalid. Although we present these activities in a sequential manner, we reiterate the importance of their spiral rather than linear unfolding. Recognition of Preexisting Data. All clients bring to assessment their unique psychological data sets. Some of their data are obvious and others less so. Typically clinicians initially are unaware of the data inasmuch as their first appointments with clients are also their first exposures to the clients’ idiographic data sets. Not to be overlooked are cultural data, which, unfortunately, clinicians frequently do not recognize and therefore do not interpret or integrate into the overall assessment and treatment planning. Data Collection. The purpose of this activity is to begin the process of formulating a clinical picture of the client. No clinical picture can be formulated without first collecting and then interpreting the psychological and cultural data about clients. There are a variety of methods available to gather data. Some of these are formal and some informal. Some are quantitative and others

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Evaluation

Application of Interventions

Establishment of Treatment Goals

Case Conceptualization

Hypothesis Testing

Hypothesis Generation

Data Collection

Recognition of Preexisting Cultural Data

Figure 2.1. The Clinical Activities of Multicultural Assessment Validity

qualitative. Usually it is in the interest of clinicians to use a variety of methods as a means of gathering as much rich information as possible. Hypothesis Generation. The purpose of this activity is to begin the process of interpreting gathered data. Hypotheses are thoughtful, integrated, and organized statements of clients’ psychological needs, assets, and liabilities. They are tentative statements in that they may be true, false, or partially accurate, depending on how well they correspond to clients’ actual idiographic experiences. The field of applied psychology offers a variety of hypothesis-generation strategies. We believe that a combination of using clinical interviews and assessment instruments is the best approach. Hypothesis Testing. The purpose of this activity is to challenge the generated hypotheses so that interpretations of the clients’ psychological data are accurate. Without hypothesis testing, clinicians are more likely to misinterpret clients’ psychological presentations. The tested hypotheses may be accepted or

MULTICULTURAL ASSESSMENT VALIDITY

rejected depending on whether they are confirmed or disconfirmed by the various clinical tests of hypotheses. We believe that a combination of confirmatory and disconfirmatory hypothesis testing strategies is the best approach. Case Conceptualization. The purpose of this activity is to develop a thorough and unique picture of the client. No two case conceptualizations should ever be identical. The picture should describe clients as individuals, as members of their culture, and as members of the human race. This multilevel description has the potential of making the assessment valid and fulfilling the ethical obligation beneficence and nonmalfeasance. Establishment of Treatment Goals. The purpose of this activity is to establish goals toward which clients should strive. The purpose of establishing goals is for clients to make improvements in their psychological functioning. The goals may be valid or invalid depending on whether they match clients’ idiographic experiences. In ethical practice, clinicians help clients select goals that meet their psychological needs. The attainment of these goals reflects the positive changes that clients make in their lives. Application of Interventions. The purpose of this activity is to facilitate clients’ attainment of their treatment goals. The interventions may be appropriate or inappropriate depending on their match to the treatment goals. In ethical practice, clinicians select interventions that help clients attain their treatment goals. Evaluation. The purpose of evaluation is to determine the extent to which (1) there is adherence to the assessment protocol and (2) clients achieve their therapeutic goals. A variety of quantitative and qualitative evaluative strategies may be employed.

The Ultimate Test of MAV The attainment of positive therapeutic outcomes is essential to MAV. On this point, we argue that this attainment is the ultimate test of MAV. Because the ultimate goal of all clinical activities is therapeutic change, it follows that the ultimate test of these activities is the benefits that accrue to clients. Any number of factors can contribute to therapeutic change. In addition to conducting valid assessments, for example, clinicians must be competent in providing evidence-based interventions. In addition, any number of factors can contribute to the failure of clients in achieving positive therapeutic outcomes. Although the assessment may be valid, clients may resist change, and they may not adhere to treatment protocols. Therapists in turn may be incompetent

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32 HANDBOOK OF MULTICULTURAL ASSESSMENT in facilitating therapeutic change. Managed care requirements may limit the number of treatment sessions and therefore undermine the potency of the treatment. While any of these factors may occur in specific cases, an unsound, inaccurate assessment almost guarantees that clients will not achieve positive treatment outcomes. If we accept therapeutic change as the ultimate test of MAV, then the treatment plan in the process should evidence a clear and unequivocal relationship between the assessment and the interventions. Therefore, any evaluation of MAV should meet at least two criteria. First, the evaluation should determine the extent to which cultural data are fully incorporated in all relevant clinical activities. The critical question to ask is, ‘‘Do the goals, outcomes, and interventions in the treatment plan converge with what is known about the client’s cultural experience?’’ Using the concept of matching borrowed from Sexton, Alexander, and Mease (2004), the question can be reframed as follows: ‘‘Does the treatment match to the client?’’ Second, the evaluation should determine whether there truly is an individualized treatment plan. The critical question to ask is, ‘‘Do the goals, outcomes, and interventions in a particular treatment plan differentiate themselves from those in treatment plans developed for individuals from diverse cultures and for individuals from the client’s own culture?’’ For obvious reasons, if the interventions are not matched to and individualized for clients, the treatment goals set for them are inappropriate. Inappropriate treatment goals automatically prevent clients from making meaningful changes in their lives. When clients fail to make meaningful changes in their lives, the first issue to consider is whether the assessment is valid.

CONCLUSION Establishing and testing the validity of multicultural assessment is the preeminent ethical issue in psychological assessment. Nothing in the field compares with this ethical concern. We have presented a view on multicultural assessment validity that extends and challenges the current thinking in the field. Our model of MAV rests on six fundamental principles. The process itself consists of eight microdecisions, each relevant to the process. We invite other multicultural scholars to join in the conversation on this important topic.

References American Counseling Association. (2006). ACA Code of Ethics. Journal of Counseling and Development, 84, 235–254. American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060–1073.

MULTICULTURAL ASSESSMENT VALIDITY Bell, C. C., & Mehta, H. (1980). The misdiagnosis of Black patients with manic depressive illness. Journal of the National Medical Association, 72, 141–145. Bronfenbrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 32, 513–531. Cottone, R. R., & Tarvydas, V. M. (1998). Ethical and professional issues in counseling. Upper Saddle River, NJ: Prentice Hall. Draguns, J. G. (1989). Dilemmas and choices in cross-cultural counseling: The universal versus the culturally distinctive. In P. B. Pedersen, J. G. Draguns, W. J. Lonner, & J. E. Trimble (Eds.), Counseling across culture (3rd ed., pp. 3–21). Honolulu: University of Hawaii Press. Fish, J. M. (2000). What anthropology can do for psychology: Facing physics envy, ethnocentrism, and a belief in ‘‘race.’’ American Anthropologist 102(3), 552–563. Goodenough, W. H. (1981). Culture, language, and society (2nd ed.). Menlo Park, CA: Benjamin-Cummings. Goodenough, W. H. (1996). Culture. In D. Levinson & M. Ember (Eds.), Encyclopedia of cultural anthropology (Vol. 1, pp. 291–299). New York: Henry Holt and Company. Neville, H. A., & Mobley, M. (2001). Social identities in contexts: An ecological model of multicultural counseling psychology processes. Counseling Psychologist, 29, 471–486. Ridley, C. R. (2005). Overcoming unintentional racism in counseling and therapy: A practitioner’s guide to intentional intervention (2nd ed.). Thousand Oaks, CA: Sage. Ridley, C. R., Li, L. C., & Hill, C. L., (1998). Multicultural assessment: Reexamination, reconceptualization, and practical application. Counseling Psychologist, 26, 827–910. Ridley, C. R., Liddle, M. C., Hill, C. R., & Li, L. C. (2001). Ethical decision making in multicultural counseling. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.). Handbook of multicultural counseling (2nd ed., pp. 165–188). Thousand Oaks, CA: Sage. Sexton, T. L., Alexander, J. F., & Mease, A. L. (2004). Levels of evidence for the models and mechanisms of therapeutic change in family and couple therapy. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed., pp. 590–646). Hoboken, NJ: Wiley. Snowden, L. R., & Cheung, F. K. (1990). Use of inpatient mental health services by members of ethnic minority groups. American Psychologist, 45, 347–355. Strakowski, S. M., Lonczak, H. S., Sax, K. W., West, S. A., Crist, A., Mehta, R., et al. (1995). The effects of race on diagnosis and disposition from a psychiatric emergency service. Journal of Clinical Psychiatry, 56, 101–107. Watzlawick, P., Beavin, J. H., & Jackson, D.D. (1967). Pragmatics of human communication: A study of interactional patterns, pathologies, and paradoxes. New York: Norton.

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CHAPTER THREE

Building Community Test Norms Considerations for Ethnic Minority Populations Robert G. Malgady Gerardita Colon-Malgady

O

ur son Jeffrey, an eighth grader in public school, recently came home with a report of his performance on a well-known standardized test. Although he is quite bright and a consistent A student in mathematics, he was confused and dismayed because his reported raw score was 36. Accustomed to ordinary school grading, quite naturally he presumed this was 36 correct of a possible score of 100 and therefore that somehow he was miserably failing. Jeffrey and his classmates, as well as many parents of school-age children, are probably not alone in such thinking. His teacher neglected to point out to him and his classmates that the so-called raw score was virtually meaningless, and attention should be paid to another number on the report, which is, the New York State percentile rank. On another occasion, Jeff took another type of state test; it did not give a score but rather indicated whether he was a 1, 2, 3, or 4. Thankfully, these numbers were accompanied by verbal labels indicating the extent to which the test taker was below, near, or above expected grade-level standards. Equally thankfully, he ‘‘scored’’ a 4. Although this anecdote sounds silly to professional psychologists and educators, it is disarming to the lay public for an obvious reason: most are not psychometricians. Perhaps one of the clearest definitions of the problem is provided in Cronbach’s classic text, Essentials of Psychological Testing (1970). Indeed knowing how to interpret test scores, regardless of issues of their

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reliability, validity, or cultural appropriateness, is what we would term a ‘‘post hoc essential.’’ That is, once tests are scored—any test for that matter, good or bad—what meaning can be derived from the score and how should it affect the disposition of the examinee (for example, promote or hold over, refer for counseling, incarcerate or parole, hire or fire)? According to Cronbach (1970), ‘‘Taken by itself, the raw score on a psychological test has little or no significance. To understand it we must bring in additional information, either about the task or about the performance of other persons tested’’ (p. 84). The distinction between these two types of information he attributes to Glaser (1963), who classified tests as either criterion or norm referenced. Criterion-referenced testing refers to a translation of the raw score into an expected behavior of the examinee (for example, acceptable academic performance of a child in the subsequent grade). Norm-referenced testing translates the raw score into the examinee’s performance relative to others presumably from the same population, say, African American sixth graders, who have taken the same test. This distinction can be fuzzy inasmuch as a test score can be used in both manners; for example, a child scoring at the ninety-fifth percentile nationally, clearly indicative of highly superior performance or aptitude relative to his or her peers, could also be used to infer that we would expect this student to meet the criteria for achieving a grade of A in school. The conception, development, psychometric refinement, and interpretation of tests, both criterion and norm referenced, can be found in any textbook on psychological or educational testing. This chapter focuses on norm-referenced testing, although we may occasionally diverge with criterion-referenced applications of normative information. Our purpose, however, is not to reiterate what is common knowledge about the topic but rather extend it to the special circumstances of psychological and educational testing of ethnic- and racial-minority children and adolescents, as well as to the equally pertinent but more recondite issue of personality testing and psychiatric diagnosis. The issues at hand and the considerations raised are undeniably applicable to all populations that fall under the rubric of being called diverse, such as gender, language, sexual orientation, and religiosity, or any other significant demographic characteristic. We begin with the basic conception of test item development, in the service of ultimately obtaining a norm-referenced assessment that is, at the most fundamental level, relevant to minority populations. We then turn to elementary considerations of establishing evidence of reliability for minority assessment. Then comes the heart of the matter: establishing norms for minorities, followed by their interpretive application, which might more commonly be called

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36 HANDBOOK OF MULTICULTURAL ASSESSMENT validity. After a brief excursion into qualitative norms, no better exemplified than by psychiatric diagnosis, we conclude with the typical recommendations for future research, some being quite seriously realistic and others pointing to virtual impossibilities. Lest we forget, presuming that an impeccable research program has truly established a valid normative reference for a multitude of minority populations, norms become outdated as time goes by, and the entire effort may need to be replicated.

WHAT’S IN A NORM? We owe the concept of norming to the ancient Greeks in their apparatus for measuring the time of day. A norm is basically a watch. The Greek word gignoskein translates as ‘‘to know.’’ Gnomon is a column, pin, or triangular plane on the surface of a disk, demarcated circularly with numbers. The shadow cast by the gnomon over the array of numbers illuminated the time of day. The time teller—the ancient psychometrician—was the ‘‘knower’’ or, by a somewhat more familiar Greek word that has intruded into the English language, the gnostic (original Greek, gnostikos). So today a norm-referenced test casts its shadow over the obelisk of individuals composing a designated population. The particular numbers, when put into an interpretable format of scalar measurement, subsequently obtain meaning to the psychometrician and the examinee. The fact that the shadow covers 25 percent of the sundial means little; that it points to three o’clock enables our knowledge of the measurement construct, time. Is time invariant across cultures? Of course not; an hour in the United States is equivalent to an hour in Spain. Psychological and educational measurements, as we know, do not conform to physical measurements. We can assume at best, and we usually do, to have achieved what S. S. Stevens (1946) originally termed an interval scale of measurement, basically the same as physical measurements but lacking a true zero (that is, we cannot psychologically register the complete absence of a trait). The task facing the psychometrician, given the limited resources of measurement scaling and less than perfectly reliable and valid tests, is how to differentiate individuals on a trait of interest in an unbiased manner.

WHY A THEORETICAL NORMAL DISTRIBUTION? The classic statistic underlying test norms is the percentile rank, no doubt because of its intuitive appeal to the test consumer and user and its ease of interpretation. It is calculated as the percentage of examinees scoring below a given score. For example, if our son brings home a score of 46 on some

BUILDING COMMUNITY TEST NORMS F r e q u e n c y

0

25

50

75

100

Score

Figure 3.1. Approximately Normal Empirical Distribution of Test Scores

achievement test and the maximum is not reported (though it really does not matter), and the accompanying report says that this score represents the seventy-seventh percentile, we now know that our son scored higher than about three-fourths of the other children taking the test. If it is a national test, then we are really proud. What parents, examinees, and even test administrators do not get to see is the underlying distribution of scores, raw scores, and their corresponding percentile ranks. In most cases, it is probably safe to assume that the distribution, especially based on a large sample size of thousands of examinees, is roughly normal. A precise graphic representation, however, would invariably show minor imperfections in the smoothness and the bell-shapedness of the distribution, as shown in Figure 3.1. Based on simply scanning Figure 3.1, the psychometrician behind the test would probably feel comfortable that the ability supposedly being measured by the test is in fact normally distributed in the population, not just the sample of test takers, large as it may be. He or she would also assume that the minor imperfections in the quasi-normal curve are due to chance fluctuations called sampling error, with some element of less-than-perfect test reliability thrown into the mixture. The remedy for all this is simply cosmetic. That is, assuming that the true underlying distribution of the trait in question is precisely normal and that the observed distribution differs from truth merely because of chance, it follows that a reasonable course of action is to smooth out the irregularities in the observed distribution to get the best representation of what the true normal distribution looks like.

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38 HANDBOOK OF MULTICULTURAL ASSESSMENT F r e q u e n c y

0

25

50

57

75

100

Score

Figure 3.2. Theoretical Normal Distribution (smooth curve) compared to Approximately Normal Empirical Distribution

This is rather an easy task. For instance, by converting the observed raw scores to unit normal deviates (z = score − mean/standard deviation), and referring the standard unit normal curve, the normal curve equivalents of the raw scores can be obtained (see Figure 3.2). For example, a person scoring 57 in Figure 3.1, slightly above the mean but dipping a bit below what would be a smooth trace of the curve, would have a slightly higher percentile rank when referenced in Figure 3.2, since theoretically more people fall below this score. The extent to which this difference is consequential in any way depends on many factors, the most fundamental of which is how nonnormal the original curve (Figure 3.1 analogue) is in the first place. As the distribution increases in irregularity and skewness (lopsidedness), the differences in percentile rank outcomes become increasingly more substantial. Whether the difference amounts to, say, 5 percentile points, this then becomes a matter for the educational or psychological practitioner to say. For instance, in some borderline cases where cutoff scores are employed to determine whether an individual is referred or not to some remedial program, smoothing the curve into normality could make the difference in whether a child is referred or not referred for special treatment. Even more elaborate means of smoothing out the curve’s irregularities are by techniques such as computing running averages around each score, such that a few lower and higher scores are averaged at each discrete point. This not only smoothes the curve but also enhances its normal shape.

BUILDING COMMUNITY TEST NORMS

In some forms of testing, such as IQ and personality testing, percentile ranks are forgone for standard scores with the same properties of normalized z-scores. Raw IQ scores mean nothing to the test consumer or school psychologist interpreting test results. They are converted by the test into normalized z-scores and then to a more familiar form in which the mean is 100 and the standard deviation is 15. Personality profiles are often similarly generated for clinical interpretation in terms of normalized T-scores, which have a mean of 50 and standard deviation of 10.

ITEM RESPONSE THEORY: SCALED SCORES Over the past thirty years or so, psychometricians have developed more modern concepts of test norming (more appropriately referred to as item norming) based on the early work of Benjamin Rasch at the University of Chicago and Frederick Lord at the Educational Testing Service. The mathematical underpinnings of these scaling methods are indeed complex and far beyond the scope of this chapter. The math is understood only by a cadre of psychometricians who work with such methodology; most test publishers and psychological and educational practitioners do not even profess to understand the techniques. In a nutshell, Figure 3.3 captures the essence of what item response theory (IRT) seeks to accomplish. The picture displayed in Figure 3.3 is referred to as an ‘‘item characteristic curve or ICC’’ in the form of what is known as a

Probability Correct 1.00

.50

.00 X2

X1

Figure 3.3. Example of an Item Characteristic Curve in IRT

Ability (X)

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40 HANDBOOK OF MULTICULTURAL ASSESSMENT Probability Correct 1.00

.50

.00 X2

X1

Ability (X)

Figure 3.4. Item Characteristic Curve Referenced with Two Individuals (X1, X2) of Different Latent Ability

normal ogive. It is much like a cumulative normal distribution, wherein the cumulative percentile-like ranks of each score are plotted on the curve. The vertical axis of Figure 3.3 represents the probability of answering a given item correctly, which is readily determined for each item. The horizontal axis, and here is the interesting conception, represents the latent ability of the examinee. So given an examinee with a latent ability of x1 in Figure 3.4, it is readily seen that this maps to a probability of about .70 of getting the item correct, referring to the vertical axis. In contrast, a person with a latent ability of x2 in Figure 3.4 has only a .30 chance of getting the item correct. The hard part is how to determine an examinee’s latent ability, which would seem to be what we are after in the first place. The unfortunate mundane answer is that typically, one’s total score on the test is used as the best proxy for latent ability—regardless of whatever evidence there is of reliability, validity, or even bias. What is advantageous about IRT scaling is that the individual items of a test can be calibrated in this fashion and banked for future use with other combinations of test items to produce multiple forms of a test, with known psychometric properties. For instance, a test publisher might calibrate a thousand such items and randomly select a hundred at a time for various testing activities around the country, producing ‘‘equivalent’’ tests composed of different questions. Of course, the items are selected such that some are easy, some of moderate difficulty, and some hard to answer correctly.

BUILDING COMMUNITY TEST NORMS

Fumiko Samejima (2000) extended this work to the graded response model of Frederick Lord’s earlier work. That is, rather than just being able to IRT-calibrate test items of a dichotomous nature (correct/incorrect), she extrapolated to the case of multiple responses, such as the ubiquitous five-point rating scale. This enabled much broader applications of IRT in psychology and education.

WHO IS IN THE NORM GROUP? Consider the example of the Scholastic Assessment Test (SAT), which for the sake of argument is normed on the population of all college-bound seniors throughout the United States in a particular year. Standard scores, not percentile ranks or IRT-scaled scores, are reported (ranging from a low of 200 to a maximum of 800, where the national average is 500 in standard deviation increments or decrements of 100 standard score points). It takes scores high in the 700s on each SAT component test to get admitted to top universities, whereas less selective universities settle for less. Right or wrong, standardized tests play a pivotal role in the educational and career trajectories of our nation’s youth. Suppose the SATs were normed for whatever reason only on college seniors who were applying to Ivy League universities or, in contrast, public four-year colleges. Imagine how an ‘‘average’’ student with a score of 500 would stack up relative to these two norm groups. It is probably safe to estimate that in the Ivy norms, the SAT score might be around 300 and in the public sector around 700. This oversimplified scenario illustrates how dramatically the composition of a norm group, based on factors that may be extraneous to measurement, can radically alter the meaning of test score performance. Consider an example in the public eye, reported in the New York Times (2006): over 90 percent of the subjects in pharmaceutical experiments were prisoners in the 1970s and 1980s. Thinking of the effects and side effects of drugs being normed in a sense on their research populations, what can be accurately inferred on behalf of the general public when the underlying norming was conducted on such an atypical population? Next consider some rather typical sociodemographic factors that should be independent of measurement, particularly as they concern ability and achievement testing. Some common ones are gender, socioeconomic status, age, and ethnicity. A reasonable question to ask of any psychological or educational test or measurement scale is whether performance differs as a function of any of these demographic factors. Nearly two decades ago, Malgady, Rogler, and Costantino (1987) reviewed the psychological literature on test bias and extracted five levels of bias in interpreting test scores. At the first level is norming the test on the appropriate

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42 HANDBOOK OF MULTICULTURAL ASSESSMENT population. If a test is normed on predominantly non-Hispanic White college students, of what relevance are any norms that are generated for ethnic minority children or adolescents who are, moreover, not college students? Many such tests do not account for diversity in their norm groups. A second concern is for the reliability and validity of the tests, based on the demographic characteristics of subsamples to which the test is applied. Is there evidence of reliability and validity for ethnic minority examinees? The unfortunate answer is usually not. When reliability and validity are estimated, do minority populations differ—that is, is a test more or less reliable or valid with ethnic minority examinees compared to their White counterparts? Differential predictor or regression is a still higher concern. Do students of diverse ethnic backgrounds with the same predictor or test score have different expected outcomes on some criterion-related measure, such as grade point average in college? If so, despite equivalent test scores, they may be worth more or less in terms of expected educational outcome depending on one’s ethnicity. The typical scenario of such bias occurs when test scores predict a useful outcome for Whites but not for, say, African Americans or Hispanics. So even if proper norming equates any mean differences in performance between ethnic groups, the very meaning of the test scores is called into question if their psychometric properties are not invariant across demographic characteristics, such as ethnicity or race. The highest level of test equating goes on at the level of item analysis, when IRT methodology is brought into play. Fritz Drasgow (1984), for example, has argued that if measurement equivalence (that is, the opposite of differential item functioning) is not established across subgroups, notions of reliability and validity, as well as statistical power to detect differences, is impugned for ethnic minority examinees. Figure 3.5 illustrates a case of differential item functioning for two individuals, minority and nonminority, with the same latent ability, but whose abilities map onto different probabilities of answering the question correctly. In the scenario depicted in Figure 3.5, a Latino and a White student of the same latent ability have very different probabilities of passing the test item correctly. Why this may be is not always readily apparent from the content of test items. Therefore, the recommended course of action is to delete such items from item banking for future test construction.

CREATING MULTICULTURAL NORMS One application of differential test norming for various ethnic groups is evident in the psychometric development of the TEMAS test (Costantino, Malgady, and Rogler, l988), a narrative assessment of cognitive, affective, and

BUILDING COMMUNITY TEST NORMS

Probability Correct 1.00

White ICC

Latino ICC .50

.00 X1

Ability(X)

Figure 3.5. Example of Differential Item Functioning for White and Latino Individuals of the Same Latent Ability (X1)

personality functioning in children and adolescents. The norms were delimited to school-age children, boys and girls aged five to eighteen, in urban school districts, primarily from low to lower-middle socioeconomic status. The norms—normalized percentile ranks and T-score profiles—were created for different subgroups because research indicates significant differences in the score distributions as a function of age, gender, and ethnicity. A variety of ethnic groups have been normed, including New York (representing inner-city areas) Puerto Ricans, other Hispanics collectively (Dominicans, Mexican Americans, Central/South Americans), native Puerto Rican islanders, African Americans, non-Hispanic Whites, and Asian Americans (primarily Chinese). These norms are subdivided by age and gender. Thus, the TEMAS test provides a profile depending on the demographic characteristics of the examinee; scores are interpreted in this way, and school-related dispositions are influenced by a student’s sociocultural context. These advantages notwithstanding, the norming of the TEMAS test was an arduous process, with extensive testing of hundreds of students within each ethnic group. Clearly, larger normative samples in the thousands would have been much more desirable though economically prohibitive for a private endeavor. In addition, much research such as this is based on convenient samples, as opposed to some reasonably stratified random sampling methodology. To the extent that selective biases creep into the inclusion of ethnic minorities in a

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44 HANDBOOK OF MULTICULTURAL ASSESSMENT norming group, the representativeness of the norms in the population meant to be served becomes increasingly questionable. Students participating in test development activities are considered by both university and school district standards as human subjects in research, so informed consent of the students and their parents is usually required. This imposes some element of selective bias in the recruitment process for minority norming, particularly if some families are illegal or undocumented immigrants, if their English-speaking and acculturative skills are below par, and if their understanding of any benefits from participation (such as monetary gain or free educational assessment) is in any way compromised.

REVIEW OF ACHIEVEMENT TESTS We reviewed the Buros Sixteenth Mental Measurements Yearbook (Kramer and Conoley, 2002) only in the area of achievement testing, which is far more advanced than other construct measures. It contained reviews of eighteen published, standardized achievement tests. Some provided descriptions of attempts for representative and random sampling in norm development; none provided separate norms by ethnicity or report on differential psychometric properties of the tests or the composite items as a function of examinee ethnicity. There are, however, two reviews worthy of mention because of their relevance to the topic. First, the Buros review states that the Assessment and Placement Services for Community Colleges, which is published by the College Board (1984), is an interesting case. Although the manual acknowledges the underrepresentation of Hispanics in the national norming sampling, it notes as well that ‘‘many manuals of other instruments remain conspicuously silent on this subject’’ (p. 41). Similarly, it notes, the Scholastic Aptitude Scales do not report separate ethnic norms, but the Manual states that many achievement tests were poorly constructed, inadequately standardized, and biased again minority students. According to the review, the bias is attributed to the fact that the test is laden with verbal stimuli. These commentaries are quite intriguing in the light of the discussion in this chapter and the fact that the major collection of achievement tests in print does not provide separate norms by ethnic group—to say nothing of research findings on invariance of psychometric characteristics of the tests. Moreover, the latter review borders on a traditional viewpoint that tests are biased because of a reliance on verbal items. The implication is that there is a verbal deficit among minority examinees, which can be overcome only by performance-type or nonverbal measures (Costantino, Dana, and Malgady, 2007).

BUILDING COMMUNITY TEST NORMS

PROBLEMS MEASURING MULTICULTURAL DIVERSITY Anthropologists have viewed culture thoroughly, although much in the manner of what cognitive psychologists would call a fuzzy concept. For instance, LeVine (1984) refers to culture as a set of cognitions shared by members of a community. Such cognitions are of many types, including intellectual, moral, aesthetic, and linguistic. Members of a society become accustomed to certain values, beliefs, and behaviors on the part of other members of our society. These customs are more or less expected of individual members of a community because there is a formal (legal) or informal (moral) consensus on their correctness. The fuzziness of culture raises several inherent questions. How large a group is needed to constitute a community or society? Are native-born members of a community or society who violate the social consensus still members of that culture? What are the necessary and sufficient criteria for distinguishing among cultures? To how many cultures can an individual belong? The alternative to thinking loosely about culture leads quite naturally to what Howard (1991) has referred to as the ‘‘shreds and patches’’ concept of culture—the attempt to atomize culture into its discrete traits or dimensions. According to LeVine (1984), this is not a popular approach in anthropology. When culture is atomized into selective lists of customary values (Democratic versus Republican), expected sex roles (female submissiveness versus male-female equality), beliefs (fatalistic versus internal locus of control), language (English versus Spanish), and behavior (assertive versus deferential), individuals’ cultural profiles as native members of the same community will register many permutations of these traits’ values. Hence, the concept of a culture becomes superfluous. The discomfort anthropologists feel in trying to reduce cultures to their essential defining features is not new. The philosopher Wittgenstein expressed it admirably as confusion engendered by a perceptual incapacity to separate similarities from differences: The result of this examination is: we see a complicated network of similarities and criss-crossing: sometimes overall similarities, sometimes similarities of detail. I can think of no better expression to characterize these similarities than ‘‘family resemblances’’; for the various resemblances between members of a family: build, features, colour of eyes, gait, temperament, etc., overlap and criss-cross in the same way. For instance . . . numbers for a family in the same way. Why do we call something a ‘‘number’’? Well, perhaps because it has a—direct—relationship to other things we call [by] the same name. We extend our concept of number as in spinning a thread we twist fibre on fibre. The strength of the thread does not reside in the fact that some one fibre runs through its whole length, but in the overlapping of many fibres [cited in Pollio, 1974, p. 99].

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46 HANDBOOK OF MULTICULTURAL ASSESSMENT Similarly, the overlapping and intertwining of the many fibers of a culture obscure their individual definitiveness, yet culture as a gestalt is detectable. As one atomizes the essential defining (necessary and sufficient) properties of any concept, such as the concept of culture, the distinctions among concepts are easily blurred. An interesting cultural anecdote occurred in a cowboy and Indian rerun we were watching on TV, wherein an Indian refers to a Black cowboy (without oxymoronic intent) as the ‘‘Black White man.’’ With atomization, even Black and White boundaries separating cultures can become unclear. Most psychologists (Sue and Zane, 1987) use the term culture loosely, more or less synonymously with ethnicity but not with race. Therefore, despite the problem of definition, since we all seem to think that we recognize a culture when we see one, we will presume that there really are coherently organized webs of customs—more than shreds and patches—interlacing a society’s collective cognitions and behaviors. The challenge of measurement of culture, the distinctions among cultures, and the more complex problem of immersion simultaneously in more than a single culture are formidable considerations in the development of multicultural test norms. Perhaps the simplest approach is to rely on an individual’s self-reported or self-identified culture or cultures. Hispanics pose a relevant case in point because of their diversity of nationality, language dominance, dialectic variability, racial characteristics, and demographic differences (socioeconomic, educational, age distribution). According to the latest U.S. Bureau of Census (2005) figures, problems with its accuracy notwithstanding, Hispanics now constitute about 13 percent of the U.S. population, outnumbering Blacks (12 percent), as the largest self-reported ethnic minority group in the United States. The distribution by national origin is 63 percent Mexican, 11 percent Puerto Rican, 5 percent Cuban, 14 percent Central and South American, and 7 percent ‘‘other’’ Hispanics. Becoming increasingly more geographically provincial, Puerto Ricans and Dominicans are the primary groups in the Northeast, Cubans in the Southeast, and Mexican Americans in the Southwest. These figures do not include the vast number of illegal aliens or undocumented status residents or the 3.5 million residents of the U.S. Commonwealth of Puerto Rico, who constitute a population double the size of New York City’s Hispanic population. According to other sources, Dominicans and Central and South Americans are the most rapidly growing immigrant groups in New York City public schools, outnumbering the influx of the next largest incoming group of youngsters, Jamaicans, by more than a two-to-one ratio (Division of Public Affairs, New York City Board of Education, 2005). The census’s five categories of Hispanic origin are nearly equivalent to each other and to non-Hispanics in male/female distribution with 49 to 52 percent

BUILDING COMMUNITY TEST NORMS

females, and there is a consistently high rate of urban residence (83 to 97 percent) across groups. Mexicans, Puerto Ricans, and Central and South Americans are considerably younger (median of twenty-four to twenty-eight years) than Cubans (median of thirty-nine years) and ‘‘other’’ Hispanics (median of thirty-one years). The rate of married status is lowest among Puerto Ricans (51 percent) and highest among Cubans (62 percent), with the remaining groups similar to non-Hispanics (54 to 58 percent). A dramatic difference is in the rate of single female–headed families: the Puerto Rican rate (43 percent) is more than double the Cuban and Mexican rates (19 percent) and one and a half times the rates of other Hispanics (27 percent) and Central and South Americans (26 percent). Cuban families are smaller in size (median, 2.81 persons) than non-Hispanic families (median, 3.13 persons). Puerto Rican (median, 3.37 persons) and other Hispanic families (median, 3.38 persons) are larger, and Central and South American (median = 3.81 persons) and Mexican (median, 4.06 persons) families are the largest. Educationally, Cubans (61 percent), Central and South Americans (60 percent), and other Hispanics (71 percent) are most likely to complete high school or above, although all at a rate well below the 80 percent non-Hispanic rate. Mexicans and Puerto Ricans are least likely (44 percent and 58 percent, respectively). Unemployment rates are distinctive, running 4 percent higher than nonHispanics, Cubans, and other Hispanics among Mexicans and Puerto Ricans. There are striking occupational differences among the groups. Whereas non-Hispanic males are most likely to be engaged in management and professional jobs (27 percent), only Cuban males follow this modal pattern (26 percent). The remaining groups are far more likely to be employed as operators, fabricators, and laborers: Mexicans at the rate of 32 percent; Puerto Ricans, 25 percent; Central and South Americans, 31 percent; and other Hispanics, 23 percent. In contrast, females in four of the five Hispanic groups are most likely to be employed in technical, sales, and administrative support positions at rates (38 to 48 percent) similar to the non-Hispanic modal rate of 45 percent; the exception is Central and South American females, employed at a 35 percent rate in service occupations. Median household income of all Hispanic groups is less than that of nonHispanic households. Cuban and other Hispanic median household incomes are the highest, followed by Central and South Americans and Mexican Americans. Puerto Ricans exhibit distinctively the lowest median household income—almost half that of non-Hispanic families. This income pattern mirrors the distribution of below-poverty-level families, ranging from only 17 percent among Cubans (compared to 12 percent among non-Hispanics) up to 31 percent among Puerto Ricans. Household income figures are somewhat deceptive because, separately, male and female Puerto Rican workers have median

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48 HANDBOOK OF MULTICULTURAL ASSESSMENT incomes comparable to or higher than most other Hispanic groups. The greater apparent poverty of Puerto Rican households, as opposed to individuals, derives largely from their lesser likelihood of having two income earners. Thus, the major social, demographic, and economic distinctions among the five Hispanic groups can be summed up as follows. Cubans and other Hispanics are the oldest, best educated, and best off financially; they have the smallest families and are least likely to be female headed. Cuban males singularly are most likely to be in higher-socioeconomic-status occupations. Puerto Ricans and Mexicans are the youngest, least educated, and poorest, and they have larger families. Puerto Rican households singularly are far most likely to be female headed. What are the consequences of this type of diversity for the development of ‘‘Hispanic’’ test norms? With regard to age diversity, there is probably a far greater need for mental health evaluation and treatment services for children and adolescents among Mexican Americans and Puerto Ricans. Well over a third of the population of these two groups is under eighteen years old, compared to less than a fifth of the Cuban American population. Income and education patterns, tending to be correlated with service use and tending to portend general mental health risk, suggest that Puerto Ricans and Mexican Americans may be at higher risk of mental disorder and yet less likely to use community mental health resources. There are probably also economic implications for service systems researchers regarding payment and insurance options. However, a far more interesting figure is the prominence of female-headed households among Puerto Ricans—up to twice the rate of other groups (the male head rate is no different from Cubans or non-Hispanic families). None of these sources of Hispanic diversity appearing in census reports, however, stem directly from cultural differences among the groups. As difficult as it may be to operationally define what is meant by culture, it is even more difficult to operationalize subcultural differences. Another characteristic of possible consequence is race. Latin American Hispanics, regardless of subgroup, vary widely across the racial spectrum from White to Black. Sensitivity to the language, racial, and broad cultural traits of Hispanic culture in general is probably sufficient, although this speculation has not been empirically tested. The most relevant subcultural diversity appears to be lodged in family structural, educational, and socioeconomically patterned differences between nationalities. Attempts to identify subcultural differences, moreover, amount to specifications of shreds and patches of culture (Howard, 1991), not the more transcendent fibral quality of cultures that anthropologists detect. To scientifically address the hurdle of subethnic or subcultural diversity, psychometric research should examine the extent to which test examinees’

BUILDING COMMUNITY TEST NORMS

subcultural profile correlates with their testing outcomes. If selected characteristics are found to be inconsequential to test performance, there is no need for concern about separate norms development. But if there is evidence that test performance varies across ethnic subgroups, there is an evidence-based need for separate test norming. This prospect is especially challenging because of the wide geographical diversity of the major subcultural enclaves in the United States. Without the resources to conduct a national norming, which would be extraordinarily costly, most test developers standardize their instruments on local populations. The ultimate goal of minority test norming should be to situate meaning of psychometric evaluation in the respondent’s complete social, demographic, and cultural context insofar as these contexts are relevant to the abilities or traits being measured. The state of the art and science of psychometric test development is such that most studies have not included more than a single subcultural group; hence, little or no information is available on the cross-subcultural generalizability of norms or, theoretically more intriguing, potential moderating effects of subcultural group membership on such findings. Suppose research reveals that multicultural test norms need to be developed to provide comprehensive measurements of given aptitudes or traits. Is this going too far, expecting too much from an already overburdened system? For Hispanics alone, there might be a need for separate considerations for the five major subcultures (and, it is hoped, not all twenty or so nationalities). In regard to assessment, standardized instruments might have five distinct norms tables in order to score Hispanic examinees; similarly, technical manuals would need to report on different factor structures, reliabilities, and criterion-related validity for each distinct Hispanic norm group indices, each probably broken down further according to the usual age and gender demarcations. The effort and cost of such normative research, followed by training of professionals who use the tests and graduate education of prospective professionals, would pose a severe economic challenge to the mental health services system. Now further suppose that we consider similar issues confronting members of Asian American, Black, Native American, and Pacific Islander cultures, each of which has even more subcultural groups than Hispanics. The level of cultural specificity may well reach unmanageable proportions. Raising some fundamental questions about the invariance of the psychometric properties of tests and need for special norms for achievement testing—or any other means of psychological measurement for that matter—across cultural, ethnic, racial, and linguistic boundaries provokes a research and development agenda of catastrophic proportion for the professional testing community. Are there real observed differences between minorities and nonminorities in test behavior? Of course there are. Whether these differences are

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50 HANDBOOK OF MULTICULTURAL ASSESSMENT inherently characteristic of the groups or an exogenous artifact of the tests remains unanswered and poignantly debated over the past four decades. No amount of statistical tinkering or methodological alchemy is likely to resolve the polemic. It has been argued extensively that no ‘‘null’’ hypotheses are true in nature (for example, Cohen, 1994; Malgady, 1996), and that the aim of psychometric research should be to determine which particular differences are consequential to the decisions that are ultimately made about people’s lives based on their test performance. Incorrect decision making, stemming from less than perfect test reliability and validity or human judgment, is statistically expected. The dogmatic faith in standardized tests as deliverers culturally universal norms, and adherence to the belief that our psychometric watches don’t need rewinding when crossing most cultural time zones, is lamentably myopic.

References Cohen, J. (1994). The earth is round (p < .05). American Psychologist, 49, 997–1003. College Board. (1984). Assessment and placement services for community colleges. New York: Author. Costantino, G., Dana, R., & Malgady, R. G. (2007). The TEMAS test: Research and applications. Mahwah, NJ: Erlbaum. Costantino, G., Malgady, R. G., & Rogler, L. H. (l988). Technical manual: The TEMAS Thematic Apperception Test. Los Angeles: Western Psychological Services. Cronbach, L. J. (1970). Essentials of psychological testing (3rd ed.). New York: HarperCollins. Drasgow, F. (1984). Scrutinizing psychological tests: Measurement equivalence and equivalent relations with external variables are the central issues. Psychological Bulletin, 95, 134–135. Glaser, R. (1963). Instructional technology and the measurement of learning outcomes. American Psychologist, 18, 510–522. Howard, G. S. (1991). Culture tales: A narrative approach to thinking, cross-cultural psychology, and psychotherapy. American Psychologist, 48, 187–197. Kramer, J. J., & Conoley, J. C. (Eds.). (2002). The sixteenth mental measurements yearbook. Lincoln, NE: University of Nebraska Press. LeVine, R. A. (1984). Properties of culture: An ethnographic view. In R. Shweder & R. A. LeVine (Eds.), Culture theory: Essays in mind, theory, and emotion (pp. 67–87). Cambridge, England: Cambridge University Press. Malgady, R. G. (1996). The question of cultural bias in assessment and diagnosis of ethnic minority clients: Lets reject the null hypothesis. Professional Psychology: Research and Practice, 27, 73–77.

BUILDING COMMUNITY TEST NORMS Malgady, R. G., Rogler, L. H., & Costantino, G. (1987). Ethnocultural and linguistic bias in mental health evaluation of Hispanics. American Psychologist, 43, 228–234. New York City Board of Education. (2005). Division of public records special report on ethnicity. Brooklyn, NY: Author. New York Times. (2006, August 23). Prisoners of drugs, sect. A, p. 22. Pollio, H. (1974). The psychology of symbolic activity. Reading, MA: Addison-Wesley. Samejima, F. (2000). Logistic positive exponent of family models. Psychometrika, 65, 319–335. Stevens, S. S. (1946). On the theory of scales of measurement. Science, 103, 677–680. Sue, S., & Zane, N. (1987). The role of culture and cultural techniques in psychotherapy: A critique and reformulation. American Psychologist, 42, 37–45. U.S. Bureau of the Census (2005, March). Current population reports: Population characteristics. Washington, DC: U.S. Government Printing Office.

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CHAPTER FOUR

Cultural Identity, Racial Identity, and the Multicultural Personality Alan W. Burkard Joseph G. Ponterotto

T

his chapter explores recent theoretical and empirical developments in the assessment of racial identity, ethnic identity, and the multicultural personality. It first presents an overview of recent theoretical and measurement work in racial and ethnic identity development—two long-standing constructs in the multicultural psychology literature. Given the wealth of information on racial and ethnic identity, we only summarize the most recent theoretical and assessment advances related to these two constructs. We then present a thorough overview of recent theoretical and empirical work on the multicultural personality, a fairly new construct relative to long-standing and systematic work in racial and ethnic identity. We believe recent theoretical and empirical work on the multicultural personality represents a major advance in the field of psychology, and we believe the construct holds much promise in stimulating important research internationally and across psychology specialties.

RACIAL AND ETHNIC IDENTITY DEVELOPMENT Theory and research in racial and ethnic identity development has been a focus in psychology for roughly four decades. Early pioneering models of racial identity development (Cross, 1971; Thomas, 1971) focused on African Americans interacting with a European American–dominated society. Advances in racial identity research occurred rapidly in the 1980s with the development of

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CULTURAL IDENTITY, RACIAL IDENTITY, AND THE MULTICULTURAL PERSONALITY

paper-and-pencil measures of Cross’s Black identity stages (Parham and Helms, 1981) and with Helms’s (1984) integrative theoretical models of both Black and White racial identity development. With the publication of Helms’s Black and White Racial Identity: Theory, Research, and Practice (1990), Black and White racial identity topics became a mainstay of empirical research programs throughout the United States, and by the start of the twenty-first century, racial identity theory was a dominant force in psychology (Ponterotto, Fuertes, and Chen, 2000). Concurrent with work on racial identity were major breakthroughs in the study of ethnic identity development. Building off theoretical work in developmental and social psychology (Erikson, 1968; Marcia, 1980; Tajfel, 1981), Phinney (1992) developed the Multigroup Ethnic Identity Measure (MEIM), which has gone on to become a widely used research instrument across psychology specialty areas. Unlike racial identity scales, which are race specific, this construct transcends individual racial and ethnic groups and can be administered across all groups.

Recent Developments in the Assessment of Racial and Ethnic Identity To focus this discussion of the most recent developments in racial and ethnic identity assessment, we have limited our coverage to the most recent revision within each category. Thus, for Black racial identity, we review the latest updates on the Cross Racial Identity Scale (CRIS; Vandiver, Cross, Worrell, and Fhagen-Smith, 2002). For White identity, we summarize the recent work on the White Racial Consciousness Development Scale–Revised (WRCDS; Lee et al., 2007). Finally for ethnic identity, we review Phinney and Ong’s (2007) recent development of the Multigroup Ethnic Identity Measure–Revised (MEIM-R). Table 4.1 lists these measures, along with other popular measures on the topic. The table includes recent reference support to allow readers to locate critical and up-to-date information on any of the measures. Cross Racial Identity Attitude Scale. The Cross Racial Identity Attitude Scale (CRIS) operationalizes the Cross (1991, 1995) revised and expanded (Cross and Vandiver, 2001) models of psychological nigrescence. The current version of the CRIS (Vandiver et al., 2002) contains forty items, of which thirty items comprise six identity types: three pre-encounter types or exemplars, one immersion-emersion exemplar, and two internalization exemplars. Ten items serve as filler items to minimize response bias. Both exploratory (percentage of variance accounted = 43.14) and confirmatory factor analyses (comparative fit index = .94) support the six-factor model (Vandiver et al., 2002). Coefficient alphas across the identity types ranged from a low of .78 for Pre-Encounter

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Oklahoma Racial Attitude Survey (ORAS), Choney and Behrens (1996)

Fischer and Moradi, 2001; Pope-Davis, Vandiver, and Stone, 1999; Rowe, Behrens, and Leach, 1995

Mark Leach: m.leach@usm. edu

Robert Sellers: [email protected]

Fischer and Moradi, 2001; Sellers, Smith, Shelton, Rowley, and Chavous, 1998

Centrality (8); Ideology: Assimilation (9), Humanist (9), Nationalist (9), Oppressed (9); Regard: Private (6), Public (6)

Multidimensional Inventory of Black Identity (MIBI) (Sellers, Rowley, Chavous, Shelton, and Smith, 1997)

Dissonant (4), Avoidant (3), Reactive (8), Dependent (3), Conflictive (8), Dominant (4), Integrative (4)

William Cross: [email protected]

JMCD, 2001, 29 (3) [Whole Special Issue]; Cokley, 2002

Pre-Encounter: Assimilation (5), Miseducation (5), Self-Hatred (5); Immersion-Emersion: Anti-White (5); Internalization: Afrocentric (5), Multiculturalist (5) (with 10 filler items)

Cross Racial Identity Scale (CRIS) Cross and Vandiver (2001), Vandiver et. al. (2002)

White racial identity development

Janet Helms: [email protected]

Contact Source

Fischer and Moradi, 2001; Helms, 1995; Helms and Cook, 1999; Ponterotto et al., 2006

Relevant Reading

Pre-Encounter (14), Encounter (4), Immersion-Emersion (9), Internalization (12) (with 11 filler items) (there is also a 30-item short form)

Subscales (items per)

Black Racial Identity Attitude Scale(RIAS-B) (Helms and Parham, 1996)

Black racial identity development

Models/Assessments

Table 4.1. Popular Models and Assessments of Racial Identity, Ethnic Identity, and the Multicultural Personality

Phinney and Ong, 2007; Ponterotto, Gretchen et al., 2003; Roberts et al., 1999

Exploration (3), Commitment (3)

Multigroup Ethnic Identity Measure–Revised (MEIM-R) Phinney and Ong (2007)

Ponterotto, in press; Ponterotto et al., 2006; Van der Zee and Van Oudenhoven, 2001 Miville, Rohrbacker, and Kim, 2004; Ponterotto, in press

Cultural Empathy (14), Open-Mindedness (18), Social Initiative (17), Emotional Stability (20), Flexibility (18) Contact (5), Appreciation (5), Comfort (5)

Multicultural Personality Questionnaire (MPQ) (Van der Zee and Van Oudenhoven, 2000)

Miville-Guzman Universality-Diversity Scale-Short Form, Miville et al. (1999), Fuertes et al. (2000)

Multicultural personality components

Cokley, 2007; Umana-Taylor et al., 2004

Exploration (7), Resolution (4), Affirmation (6)

Ethnic Identity Scale (EIS) (Umana-Taylor, Yazedjian, and Bamaca-Gomez, 2004)

[email protected]. Columbia.edu

Karen van der Zee: K.I.van.Oudenhoven [email protected]

See the appendix for complete MEIM-R

Adrian [email protected]

Janet Helms: [email protected]

Fischer and Moradi, 2001; Helms, 2005; Helms, 2007; Helms and Cook, 1999

Contact (10), Disintegration (10), Reintegration (10), Pseudo-Independence (10), Autonomy (10)

White Racial Identity Attitude Scale (WRIAS) (Helms and Carter, 1990)

Ethnic identity development

Lee et al., 2007

Autonomy (9)

Contact (8), Reintegration (14), PseudoIndependence (9)

White Racial Consciousness Development Scale–Revised (WRCDS-R) (Lee et. al., 2007)

Sang Min Lee: [email protected]

56 HANDBOOK OF MULTICULTURAL ASSESSMENT Miseducation to a high of .89 for both Pre-Encounter Self-Hatred and Immersion-Emersion Anti-White. The specific identity types measured by the CRIS are briefly defined here: • Pre-Encounter Assimilation. The exemplar of this type places little emphasis on racial group identity and focuses instead on an identity as an American and as an individual. Black culture is either not engaged or, if engaged, this exemplar speaks out against race-based programs (such as affirmative action). • Pre-Encounter Miseducation. The exemplar of Miseducation accepts stereotypical information about Black persons, and is successful at compartmentalizing their own self-group stereotypes to maintain their own esteem and self-image. Such individuals seldom engage the Black community as they see little strength in this community. • Pre-Encounter (Racial) Self-Hatred. The Self-Hatred exemplar holds disdain for the Black culture, and has deep-seated negative feelings about being Black. Such individuals rarely engage Black culture. • Immersion-Emersion Anti-White. Exemplars in this identity type are often emotionally volatile, hating White persons and all that they represent and engaging Black culture in frequently unpredictable ways. • Internalization Nationalist. The exemplars in this internalization state embrace their Africentric identity, Black people, and the Black community. These individuals are highly engaged in what they perceive as Black problems and causes and Black culture. • Internalization Multiculturalist. The Multiculturalist identity type engages Black culture and problems. It also engages, with equal energy, her or his multiple identities (for example, religious, gender, sexual orientation identities). Their Black identity is one critical representation of the overall identity (for a more detailed description of Cross’s revised and expanded model, see Cross, 1995; Cross and Vandiver, 2001; and Ponterotto, Utsey, and Pedersen, 2006). Of the many racial and ethnic identity measures, the development of the CRIS serves as an exemplar in the scale development process. The CRIS research teams, led by William Cross and Beverly Vandiver, systematically planned multistage, multiyear studies designed to develop and validate the CRIS. The research teams demonstrated how theory leads to instrument development and then how testing the instrument leads to theory modification. Thus, theory development and testing can be seen as an iterative process as incoming data inform the further refinement of the theory. Reviewing the many stages and studies in the CRIS development process is beyond our goals for this chapter, and we direct readers to the special issue of the Journal of Multicultural Counseling and Development (2001, 29[3]) devoted to this topic. Psychometric data on score reliability and validity of the CRIS

CULTURAL IDENTITY, RACIAL IDENTITY, AND THE MULTICULTURAL PERSONALITY

are impressive (see Ponterotto et al., 2006; Vandiver et al., 2002). We strongly recommend the use of the CRIS for researchers interested in studying Cross’s (1991, 1995; Cross and Vandiver, 2001) revised and expanded model of Black racial identity development. White Racial Consciousness Development Scale–Revised. The White Racial Consciousness Development Scale–Revised (WRCDS-R; Lee et al., 2007) is the most recent instrument designed to operationalize Helms’s landmark theory (1984) of White racial identity development. The original WRCDS (Claney and Parker, 1989) was a fifteen-item, five-factor scale (three items per factor) measuring the Contact, Disintegration, Reintegration, Pseudo-Independence, and Autonomy stages of Helms’s (1984) original model. Due to psychometric limitations of the original WRCDS (see Choney and Rowe, 1994), Lee et al. (2007) set out on an impressive five-step scale development process to revise the instrument. Step One was to expand the original item pool, through focus groups discussion and individual interviews (using all White criterion-group sampling), from fifteen items to ninety-nine items. In Step Two, item refinement and selection, the research team used card sorting procedures to reduce the item pool to eighty items. Step Three involved subjecting the eighty-item measure to exploratory factor analysis. Using carefully designed item elimination and factor assignment criteria, the authors reduced the item pool to forty items. The revised forty-item instrument consists of four robust factors (accounting for 51.6 percent of the variance) labeled Contact (eight items), Reintegration (fourteen items), Pseudo-Independence (nine items), and Autonomy (nine items). Step Five was to administer the forty-item WRCDS-R to a new sample and conduct a confirmatory factor analysis. The results supported the four-factor structure, with multiple indexes of fit falling between .91 and .94. Coefficient alphas across subscales were .81 for Contact, .86 for Reintegration, .84 for Pseudo-Independence, and .71 for Autonomy. Multigroup Ethnic Identity Measure–Revised. Phinney’s original Multigroup Ethnic Identity Measure–Revised (MEIM; 1992) contained twenty-two items: fourteen items measuring Ethnic Identity (EI) achievement, which assessed behaviors and attitudes reflective of ethnic identity exploration, a sense of affiliation to one’s ethnic group, and practices specific to the group; and six items measuring Other Group Orientation (OGO), measuring attitudes regarding interaction with people representing different ethnic groups. Exploratory factor analyses supported Phinney’s two-factor model (EI and OGO), though confirmatory factor analyses found the two-factor model to represent only a mediocre fit, with various goodness-of-fit indexes ranging from .81 to .84 (Ponterotto, Gretchen, Utsey, Stracuzzi, and Saya, 2003).

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58 HANDBOOK OF MULTICULTURAL ASSESSMENT Roberts et al. (1999) factor-analyzed only the fourteen-item Ethnic Identity Achievement component of the MEIM and settled on a twelve-item, two-factor solution (51.2 percent of variance) represented by affirmation, belonging, and commitment (seven items) and ethnic exploration and behaviors (five items) (two items were deleted based on low factor loadings). Recently, in a series of systematic studies, Phinney and Ong (2007) made additional revisions to the Roberts et al. (1999) twelve-item MEIM version to create the most current form. The new MEIM-R consists of only six items: three that measure ethnic identity exploration (coefficient alpha = .76) and three that measure ethnic identity commitment (coefficient alpha = .78). Quite impressively, confirmatory factor analysis on the MEIM-R with an independent sample demonstrated an excellent fit to the data, with various goodness-of-fit indices ranging from .96 to .98; these indices are extraordinarily high. The MEIM-R and corresponding scoring directions are reproduced in the appendix of this chapter.

Summary of Recent Racial and Ethnic Identity Psychometric Developments We find the recent theoretical and empirical work on measuring racial and ethnic identity to be exciting developments for the field. The three new instruments reviewed briefly—the CRIS (Cross and Vandiver, 2001; Vandiver et al., 2002), WRCDS-R (Lee et al., 2007), and MEIM-R (Phinney and Ong, 2007)—were all carefully and methodically designed and hold great potential for advancing study in the area. Of the three instruments discussed, the CRIS has received most empirical attention, whereas the WRCDS-R and the MEIM-R represent more recent revisions and undoubtedly need to be examined in additional studies before we can be confident that the factor structure and score reliabilities are holding across multiple samples. (Readers interested in reviews of a wide variety of racial and ethnic identity measures are referred to Dana, 2005; Fischer and Moradi, 2001; and Trimble, 2005.)

MULTICULTURAL PERSONALITY: THEORY AND MEASUREMENT Although ethnic and racial identity models focus on the meaning one makes of their ethnicity and race, these models offer less insight into how individuals adapt to or become effective in culturally diverse environments. Understanding how people adapt to cultural diversity is of interest as our schools, work environments, and neighborhoods become increasingly culturally pluralistic. For example, demographic predictions suggest that current ethnic/racial minority groups will make up over 50 percent of the population in the United States by the year 2050. Furthermore, ethnic/racial minority groups currently represent the majority in many U.S. cities (American Psychological Association, 2003;

CULTURAL IDENTITY, RACIAL IDENTITY, AND THE MULTICULTURAL PERSONALITY

U.S. Census, 2004). As the cultural demographics of our society change, it seems reasonable to expect that some individuals will adapt more quickly and more effectively to a culturally diverse society than others. For example, as society diversifies, individuals will need to contend with cultural differences in communication style and values about time, self, and relation to one’s own and others’ cultural heritage and community. As such, understanding how individuals adapt and what personal attributes contribute to effectiveness in culturally diverse environments will increasingly become an important topic to researchers, educators, and human service professionals (Coleman, 1995; Ponterotto, Utsey, and Pedersen, 2006). A few conceptual models offer insights into the personal characteristics of individuals who are effective in culturally diverse environments. These models have focused on such topics as assisting culturally diverse counseling clients to develop bicultural skills and a multicultural orientation to life (Ramirez, 1991, 1999), assisting students to become ‘‘multicultural citizens’’ or ‘‘multicultural persons’’ (Banks, 2001; Nieto, 2000), and understanding the personality characteristics of individuals who successfully negotiate culturally diverse work environments, particularly those who work in international settings (Van Der Zee, Atsma, and Brodbeck, 2004; Van Der Zee and Van Oudenhoven, 2000). Building on this prior theoretical and empirical work in education, developmental psychology, and personnel psychology, Ponterotto and his colleagues (Ponterotto, Costa, and Werner-Lin, 2002; Ponterotto, Jackson, and Nutini, 2001) discussed the notion of a multicultural personality and suggested that individuals possessing such a personality may be better able to adjust to cultural pluralism in our society, be more effective in culturally diverse environments, and consequently experience a higher level of psychological well-being and quality of life. In the remaining portion of this chapter, we provide a brief overview of models that have provided a theoretical foundation for the current conceptualization of the multicultural personality. Following this discussion, we offer a definition of the multicultural personality, which includes important theoretical and operational tenets of the model.

Theoretical Influences on the Multicultural Personality Three theories of cultural adaptation have important implications for a model of the multicultural personality. Ramirez’s (1999) cognitive and cultural theory of personality sought to explain adjustment patterns and coping effectiveness in culturally diverse environments. Ramirez suggested that culture, community and family values, and beliefs influence the development of an individual’s learning and problem-solving style. These styles can be identified on a cultural or a cognitive continuum. Cultural styles range from traditionalism (such as family loyalty, sense of community commitment, respect for authority,

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60 HANDBOOK OF MULTICULTURAL ASSESSMENT emphasis of clear gender role distinctions) to modernism (emphasis on individual identity and autonomy, encouragement to question authority, flexible boundaries between gender roles). Cognitive styles range from field sensitive (prefers working with others, personalizes communication, values warm and informal relationships) to field independent (prefers working independently, more impersonal and task-oriented communication, distant and formal in relationships). Personality flex, or the integration of cultural and cognitive styles, is central to the process of adjustment and coping in diverse environments and has three components: (1) the degree to which an individual’s cultural and cognitive style is developed, (2) the individual’s ability to shift between the cultural and cognitive styles, and (3) the degree to which the individual has been able to combine the cultural and cognitive styles to develop a multicultural style, or a way of adapting to cultural diversity. Effective coping, then, is believed to occur when an individual is well developed in both cultural and cognitive styles and is able to move fluidly between the two styles to meet the needs, demands, and expectations of the environment, particularly environments that are culturally diverse. To support his theory of personality flex, Ramirez (1999) cites findings from several studies connecting personality structure, cultural adaptability, and successful outcomes in a multicultural environment. Research has indicated, for instance, that academically successful children and college students tend to have more flexibility in their cultural and cognitive styles. Moreover, individuals who were found to be well developed with respect to only one of the two styles, either cultural or cognitive, were not as effective in coping as were those who could effectively use both styles (Ramirez, 1987, 1998). People who were identified as having more cultural and cognitive style flexibility were also found to have lived in many different cultures, had more positive experiences with culturally different individuals, and were more attracted to diversity (Ramirez, 1999). Within the context of an emerging theory of multicultural personality, one might conclude that individuals high in personality flex may have more intrapersonal and interpersonal flexibility, may be more open-minded, and may cope more effectively with diverse environments; whereas individuals low in personality flex may be more reactant to diversity, may have less intrapersonal and interpersonal flexibility, and may have fewer coping resources. In contrast to Ramirez’s focus (1999) on a personality trait to explain how we adapt to cultural diversity, Miville et al. (1999) proposed that awareness and acceptance of differences and similarities are crucial for adjusting to culturally diverse environments. Miville and her colleagues identified their concept as the universal-diverse orientation (UDO), basing this construct in part on the existential counseling writings of Vontress (1988, 1996). More specifically,

CULTURAL IDENTITY, RACIAL IDENTITY, AND THE MULTICULTURAL PERSONALITY

Vontress proposed that the ability to simultaneously accept and appreciate the cultural differences and similarities in others was critical to relationship development between culturally different people as well as an individual’s adaptation to cultural diversity. To operationalize the UDO construct, Miville et al. (1999) developed the Miville-Guzman Universality-Diversity Scale (MGUDS). Based on an initial study, the MGUDS is positively correlated with higher levels of empathy, positive attitudes toward feminism, and positive aspects of African American and White racial identity. In addition, the MGUDS shows an inverse correlational relationship with dogmatism, negative attitudes toward gays and lesbians, and the negative aspects of African American and White racial identity attitudes. These results suggest that individuals who score high on a measure of UDO attitudes have more openness to and appreciation of multicultural issues and an increased capacity to understand others than do individuals who obtain low scores on the UDO measure. In another investigation, Lone (2002) found that the MGUDS was positively correlated with Openness to Experience (a Big Five personality trait as measured by the NEO-Personality Inventory–Revised; Costa and McCrae, 1992) and had an inverse relationship with authoritarianism and religious fundamentalism. These collective findings suggest that high levels of UDO are associated with interpersonal flexibility and cognitive flexibility. A recent integrative review of research using the MGUDS (or its short form) found the UDO construct to correlate positively to counselors’ perceived multicultural counseling competence and to college students’ levels of maturity, empathy, academic performance, and general psychological health (Ponterotto, in press). Whereas Miville et al. (1999) and Ramirez (1999) each attended to a single, focused construct of cultural adaptation, Van Der Zee and her colleagues (Van Der Zee and Van Oudenhoven, 2000, 2001; Van Der Zee, Zaal, and Piekstra, 2003; Van Oudenhoven, Mol, and Van der Zee, 2003) conceptualized and investigated several dispositions, skills, and traits of business personnel that may underlie intercultural adaptation and effectiveness. Others have noted that in the international workplace, job turnover rates and dissatisfaction are relatively high (Kealey and Protheroe, 1996; Mendendall and Oddou, 1985), which may be due to employees’ inability to adapt to culturally diverse environments. In their proposed model of the multicultural personality, Van Der Zee and Van Oudenhoven (2000, 2001) identified a matrix of personality traits that predict multicultural effectiveness in international work environments. This matrix has five traits: Cultural Empathy (ability to convey interest in others and understand the emotions, thoughts, and experiences of culturally different people), Emotional Stability (ability to maintain calmness in stressful situations), Flexibility (ability to adjust behavior to adapt to the host country

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62 HANDBOOK OF MULTICULTURAL ASSESSMENT and learn from interpersonal mistakes or miscues), Open-Mindedness (open and unprejudiced attitude toward culturally diverse groups and culturally diverse norms and values), and Social Initiative (clear goals, initiative to solve problems, and seeks out culturally diverse social situations). Van Der Zee and Van Oudenhoven (2000, 2001) operationalized their conceptualization of the multicultural personality through the Multicultural Personality Questionnaire (MPQ). In a series of European studies on the five factors of the MPQ (Cultural Empathy, Emotional Stability, Flexibility, Open-Mindedness, Social Initiative), Van Der Zee and colleagues (Van Der Zee and Van Oudenhoven, 2000, 2001; Van Der Zee et al., 2003; Van Oudenhoven et al., 2003) found MPQ factor scores to be positively associated, but not redundant, with the Big Five (Costa and McCrae, 1992) personality characteristics of agreeableness, extraversion, and openness to experience and inversely related to hostility, rigidity, neuroticism, social anxiety, and feelings of inadequacy. In addition, individuals scoring higher on the Open-Mindedness and Social Initiative scales were found to seek out multicultural activities more often than those who scored lower on these scales. Moreover, flexibility was positively associated with high interest in international careers. More recently, research on the MPQ has begun to emerge in the United States. For example, MPQ scale scores were found to be positively associated with psychological well-being in college student samples (Ponterotto et al., 2007). A recent review of research incorporating the MPQ found that its factors predicted variance in work-related and quality-of-life criterion variables above and beyond the variance accounted for by the Big Five (Ponterotto, in press). When theory and research with respect to cultural adaptation models are considered, several themes consistently emerge. First, individuals who are more effective in culturally diverse environments appear to have a general openness to experience, and they are particularly open to and have an appreciation of multicultural issues in comparison to individuals who are less effective. In addition, individuals who are more effective in culturally diverse environments have a broader range of intrapersonal and interpersonal skills and greater flexibility to use these skills in diverse settings when compared to individuals lower in effectiveness. Perhaps due to the development of such intra- and interpersonal skills, individuals who are effective in culturally diverse environments also seek out diverse cultural and racial experiences more often than do individuals who are less effective. Once in diverse situations, people effective in culturally diverse environments found these experiences more comfortable and fulfilling in comparison to those who were not effective in such environments. Finally, people effective in culturally diverse environments reported higher levels of psychological well-being than those individuals who did not emerge as effective (see Ponterotto, in press). The consistency of these observations across theory and research thus serves as a foundation

CULTURAL IDENTITY, RACIAL IDENTITY, AND THE MULTICULTURAL PERSONALITY

for our proposed conceptualization of the multicultural personality. In the following section, we provide a definition of the multicultural personality, offer suggestions for how to operationalize this concept, and review the existing research.

Definition of the Multicultural Personality Drawing on an international corpus of cultural adaptation literature, Ponterotto et al. (2006) characterize an individual who possesses a multicultural personality as emotionally stable; is secure in her or his racial, ethnic, and other identities; embraces diversity in her or his personal life and makes active attempts to learn about other cultures and interact with culturally different people (e.g., friends, colleagues); has a spiritual essence with some sense of connectedness to all persons; has wide-reaching empathic ability in multiple contexts; is self-reflective and cognitively flexible; has a sense of humor; effectively negotiates and copes within multiple roles and cultural contexts; possesses the ability to live and work effectively among different groups and types of people; understands the biases inherent in his or her own worldview and actively learns about alternate worldviews; understands the impact of internalized racism (and homophobia) and unearned privilege in her or his personal life; and is a social activist, empowered to speak out against all forms of social injustice (e.g., racism, homophobia, sexism, ageism, domestic violence, religious stereotyping) [p. 130].

In addition, Ponterotto and his colleagues (Ponterotto and Austin, 2005; Ponterotto, Mendelsohn, and Belizaire, 2003; Ponterotto et al., 2001, 2002) hypothesized that individuals who possess a multicultural personality may experience higher levels of psychological well-being than individuals who do not. Thus, this definition highlights three important aspects of the multicultural personality model (openness to and appreciation of multicultural issues, intrapersonal-interpersonal traits, and physical and psychological well-being) and the hypothesized relationship among these characteristics. We briefly discuss each of the components and the proposed relationships among the components. First, openness to and appreciation of multicultural issues appears to be a characteristic common among individuals who effectively adapt to diverse environments. These individuals also demonstrate cognitive and behavioral flexibility. Perhaps their openness to and appreciation of multicultural issues helps them approach culturally diverse situations with intrapersonal and interpersonal flexibility. Vontress (1988, 1996), for example, emphasized that flexibility is essential to an individual’s ability to simultaneously accept and appreciate the cultural differences and similarities in others. Similarly, Helms (1995) revised her models of Black and White racial identity development to

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64 HANDBOOK OF MULTICULTURAL ASSESSMENT include information-processing strategies for each of the ego statuses. Interestingly, flexibility is emphasized as a strategy in the final status of each model, for individuals in these statuses of development are often capable of engaging ‘‘in increasingly more complex race-related behavior because they have more information-processing mechanisms by which to respond’’ (p. 184). Common to each of these models is the idea that people move from a position of rigidity regarding culture and in their personal style to a position of increased openness to and appreciation of culture and increased intra- and interpersonal flexibility. As a second component of our multicultural personality model, we have noted that individuals at higher levels of cultural adaptation tend to show greater psychological well-being (happiness, self-esteem, life satisfaction, physical health), than those at lower statuses of development. Here again, theorists (Banks, 2001; Helms and Cook, 1999; Ponterotto et al., 2006; Sue, 2003) appear to contend that people lead fuller and richer lives when they are able to integrate and appreciate culture in their lives. Similarly, some theorists (Bowser and Hunt, 1996; Ridley, 2005; Sue, 2003) also maintain that individuals who remain closed to diversity or are intentionally or unintentionally racist are indeed negatively affected by this orientation to cultural diversity and in the quality of their lives. Finally, research findings on cultural adaptation models consistently demonstrate positive correlations with intrapersonal and interpersonal traits and skills (empathy, identifying and expressing affect, development of mature relationships, inner-directedness, cognitive flexibility, intrapersonal and interpersonal flexibility) and an inverse relationship for individuals with lower levels of cultural adaptation. Related to our current conceptualization, then, we expect that higher levels of these aspects of the multicultural personality will be associated with higher levels of positive personality traits and intrapersonal and interpersonal skills than lower levels of the multicultural personality. As such, this finding may have important implications for future research on the multicultural personality. For example, perhaps the multicultural personality moderates the accessibility of some intra- or interpersonal skills particularly in culturally diverse settings. In such circumstances, Barron and Kenny’s model of moderating effects in psychological research (1986; also see Frazier, Tix, and Barron, 2004) may have important utility in understanding how the multicultural personality affects adaptation to cultural diversity.

Empirical Findings Three preliminary investigations tested directly Ponterotto et al.’s multicultural personality theory (2002, 2006). These early investigations focused on examining the relationship between multicultural personality dispositions and

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psychosocial well-being. Brummett, Wade, Ponterotto, Thombs, and Lewis (2007) for instance, found positive associations between universal-diverse orientation (UDO; as measured by the MGUDS-S) and measures of quality of life such as self-esteem, psychological hardiness, and social-interpersonal functioning. Similarly, Burkard, Ponterotto, Johnson, and Costa (2007) found that UDO moderated the relationship between reactance and self-esteem for women but not men. These findings indicate that individuals who have the ability to simultaneously appreciate the cultural similarities and differences in others show positive quality of life and well-being. In another study, Ponterotto et al. (2007) examined the relationship between multicultural personality dispositions (as measured by an MPQ three-factor model) of openness, adaptation, and social initiative and various dimensions of psychological well-being (autonomy, environmental mastery, personal growth, self-acceptance positive relations with others, and purpose in life). Perhaps the most noteworthy finding is the relationship between higher scores on the three MPQ scales of openness, adaptation, and social initiative and higher scores on measures of psychological well-being (Ryff, 1989a, 1989b). These preliminary investigations offer some evidence of the relationship between multicultural personality dispositions and well-being.

Summary and Recommendations for Measurement of the Multicultural Personality The construct of the multicultural personality is relatively new to the research community. As such, much more research is needed to answer at least the following four sets of questions: (1) Is there such a thing as the ‘‘multicultural personality’’? What makes it a personality type rather than a set of particular adaptability skills? (2) How can the multicultural personality be best operationalized and tested? (3) What are the implications of multicultural personality levels for psychological services to an increasingly diverse community? (4) What implications may the multicultural personality have for individual adaptation to culturally diverse schools, workplace environments, or communities and neighborhoods? Currently there is no comprehensive instrument that taps all the components of the lengthy multicultural personality definition introduced by Ponterotto et al. (2006). The Burkard et al. (2007) and Ponterotto et al. (2007) research teams have relied on instruments such as the MGUDS-S and MPQ that operationalize only select components of our current conceptualization of the multicultural personality. Until instruments can be developed that more comprehensively measure all the facets of the multicultural personality, theoretical and empirical advancements of the topic will be limited.

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CONCLUSION This chapter has reviewed recent theoretical and empirical advances in the study of racial and ethnic identity development. Brief descriptions of the Cross Racial Identity Scale (Cross and Vandiver, 2001), the White Racial Consciousness Development Scale–Revised (Lee et al., 2007), and the Multigroup Ethnic Identity Measure–Revised (Phinney and Ong, 2007) were presented. We believe that these measures, which were carefully developed and tested, hold great promise for advancing the study of racial and ethnic identity development. This chapter included an in-depth discussion of theory and research on the multicultural personality. This construct focuses on the intersection of openness to diversity and multiculturalism, inter- and intrapersonal traits, and psychological well-being. Although the construct is new to the field, we believe it holds great promise for psychology, but at this point, it needs elaboration and further testing.

APPENDIX: PHINNEY AND ONG’S MULTIGROUP ETHNIC IDENTITY MEASURE–REVISED Editors’ note: Phinney and Ong (2007) state that MEIM-R items should be preceded by an open-ended question that queries the respondent’s spontaneous ethnic self-label. Furthermore, the scale should conclude with a list of ethnic self-labels that respondents can check to indicate mother’s and father’s ethnic background (see also Phinney, 1992). The MEIM-R yields two scores: Exploration (the mean of items 1, 4, and 5) and Commitment (the mean of items 2, 3, and 6). An MEIM-R total score can also be calculated. We are grateful to Jean S. Phinney who provided us with permission to reproduce the MEIM-R with scoring directions in this chapter. Please circle the appropriate number under each statement where 1 = Strongly Disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, and 5 = Strongly Agree: 1. I have spent time trying to find out more about my ethnic group, such as its history, traditions, and customs. 1 2 3 4 5 2. I have a strong sense of belonging to my own ethnic group. 1 2 3 4 5 3. I understand pretty well what my ethnic group membership means to me. 1 2 3 4 5

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4. I have often done things that will help me understand my ethnic background better. 1 2 3 4 5 5. I have often talked to other people in order to learn more about my ethnic group. 1 2 3 4 5 6. I feel a strong attachment towards my own ethnic group. 1 2 3 4 5

References American Psychological Association. (2003). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist, 58, 377–402. Banks, J. A. (2001). Citizenship education and diversity: Implications for teacher education. Journal of Teacher Education, 52, 5–16. Barron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Social and Personality Psychology, 51, 1173–1182. Bowser, B. P., & Hunt, R. G. (1996). Impacts of racism on White Americans (2nd ed.). Thousand Oaks, CA: Sage. Brummett, B. R., Wade, J. C., Ponterotto, J. G., Thombs, B., & Lewis, C. (2007). Psychosocial well-being and a multicultural personality disposition. Journal of Counseling and Development, 85, 73–81. Burkard, A. W., Ponterotto, J. G., Johnson, A., & Costa, C. I. (2007). The multicultural personality: A preliminary investigation. Manuscript submitted for publication. Choney, S. K., & Behrens, J. T. (1996). Development of the Oklahoma Racial Attitudes Scale-Preliminary Form (ORAS-P). In G. R. Sodowsky & J. C. Impara (Eds.), Multicultural assessment in counseling and clinical psychology (pp. 225–240). Lincoln, NE: Buros Institute of Mental Measurements. Choney, S. K., & Rowe, W. (1994). Assessing White racial identity: The White Racial Consciousness Development Scale (WRCDS). Journal of Counseling and Development, 73, 102–104. Claney, D., & Parker, W. M. (1989). Assessing White racial consciousness and perceived comfort with Black individuals: A preliminary study. Journal of Counseling and Development, 67, 449–451. Cokley, K. O. (2002). Testing Cross’s revised racial identity model: An examination of the relationship between racial identity and internalized racism. Journal of Counseling Psychology, 49, 476–483. Cokley, K. O. (2007). Critical issues in the measurement of ethnic and racial identity: A referendum on the state of the field. Journal of Counseling Psychology, 55, 224–234.

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68 HANDBOOK OF MULTICULTURAL ASSESSMENT Coleman, H.L.K. (1995). Strategies for coping with cultural diversity. Counseling Psychologist, 23, 722–740. Costa, P. T., Jr., & McCrae, R. R. (1992). Revised NEO Personality Inventory (NEO-Pi-R) and NEO Five Factor Inventory (NEO-FFI) professional manual. Odessa, FL: Psychological Assessment Resources. Cross, W. E., Jr. (1971, July). The Negro-to-Black conversion experience. Black World, pp. 13–27. Cross, W. E., Jr. (1991). Shades of Black: Diversity in African-American identity. Philadelphia: Temple University Press. Cross, W. E., Jr. (1995). The psychology of nigrescence: Revising the Cross model. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (pp. 93–122). Thousand Oaks, CA: Sage. Cross, W. E., Jr., & Vandiver, B. J. (2001). Nigrescence theory and measurement: Introducing the Cross Racial Identity Scale (CRIS). In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 371–393). Thousand Oaks, CA: Sage. Dana, R. H. (2005). Multicultural assessment: Principles, applications, and examples. Mahwah, NJ: Erlbaum. Erikson, E. H. (1968). Identity: Youth and crisis. New York: Norton. Fischer, A. R., & Moradi, B. (2001). Racial and ethnic identity: Recent developments and needed directions. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 341–370). Thousand Oaks, CA: Sage. Frazier, P. A., Tix, A. P., & Barron, K. E. (2004). Testing moderator and mediator effects in counseling psychology research. Journal of Counseling Psychology, 51, 115–134. Fuertes, J. N., Miville, M. L., Mohr, J. J., Sedlacek, W. E., & Gretchen, D. (2000). Factor structure and short form of the Miville-Guzman Universality-Diversity Scale. Measurement and Evaluation in Counseling and Development, 33, 157–169. Helms, J. E. (1984). Toward a theoretical explanation of the effects of race on counseling: A Black and White model. Counseling Psychologist, 12, 153–165. Helms, J. E. (Ed.). (1990). Black and White racial identity: Theory, research, and practice. Westport, CT: Greenwood Press. Helms, J. E. (1995). An update on Helms’ White and people of color racial identity models. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (pp. 181–198). Thousand Oaks, CA: Sage. Helms, J. E. (2005). Challenging some misuses of reliability as reflected in the evaluations of the White Racial Identity Attitude Scale (WRIAS). In R. T. Carter (Ed.), Handbook of racial-cultural psychology and counseling: Theory and research (Vol. 1, pp. 360–390). Hoboken, NJ: Wiley. Helms, J. E. (2007). Some better practices for measuring racial and ethnic identity constructs. Journal of Counseling Psychology, 54, 235–246.

CULTURAL IDENTITY, RACIAL IDENTITY, AND THE MULTICULTURAL PERSONALITY Helms, J. E., & Carter, R. T. (1990). Development of the White Racial Identity Inventory. In J. E. Helms (Ed.), Black and White racial identity: Theory, research, and practice (pp. 67–80). Westport, CT: Greenwood. Helms, J. E., & Cook, D. A. (1999). Using race and culture in counseling and psychotherapy. Needham Heights, MA: Allyn & Bacon. Helms, J. E., & Parham, T. A. (1996). The Racial Identity Attitudes Scale. In R. L. Jones (Ed.), Handbook of tests and measurements for Black populations (Vol. 1, pp. 167–174). Hampton, VA: Cobb & Henry. Kealey, D. J., & Protheroe, D. R. (1996). The effectiveness of cross-cultural training for expatriates: An assessment of the literature on the issues. International Journal of Intercultural Relations, 20, 141–165. Lee, S. M., Puig, A., Pasquarella-Daley, L., Denny, G., Rai, A. A., Dallape, A., et al. (2007). Revising the White Racial Consciousness Development Scale. Measurement and Evaluation in Counseling and Development, 39, 194–208. Lone, R. F. (2002). Right-wing authoritarianism and religious fundamentalism as related to universal-diverse orientation. Dissertation International Abstracts, 62 (8-B), 3850. Marcia, J. (1980). Identity in adolescence. In J. Adelson (Ed.), Handbook of adolescent psychology (pp. 159–187). Hoboken, NJ: Wiley. Mendendall, M., & Oddou, G. (1985). The dimensions of expatriate acculturation: A review. Academy of Management Review, 10, 39–47. Miville, M. L., Gelso, C. J., Pannu, R., Liu, W., Touradji, P., Holloway, P., et al. (1999). Appreciating similarities and valuing differences: The Miville-Guzman Universality-Diversity Scale. Journal of Counseling Psychology, 46, 291–307. Miville, M. L., Rohrbacker, J. M., & Kim, A. B. (2004). From prejudice and discrimination to awareness and acceptance. In J. L. Chin (Ed.), The psychology of prejudice and discrimination: Vol. 4, Disability, religion, physique, and other traits (pp. 207–232). Westport, CT: Praeger. Nieto, S. (2000). Affirming diversity: The sociopolitical context of multicultural education (3rd ed.). White Plains, NY: Longman. Parham, T. A., & Helms, J. E. (1981). Influences on Black students’ racial identity attitudes on preferences for counselor race. Journal of Counseling Psychology, 28, 250–256. Phinney, J. S. (1992). The Multigroup Ethnic Identity Measure: A new scale for use with diverse groups. Journal of Adolescent Research, 7, 156–176. Phinney, J. S., & Ong, A. D. (2007). Conceptualization and measurement of ethnic identity: Current status and future directions. Journal of Counseling Psychology, 54, 271–281. Ponterotto, J. G. (in press). Theoretical and empirical advances in multicultural counseling and psychology. In S. D. Brown & R. W. Lent (Eds.), Handbook of counseling psychology (4th ed.). Hoboken, NJ: Wiley.

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70 HANDBOOK OF MULTICULTURAL ASSESSMENT Ponterotto, J. G., & Austin, R. (2005). Emerging approaches to training psychologists to be culturally competent. In R. T. Carter (Ed.), Handbook of racial-cultural psychology and counseling: Training and practice (Vol. 2, pp. 19–35). Hoboken, NJ: Wiley. Ponterotto, J. G., Costa, C. I., Brobst, K., Kowalewska, D., Mendelsohn-Kacanski, J., Scheinholtz, J., et al. (2007). Multicultural personality dispositions and psychological well-being. Journal of Social Psychology, 147, 119–136. Ponterotto, J. G., Costa, C. I., & Werner-Lin, A. (2002). Research perspectives in cross cultural counseling. In P. B. Pedersen, J. G. Draguns, W. J. Lonner, & J. E. Trimble (Eds.), Counseling across cultures (5th ed., pp. 395–420). Thousand Oaks, CA: Sage. Ponterotto, J. G., Fuertes, J. N., & Chen, E. C. (2000). Models of multicultural counseling. In S. D. Brown & R. W. Lent (Eds.), Handbook of counseling psychology (3rd ed., pp. 639–669). Hoboken, NJ: Wiley. Ponterotto, J. G., Gretchen, D., Utsey, S. O., Stracuzzi, T., & Saya, R., Jr. (2003). The Multigroup Ethnic Identity Measure (MEIM): Psychometric review and further validity testing. Educational and Psychological Measurement, 63, 502–515. Ponterotto, J. G., Jackson, M. A., & Nutini, C. D. (2001). Reflections on the life stories of pioneers in multicultural counseling. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 138–161). Thousand Oaks, CA: Sage. Ponterotto, J. G., Mendelsohn, J., & Belizaire, L. (2003). Assessing teacher multicultural competence: Self-report scales, observer-report evaluations, and a portfolio assessment. In D. B. Pope-Davis, H.L.K. Coleman, W. M. Liu, & R. Toporek (Eds.), Handbook of multicultural competencies (pp. 191–210). Thousand Oaks, CA: Sage. Ponterotto, J. G., Utsey, S. O., & Pedersen, P. B. (2006). Preventing prejudice: A guide for counselors, educators, and parents (2nd ed.). Thousand Oaks, CA: Sage. Pope-Davis, D. B., Vandiver, B. J., & Stone, G. L. (1999). White racial identity attitude development: A psychometric examination of two instruments. Journal of Counseling Psychology, 46, 70–79. Ramirez, M. III. (1987). The impact of culture change and economic stressors on the physical and mental health of Mexican Americans. In R. Rodriquez & M. T. Coleman (Eds.), Mental health issues of Mexican-origin population in Texas. Austin, TX: Hogg Foundation for Mental Health. Ramirez, M. III. (1991). Psychotherapy and counseling with minorities: A cognitive approach to individual and cultural differences. New York: Pergamon. Ramirez, M. III. (1998). Multicultural/multiracial psychology: Mestizo perspectives in personality and mental health. Northvale, NJ: Jason Aronson. Ramirez, M. III. (1999). Multicultural psychotherapy: An approach to individual and cultural differences (2nd ed.). New York: Pergamon. Ridley, C. R. (2005). Overcoming unintentional racism in counseling and therapy: A practitioner’s guide to intentional intervention (2nd ed.). Thousand Oaks, CA: Sage.

CULTURAL IDENTITY, RACIAL IDENTITY, AND THE MULTICULTURAL PERSONALITY Roberts, R. E., Phinney, J. S., Masse, L. C., Chen, Y. R., Roberts, C. R., & Romero, A. (1999). The structure of ethnic identity of young adolescents from diverse ethnocultural groups. Journal of Early Adolescence, 19, 301–322. Rowe, W., Behrens, J. T., & Leach, M. M. (1995). Racial/ethnic identity and racial consciousness: Looking back and looking forward. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (pp. 218–235). Thousand Oaks, CA: Sage. Ryff, C. D. (1989a). Beyond Ponce de Leon and life satisfaction: New direction in quest of successful aging. International Journal of Behavioral Development, 12, 35–55. Ryff, C. D. (1989b). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57, 1069–1081. Sellers, R. M., Rowley, S.A.J., Chavous, T. M., Shelton, J. N., & Smith, M. A. (1997). Multidimensional Inventory of Black Identity: A preliminary investigation of reliability and construct validity. Journal of Personality and Social Psychology, 73, 805–815. Sellers, R. M., Smith, M. A., Shelton, J. N., Rowley, S.A.J., & Chavous, T. M. (1998). Multidimensional model of racial identity: A reconceptualization of African American identity. Personality and Social Psychology Review, 2, 18–39. Sue, D. W. (2003). Overcoming our racism: The journey to liberation. San Francisco: Jossey-Bass. Tajfel, H. (1981). Human groups and social categories. Cambridge, MA: Cambridge University Press. Thomas, C. W. (1971). Boys no more. Westgerville, OH: Glencoe Press. Trimble, J. E. (2005). An inquiry into the measurement of ethnic and racial identity. In R. T. Carter (Ed.), Handbook of racial-cultural psychology and counseling: Theory and research (Vol. 1, pp. 320–359). Hoboken, NJ: Wiley. Umana-Taylor, A. J., Yazedjian, A., & Bamaca-Gomez, M. (2004). Developing the Ethnic Identity Scale using Eriksonian and social identity perspectives. Identity: An International Journal, 4, 9–38. U.S. Census Bureau. (2004). Projected population of the United States, by race and Hispanic origin: 2000 to 2050. Retrieved February 24, 2007, from http:www.census.gov/ ipc/www/usinterimproj/natprojtab01a.pdf. Van der Zee, K. I., Atsma, N., & Brodbeck, F. (2004). The influence of social identity and personality on outcomes of cultural diversity in teams. Journal of Cross-Cultural Psychology, 35, 283–303. Van Der Zee, K. I., & Van Oudenhoven, J. P. (2000). The Multicultural Personality Questionnaire: A multidimensional instrument of multicultural effectiveness. European Journal of Personality, 14, 291–309. Van Der Zee, K. I., & Van Oudenhoven, J. P. (2001). The Multicultural Personality Questionnaire: Reliability and validity of self- and other ratings of multicultural effectiveness. Journal of Research in Personality, 35, 278–288.

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72 HANDBOOK OF MULTICULTURAL ASSESSMENT Van Der Zee, K. I., Zaal, J. N., & Piekstra, J. (2003). Validation of the Multicultural Personality Questionnaire in the context of personnel selection. European Journal of Personality, 17, 77–100. Van Oudenhoven, J. P., Mol, S., & Van Der Zee, K. I. (2003). Short note: Study of the adjustment of Western expatriates in Taiwan ROC with the Multicultural Personality Questionnaire. Asian Journal of Social Psychology, 6, 159–170. Vandiver, B. J., Cross, W. E., Jr., Worrell, F. C., & Fhagen-Smith, P. (2002). Validating the Cross Racial Identity Scale. Journal of Counseling Psychology, 49, 71–85. Vontress, C. E. (1988). An existential approach to cross-cultural counseling. Journal of Multicultural Counseling and Development, 16, 78–83. Vontress, C. E. (1996). A personal retrospective on cross-cultural counseling. Journal of Multicultural Counseling and Development, 24, 156–166.

CHAPTER FIVE

Acculturation and Multicultural Assessment Issues, Trends, and Practice Lourdes M. Rivera

B

y 2050 half of the U.S. population is expected to consist of racially and ethnically diverse individuals (U.S. Census, 2004). In such a diverse and rapidly changing society, the need for multicultural assessment in clinical and educational settings that takes into consideration the varied realities and experiences of diverse individuals is critical. Acculturation is one key construct that is important in multicultural assessment. Understanding an individual’s acculturation status, experiences, and strategy can provide valuable information in interpreting assessment results, understanding presenting issues, identifying appropriate intervention strategies, and working effectively with multicultural individuals in clinical and educational settings. Acculturation has been found to be related to mental health issues (Gamst et al., 2002; Organista, Organista, and Kurasaki, 2003; Rogler, Cortes, and Malgady, 1991; Zea, Asner-Self, Birman, and Buki, 2003), academic issues (Ibanez, Kuperminc, Jurkovic, and Perilla, 2004; Valencia and Johnson, 2006), changes in cultural values and beliefs (Marin, 1992; Marin and Gamba, 2003), and family relationships and functioning (Chun and Akutsu, 2003). Although the exact nature of the influence of acculturation on outcome variables of interest has not been determined (for example, some studies indicate that acculturation has a positive influence, whereas others suggest that it has a negative influence), acculturation continues to emerge as a significant factor. Thus, clinicians attempting to gain a better understanding of culturally diverse populations and provide effective services cannot ignore the impact of acculturation on the lives

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74 HANDBOOK OF MULTICULTURAL ASSESSMENT and functioning of their clients. In addition, the assessment of acculturation can be useful in determining the validity of standardized test results obtained for diverse populations (Cuellar, 2000; Dana, 1996, 2000). As our society becomes increasingly diverse, it is more than critical that acculturation be an integral component of multicultural assessment; it is an ethical imperative (American Psychological Association, 2003; Cuellar, 2000; Dana, 1996). Although the importance of acculturation in multicultural assessment has been established, the issue of its conceptualization and measurement continues to present some difficulties (Cabassa, 2003; Kim and Abreu, 2001; Ryder, Alden, and Paulhus, 2000; Zane and Mak, 2003). Since the first definition of acculturation was proposed by Redfield, Linton, and Herskovits (1936) in the field of anthropology, numerous other definitions and conceptualizations have been proposed in the social, psychological, and behavioral sciences literature. The conceptualization of acculturation has gone from a unidimensional and linear construct (Gordon, 1964) to the more widely accepted conceptualization as a bidimensional, multifaceted construct (Berry, 1980, 2003; LaFromboise, Coleman, and Gerton, 1993; Marin and Gamba, 1996). This perspective seeks to recognize the great complexity of this phenomenon and the extreme differences that can be manifested by individuals within ostensibly the same ethnic group or even the same family system (Chun and Akutsu, 2003). Numerous instruments have been developed to assess acculturation over the past three decades. However, the use of different indicators and methods of operationalizing this construct continues to pose a number of challenges. A review of the conceptual and empirical literature highlights the work that remains to be done (Cabassa, 2003; Kim and Abreu, 2001; Kohastu, 2005; Persky and Birman, 2005; Roysircar-Sodowsky and Maestas, 2000; Ryder et al., 2000). Yet despite these issues, acculturation remains an essential component of any multicultural assessment process. This chapter provides an overview of the current status of and issues related to conceptualizing and assessing acculturation. To this end, it is divided into three main sections. The first section provides a brief overview of the evolution of the construct of acculturation from its unidimensional conceptualization to its more currently accepted bidimensional conceptualization. The second section addresses the need for greater clarity in what is meant by acculturation in the conceptual and empirical literature. A key focus of this discussion is the relationship of acculturation to the constructs of ethnic identity and racial identity. The considerable overlap between these constructs and the tendency for them to be used interchangeably has received much attention, and the need for greater distinction and clarity between these constructs has been repeatedly called for in the literature (Delgado-Romero, Galvan, Maschino, and

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Rowland, 2005; Fischer and Moradi, 2001; Helms, 1994; Liebkind, 2006; Phinney, 2003; Roysircar-Sodowsky and Maestas, 2000). The third section summarizes issues related to the measurement of acculturation and its use in research and practice. It is beyond the scope of this chapter to provide a thorough review of the available measures and their respective psychometric properties (for a more detailed discussion of these issues, see Kim and Abreu, 2001; Zane and Mak, 2003). This section also discusses the need for incorporating a qualitative component in the assessment process as a way of acquiring a better understanding of this complex phenomenon. Finally, a summary and conclusion of the related issues in the assessment of acculturation in research and practice is provided. In previous editions of this Handbook, the importance of assessing acculturation was addressed throughout various chapters. It is a testament to the importance of acculturation in understanding the lives of diverse populations in a multicultural society and to the attention that it is receiving in the field that the editors have devoted a chapter to this topic.

UNDERSTANDING ACCULTURATION For a considerable time, acculturation has been one of the key variables explored, examined, and assessed in attempting to understand and explain differences among racial and ethnic groups, as well as a means of seeking to understand individual differences (Betancourt and Lopez, 1993; Gamst et al., 2002; Phinney and Flores, 2002; Sam and Berry, 2006). It has received much attention in the clinical, psychological, and educational arenas, but there is no consensus on how acculturation is conceptualized or operationalized. This section addresses the issues in defining acculturation, the dimensionality of acculturation, and other factors that have been identified as critical in attempting to understand the process of acculturation and its significant impact in the lives of culturally diverse individuals. Although the research and conceptual literature has predominantly focused on the acculturative process of ethnic minorities and immigrants, acculturative change can be considered as occurring for members of the dominant or mainstream culture as well. A recent call in the field has been the need to understand and examine aspects of both the culture of origin and the host culture (Berry, 2003) in order to gain a comprehensive understanding of this process. For the purpose of this chapter, however, the discussion focuses on the change process undergone by racial/ethnic minorities and immigrants as they adapt to and function in the mainstream U.S. culture.

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Defining Acculturation The earliest definition of acculturation as ‘‘phenomenona, which result when groups of individuals having different cultures come into continuous first-hand contact, with subsequent changes in the original cultural patterns of either or both groups’’ was provided by Redfield et al. (1936, p. 149) in the field of anthropology. Since then, the definition of acculturation has continued to evolve and expand as a better and more complex understanding of it and its impact on the well-being and functioning of various groups and individuals has been gained. More recent definitions have sought to incorporate the various ways in which acculturation influences individuals at the behavioral, cognitive, and affective levels (Marin, 1992; Cuellar, Arnold, and Maldonado, 1995). Recently greater attention has focused on changes in values, as change at this level is considered to influence behavior in a more profound manner (Marin and Gamba, 2003). Marin (1992) referred to acculturation as a process whereby change occurs in an individual’s attitudes, behaviors, and values due to contact with the new culture. He states that this change process is dependent on the individual’s degree of identification with the original culture, the significance given to contact with members of other cultures, and the population density (host versus dominant cultural group members). Cuellar et al. (1995), in a similar vein, defined acculturation as a phenomenon that influences individuals at the behavioral (such as language and food preferences), affective (such as feelings related to connection with one’s culture), and cognitive (such as beliefs about gender roles) levels. These definitions imply that the environment in which individuals find themselves and their individual characteristics and preferences are important to the acculturative process. Thus, acculturation generally is viewed as a dynamic process of change and adaptation that individuals undergo as a result of contact with members of different cultures. This change is influenced by the environment the individual resides in, as well as qualities innate to that individual. These changes influence the attitudes, beliefs, values, affect, and behaviors of those undergoing the acculturation process. In turn, this change has implications for how individuals function in their new society.

Dimensionality of Acculturation Early models of acculturation conceptualized it as a unidimensional process ultimately leading to assimilation to the mainstream culture (Gordon, 1964). Within this framework, acculturation was seen as occurring along a continuum, with the culture of origin at one end and the new or host culture at the other. Individuals undergoing acculturation were seen as relinquishing values, beliefs, and behaviors of their own culture as they adapted to or acquired those of

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the new culture. This perspective basically viewed individuals as losing one culture as they gained another, with the ultimate result being assimilation into the new host culture. Much of the research in the area of acculturation has been conducted from the unidimensional perspective. This can be seen in the development of the original Acculturation Rating Scale for Mexican Americans (Cuellar, Harris, and Jasso, 1980) and the Suinn-Lew Asian Self Identity Acculturation Scale (SL-ASIA; Suinn, Rickard-Figueroa, Lew, and Vigil, 1987). These instruments assess different aspects of acculturation, with the process of change considered as occurring along a continuum between acculturation to the host culture and the culture of origin. Although the ASIA allowed for individuals who obtained scores in the middle to be considered bicultural, it was still conceptualized as a unidimensional process. This approach, although providing an expanded view of the process of acculturation by examining different aspects of acculturation such as language and behaviors, continued to present acculturation as occurring along a continuum in which more of one culture (the host culture) results in having less of the culture of origin. This unidimensional conceptualization of acculturation has received much criticism and has basically given way to the more widely accepted view of acculturation as a process that occurs along two dimensions: the culture of origin and the host culture (Berry and Sam, 1997; LaFromboise et al., 1993; Marin and Gamba, 1996). Berry (1980, 2003) proposed that a distinction be made between the preference individuals have for maintaining their culture of origin and preference for participating in the dominant culture. Within this conceptualization, an individual is seen as able to retain the culture of origin, while also adapting to the new or host culture. Because the two dimensions are free to vary independent of each other, an individual can be high on adherence to both cultures, neither culture, or a combination of both. In addition, there are different domains (for example, values, language) along which change can occur, and change along these domains is also free to vary (Berry, 2003; Ryder et al., 2000; Zea et al., 2003). Based on this bidimensional conceptualization of acculturation, Berry (1980, 2003) proposed that individuals face the prospect of adopting one of four acculturative strategies: • Assimilation, in which the individual embraces the host culture and rejects the culture of origin • Separation, in which the individual avoids interaction with the majority culture and holds on to the culture of origin • Marginalization, in which there is little, if any, interest in maintaining the culture of origin or of interaction with or adopting the host culture

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78 HANDBOOK OF MULTICULTURAL ASSESSMENT • Integration, in which the individual embraces the host culture while simultaneously holding onto the culture of origin This bidimensional conceptualization has received empirical support (Ryder et al., 2000; Phinney and Flores, 2002; Zea et al. 2003). Based on data from three different studies with Asian samples, acculturation, within the context of personality, self-identity, and adjustment, was compared using a unidimensional and bidimensional model. Ryder et al. (2000) concluded that a bidimensional model of acculturation is more valid and useful in capturing the complexity of the acculturation process. Results of the three studies indicate that adherence to the mainstream culture is independent of adherence to the culture of origin. In addition, results indicated that difference can exist along different variables (for example, personality characteristics or adjustment). Similar findings were reported by Zea et al. (2003) with a sample of Latino college students. Using a bidimensional measure of acculturation consisting of three subscales (cultural identity, language, and cultural competence), the researchers found support for the bidimensional nature of acculturation as it relates to the domains of language (English/Spanish), and cultural competence (knowledge of both cultures). Support for the bidimensional model in the domain of identity (U.S.-American versus culture of origin), however, was not obtained. In explaining these results, the authors suggest that it may not be possible to strongly hold two separate identities, and thus it may be more helpful to consider the blending of identities. They recommend that future studies incorporate items that tap into the possible blending of identities. It is worth noting that researchers have proposed that even a bidimensional framework may be too limited for understanding the complex process of acculturation. The relation between ethnic identity and acculturation needs to be better understood and the distinctions between them clarified. A sense of identity is often included in measures of acculturation as one of the domains influenced by the acculturation process (Chung, Kim, and Abreu, 2004; Kim and Abreu, 2001; Phinney, 2003; Zane and Mak, 2003; Zea et al., 2003). Persky and Birman (2005) examined identity as an aspect of acculturation among a sample of Russian-speaking Jewish refugees from the former Soviet Union living in the United States. Their goals were to identify the salience and relationship among three identities: American, Jewish, and Russian. In addition, they sought to examine the influence of each identity on indicators of psychological adjustment. Using items adapted from the Language, Identity, and Behavior acculturation scale (Birman and Tricket, as cited in Persky and Birman, 2005), researchers assessed participants’ identity in relation to the American and Russian cultures, as well as Jewish identity. Three measures of psychological adjustment were used: alienation, life satisfaction, and symptom distress. The researchers report

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a complex relationship among the measures of identity and the psychological adjustment indicators. For example, although Jewish identity was the most salient, it did not have a central role in aspects of psychological adjustment, although this finding was expected. Their findings suggest that individuals may in fact acculturate and identify with more than two cultures and that a complex relation among these may influence psychological adjustment. In regard to the relevance of the bidimensional model of acculturation and ethnic identity models, they go on to suggest that ‘‘the nature of ethnic identity and acculturation experiences of Soviet Jews calls into question the relevance of either model to their experience and suggests that an expanded framework is needed to include a broader range of intercultural experiences’’ (Persky and Birman, 2005, p. 368). Given the realities of a multicultural society in which individuals come into contact with more than one culture distinct from their own, a society in which more people have identified themselves as biracial, and in which cultures are combined through multicultural marriages and adoptions, it would seem beneficial for researchers and practitioners to begin to examine acculturation along more than two dimensions. Recently Chung et al. (2004), introduced a measure of acculturation for Asian Americans that contained three cultural dimensions: culture of origin, Asian American, and European American. Based on preliminary analysis, the authors report strong reliability and validity data.

Contextual Considerations Another significant aspect to be considered is how racial/ethnic minorities and immigrants experience the acculturative process is context. Berry (1997) identified three distinct contextual factors that influence how acculturation is experienced by individuals: voluntariness (for example, Was it their choice?), mobility (for example, Did they enter a new environment, or were they colonized?), and permanence (for example, Is it a temporary or permanent situation?). Basically it is proposed that depending on the circumstances that lead to the individual’s engagement with the new culture, different acculturative experiences and outcomes can be expected. An individual who chooses to engage with a new culture will adapt, function, and experience the process differently from someone who has been forced to immigrate and engage with the new culture. Contextual factors are considered to contribute to within-group differences and thus form a critical part of any assessment process. Cabassa (2003), building on previous literature, provided a list of additional contextual factors to consider in attempting to understand the acculturation experiences of individuals. Among the contextual factors identified are social support networks and financial circumstances. Other writers have proposed that in order to understand the acculturative process of ethnic and

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80 HANDBOOK OF MULTICULTURAL ASSESSMENT racial minorities, attention needs to be paid to the experiences of racism and discrimination to which these populations have been exposed (Kohatsu, 2005). These experiences have an impact not only on individuals’ preference to adapt to the host culture; they may impede immigrants’ ability to acculturate even if they wanted to. The construct of acculturation has thus evolved from being conceptualized as a unidimensional, linear phenomenon in which more of one culture meant less of another, to the more widely accepted current conceptualization of its being a bidimensional and, in some cases, multidimensional construct. Greater attention has been given to the various domains (attitudes, beliefs, values) that are affected by acculturation, as well as the different contexts within which acculturation takes place. These expanded conceptualizations of acculturation have yielded a better understanding of this phenomenon while at the same time posing challenges for its measurement and distinction from other related constructs. The next two sections address acculturation in relation to constructs considered to be related and the challenges of measuring and assessing acculturation in research and practice.

RELATED IDENTITY CONSTRUCTS Two constructs that have received much attention in relation to acculturation and that are discussed here are ethnic identity (Liebkind, 2006; Phinney, 2003, Roysircar-Sodowsky and Maestas, 2000) and racial identity (Helms, 1990, 1994). Although other aspects of identity are important to consider in multicultural assessment, such as spirituality and gender, ethnic and racial identity are addressed here given the overlap between them and the tendency for them to be used interchangeably (Gelso et al., 1988; Helms and Talleyrand, 1997; Phinney, 1996). This discussion provides some conceptual clarity and distinction between these two constructs and their relation to acculturation.

Ethnic Identity Ethnic identity has been defined as ‘‘a dynamic, multidimensional construct that refers to one’s identity or sense of self as a member of an ethnic group’’ (Phinney, 2003, p. 63). Phinney goes on to state that ‘‘ethnic identity is constructed and modified as individuals become aware of differences among ethnic groups and attempt to understand the meaning of their ethnicity within the larger setting’’ (p. 63). Ethnic identity is considered to be an aspect of acculturation (Phinney, 1990), particularly as it relates to changes that occur over time in a new culture and generational status. Phinney (2003) proposes that ethnic identity, though related to acculturation, can be distinguished from acculturation by the focus that is placed on an individual’s feelings related to

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ethnic group membership and self-labeling as a member of a particular ethnic group. Thus, one’s ethnic identity is considered to be separate from one’s level of adaptation or acculturation to the dominant culture (Phinney, 2003). Roysircar-Sodowsky and Maestas (2000) have described the relationship between ethnic identity and acculturation as a push and pull between adapting to the host culture and remaining connected to the culture of origin. The tension between these competing feelings is considered to result in acculturative stress that may or may not have an adverse effect on one’s functioning. They propose that ethnic identity and acculturation are two separate and relatively independent constructs. They further propose that the construct of acculturation is more accurately used for immigrants who are in the process of adjusting and adapting to the new or host culture, while ethnic identity is more appropriately used for understanding the children of immigrants as they grapple with the challenge of deciding what aspects of their culture of origin they wish to hold on to. However, they do acknowledge that both experience the process of acculturation, although in different ways. Thus, one’s ethnic identity can be considered independent of one’s acculturation to the mainstream culture because even though one may have adapted the behavior or skills (LaFromboise et al., 1993) of the dominant group, one can still consider oneself a member of a specific ethnic group. Acculturation studies that have included a measure of ethnic identity (Zea et al., 2003) have supported the ability of individuals to be acculturated to both the culture of origin and the host culture in certain domains, such as language use, while not providing support for the ability to hold two separate ethnic identities. Thus, there seems to be some empirical support for the distinction between ethnic identity and acculturation. Research that has examined identity in relation to acculturation (Persky and Birman, 2005) suggests a complex relationship between acculturation and identity and that this relationship has implications for understanding outcomes such as adaptation. As more measures of acculturation are developed that include an identity subscale, it is expected that the complex relationship between these two constructs, as well as their combined impact on the behaviors and functioning of diverse individuals, will be clarified.

Racial Identity Ethnic identity and racial identity are often used interchangeably in the literature. However, scholars have repeatedly called for greater clarity and distinction between these constructs given the powerful impact of racism and discrimination on members of visibly racial/ethnic groups (Helms, 1994; Helms and Talleyrand, 1997). According to Helms (1990, 1994) racial identity refers to the extent to which individuals identify or do not identify with a particular racial group and the quality of that identification, that is, positive or negative.

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82 HANDBOOK OF MULTICULTURAL ASSESSMENT This identification is influenced by experiences of racism and discrimination encountered in society by members of visibly racial/ethnic groups due to the phenotypic (that is, physical) characteristics of their assumed racial group classification. These experiences are considered to influence how members of these groups experience and interact with the dominant group and larger society, as well as their acculturative experience (Kohatsu, 2005). Ethnicity, or one’s ethnic identity, is not so clearly or visibly identified. For example, Latinos can be labeled Black, Asian, or White. Thus, to a certain extent, their experiences in the larger society may be influenced more by how they are treated due to the physical characteristics attributed to a racial classification, and not necessarily due to an ethnic classification. However, it is possible that identification as a Latino/a may be more significant to the individual than identification as Black, Asian, or White. Kohatsu (2005) proposed that racial identity, ethnic identity, and acculturation occur simultaneously and interactively, which requires conceptually separating and clearly defining each construct. Thus, it seems that it would be beneficial to assess how one’s sense of both racial and ethnic identity is influencing the acculturation process. Acculturation can be distinguished from ethnic identity to the extent that ethnic identity is conceptualized primarily as an individual’s identification (affectively and cognitively) with an ethnic group, while acculturation is considered the adaptation of behaviors and attitudes that enable a culturally diverse individual to function within a culture different from his or her culture of origin. The distinction between racial identity and ethnic identity is much more complicated as one’s ethnic identity and racial identity may be very much interconnected. However, a significant distinction can be made based on the phenotypic characteristics of individuals from culturally diverse backgrounds and how experiences of racism and discrimination due to these physical characteristics influence the acculturation process. For this reason, it has been proposed that racial identity may be a more salient factor than ethnic identity. Whether using an ethnic identity or racial identity perspective, the significant issue is that experiences of racism and discrimination have a powerful impact on how individuals are treated and in how they experience their environments, and thus these need to be considered in the multicultural assessment process.

ASSESSING ACCULTURATION: RESEARCH AND PRACTICE The measurement of acculturation continues to receive much attention as researchers work to refine and improve the tools used to measure this construct. In the past few decades, numerous measures of acculturation have been developed (Cuellar, 2000; Kim and Abreu, 2001; Zane and Mak, 2003). The majority of these measures were developed for use with Hispanic/Latino

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populations (Cuellar et al., 1995; Marin and Gamba, 1996; Szapocznik, Kurtines, and Fernandez, 1980). However, measures for use with Asian Americans (Suinn et al., 1987; Yao, 1979), African Americans (Landrine and Klonoff, 1994; Snowden and Hines, 1999), and Native Americans (Boyce and Boyce, 1983) have also been developed. Despite the progress that has been made, many limitations and challenges remain in the measurement of acculturation and in understanding its relation to various aspects of human behavior and functioning.

Research The relation between the constructs of acculturation and ethnic/racial identity is an area that requires further attention (Phinney, 2003; Roysircar-Sodowsky and Maestas, 2000). The relation between identity and acculturation and the respective influence of aspects of each on outcomes such as psychological adaptation (Persky and Birman, 2005) and other variables of interest such as sex role attitudes (Phinney and Flores, 2002) are complex, and efforts to obtain greater clarity are needed. It is expected that as researchers continue to examine these constructs in relation to each other by using measures that include a subscale for identity, along with other domains of acculturation, greater clarity will be obtained. Perhaps the greatest challenge to obtaining clarity in the measurement of acculturation is the lack of consistency in the indicators of acculturation used across different instruments and even within the same instrument (Kim and Abreu, 2001; Chun and Akutsu, 2003; Zane and Mak, 2003). Most measures focus on behavioral aspects of acculturation, while others may focus on affective or cognitive aspects of acculturation. In many cases, these different domains are included within the same instrument. For example, Zane and Mak (2003), in a review of twenty-one acculturation measures, found that there tends to be little overlap in what these measures assess. They conducted a content analysis that resulted in ten areas that were being tapped by the measures reviewed: language use and preference, social affiliation, daily living habits, cultural traditions, communication style, cultural identity and pride, perceived prejudice and discrimination, generational status, family socialization, and cultural values. Given the varied domains being assessed among these measures, Zane and Mak pose the question of whether the same acculturation phenomenon is being measured across and within ethnic groups. In addition, the use of such different indicators across and within measures makes it difficult to draw comparisons across different studies of acculturation. The use of indirect or proxy measures of acculturation is another area of concern (Betancourt and Lopez, 1993; Cabassa, 2003). Proxy indicators of acculturation include language use, generational status, and cultural knowledge. Perhaps the most widely used proxy measure of acculturation is

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84 HANDBOOK OF MULTICULTURAL ASSESSMENT language (Zane and Mak, 2003). Although language use and proficiency can be a significant indicator of acculturation, it is only one dimension, and given that individuals can be proficient in more than one language, the information provided by this indicator is limited. A similar argument can be made for the use of generational status and other indirect indicators; they only provide but a small piece of the puzzle in understanding the complexity of acculturation. The limited inclusion of cultural values as part of the assessment of acculturation (Chun and Akutsu, 2003; Marin and Gamba, 2003; Zane and Mak, 2003) is of particular concern given the significance that adherence to cultural values has for influencing behavior and as an indicator of level of acculturation. For example, Marin (1992) suggested that changes in cultural values may have a more profound effect on culturally diverse groups than changes in behaviors (for example, language preference). Thus, changes in cultural values may be more indicative of the process and status of acculturation and provide a better measure of acculturation. Based on a review of the literature that examined values in relation to acculturation, Marin and Gamba (2003) conclude that there is substantial evidence to support the contention that acculturation influences certain values and beliefs of ethnically diverse individuals. In addition, they report that as individuals become more acculturated, some traditional values may remain strong while others are more susceptible to change. Thus, a true understanding of the degree of acculturation and its impact on people’s lives requires that cultural values be included as part of the assessment process. Another limitation is the practice of collapsing scores among indicators of acculturation, such as language or attitudes, within a measure into a total scale score of acculturation. By averaging out scores from multiple indicators, we may be losing some of the complexity inherent in the acculturative process. For example, someone may obtain a high score on language use and proficiency but a low rating on adherence to cultural values. By averaging out these scores, we are losing valuable information about the acculturation process and how it is influencing individuals. Finally, despite the accepted view of acculturation as a bidimensional construct, most measures of acculturation in use are unidimensional (Cabassa, 2003; Kim and Abreu, 2001; Ryder et al., 2000; Zane and Mak, 2003). For example, of the thirty-three measures that Kim and Abreu (2001) reviewed, twenty-three were unidimensional measures. The continued use of unidimensional measures limits understanding of the complex and dynamic process of acculturation. It also limits the ability to compare results from studies that use unidimensional measures to those that use bidimensional measures. Fortunately, researchers have begun to introduce multidimensional measures of acculturation (Chung et al., 2004) or adapt existing unidimensional measures in order to assess acculturation along two cultural dimensions (Cuellar et al., 1995).

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Numerous recommendations to address the limitations in the measurement of acculturation have been proposed. For example, Cabassa (2003) recommended that researchers refrain from using proxy measures of acculturation, make a greater effort to conceptualize the indicators of acculturation, include contextual factors as part of the process of acculturation, and incorporate theory into research designs. Others have called for the inclusion of cultural values (Marin and Gamba, 2003; Zane and Mak, 2003) in the assessment of acculturation, given its powerful influence on behaviors and the resistance some values may have to change. Recognizing the complexity of the acculturation process and the varied factors that contribute to it, Zane and Mak (2003), propose that acculturation be assessed within a ‘‘specific element approach.’’ This approach entails identifying a specific psychological variable and examining how it relates to other variables of interest. They describe several studies with Asian Americans that included as a specific element the concept of loss of face and examined it in relation to individuals’ responses to psychotherapy. Loss of face has been identified as a significant aspect of interpersonal relations among East Asian cultures and is considered to influence behaviors. By focusing on one element that may be influenced by acculturation and examining its relation to other variables of interest, the authors propose that a better understanding of the process of acculturation and its relation to other variables, such as response to treatment or help seeking, can be achieved. Results from the studies they reviewed suggest that loss of face may be related to issues such as self-disclosure and preference for different approaches in therapy (for example, directive treatment). This type of information would be extremely useful in determining appropriate treatment approaches. Clearly there are many ways in which the assessment of acculturation can be conducted to provide greater understanding of this process and the relation of different aspects of acculturation to the understanding and treatment of culturally diverse groups.

Practice The complexity of measuring acculturation can be daunting, as is the difficulty in identifying the relation of various aspects of acculturation to human behavior, functioning, and coping. Given this complexity, one cannot assume that the same score on the same measure for two separate individuals holds the same meaning. Despite these difficulties, the need to incorporate some measure of acculturation when working with culturally diverse populations is essential (Cuellar, 2000; Dana, 1996). Thus, a measure of acculturation needs to be incorporated in the process of multicultural assessment. There are numerous measures of acculturation available, and selecting an appropriate one can be a difficult task. When selecting acculturation measures,

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86 HANDBOOK OF MULTICULTURAL ASSESSMENT practitioners are advised to do so within the context of the setting they are working in and the purpose of the evaluation and possible outcomes of the assessment. For example, within a clinical setting, consideration of cultural values may be of greater significance in determining treatment approaches. In an educational setting, English-language proficiency may be of greater concern. This is not to say that all aspects of acculturation should not be considered; however, different aspects of acculturation may be more relevant than others, depending on the type of assessment being conducted and its purpose. In addition to using acculturation measures as part of multicultural assessment, incorporating qualitative assessments can offer a broader and more comprehensive understanding of acculturation status and the influence of acculturation in the lives of culturally diverse individuals. This broader understanding can assist practitioners in evaluating presenting issues and problems and identifying the most appropriate interventions in any given situation. A number of frameworks for conducting qualitative assessment have been proposed. In the second edition of this Handbook, Ponterotto, Gretchen, and Chauhan (2001) provided an overview of six models that offer guidance in attaining qualitative cultural information when working with diverse clients. Based on their review of the six models, they offer a comprehensive framework practitioners can use in assessing clients along four dimensions: (1) client’s worldview and perception of the problem, (2) client’s family background, (3) cultural explanations of the individual’s presenting illness, (4) and cultural elements of the provider-client relationship. This type of information can assist practitioners in obtaining a better understanding of the acculturation status and process of culturally diverse clients. It also enables practitioners to attend to issues of diversity in their relationship with clients and consider contextual factors that have been and may continue to be important to the lives of culturally diverse individuals. Although this framework is geared to working in a clinical setting, gathering this type of information in an educational setting can also be of value. Practitioners in all settings are encouraged to explore various methods by which the assessment of acculturation can become a routine component of multicultural assessment.

SUMMARY AND CONCLUSION This chapter has provided an overview of the issues in the conceptualization and measurement of acculturation and the issues inherent in truly understanding the impact of this construct in the lives of culturally diverse individuals. Clearly much work remains to be done in order to untangle the phenomenon

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of acculturation from related constructs such as ethnic identity. The need to examine the acculturation process of racial/ethnic minorities within a contextual framework that acknowledges and takes into account the impact of situational, socioeconomic realities, and experiences of discrimination and oppression was also addressed. Finally, this chapter touched on some recommendations for refining the measurement of acculturation and the use of qualitative assessment in understanding acculturation. Understanding an individual’s acculturation status can add valuable information to evaluation procedures and intervention decisions. Different aspects of acculturation can vary in the degree of change and the pace at which change takes place. For example, an individual’s behavioral adaptations may indicate a certain level of acculturation to mainstream culture, and adherence to values may suggest acculturation at a different level. Thus, from a bidimensional, multifaceted framework for understanding acculturation, we cannot assume that an individual who has adapted behaviors associated with the mainstream culture also holds the values of the mainstream culture, and vice versa. These distinctions have implications for understanding and providing services to culturally diverse groups and for multicultural assessment. As repeatedly noted in the literature, researchers need to begin to clarify what it is they are measuring when they assess acculturation and how exactly they are measuring it. What are the indicators that have been used in the assessment, and how do they relate to specific outcomes? Clear conceptual and operational definitions of what is being measured in assessing acculturation are critical in any clinical, educational, or other type of setting, especially when this information informs the diagnosis and treatment of culturally diverse individuals. Whenever possible, practitioners and researchers should use multiple indicators of acculturation (that are not combined into a composite score) in order to foster understanding of this complex process. This is particularly relevant when using standardized psychological tests with members of groups that have not been included in the standardization sample for these tests (Cuellar, 2000). Although practitioners can use indexes of correction for culture (Cuellar, 2000; Dana, 1996), the incorporation of qualitative information and gathering information from other sources such as family and teachers would greatly contribute to a better understanding of the individual and his or her experiences. A number of frameworks have been proposed that can guide clinicians and educators in incorporating this type of information in multicultural assessment (Ponterotto et al., 2001). Qualitative assessment in conjunction with quantitative data can provide a fuller understanding of the nuances of acculturation, its process, and its impact on behaviors and experiences of culturally diverse individuals.

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References American Psychological Association. (2003). Guidelines on multicultural education, training, research, practice and organizational change for psychologists. American Psychologist, 58, 377–402. Berry, J. W. (1980). Acculturation as varieties of adaptation. In A. Padilla (Ed.), Acculturation: Theory, models, and findings (pp. 9–25). Boulder, CO: Westview. Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology: An International Review, 46, 5–33. Berry, J. W. (2003). Conceptual approaches to acculturation. In K. M. Chun, P. B. Organista, & G. Marin (Eds.), Acculturation: Advances in theory, measurement, and applied research (pp. 17–37). Washington DC: American Psychological Association. Berry, J. W., & Sam, D. (1997). Acculturation and adaptation. In J. W. Berry, M. H. Segall, & C. Kagitcibasi (Eds.), Handbook of cross-cultural psychology: Vol. 3, Social behavior and applications (pp. 291–326). Needham Heights, MA: Allyn & Bacon. Betancourt, H., & Lopez, S. R. (1993). The study of culture, ethnicity, and race in American psychology. American Psychologist, 48, 629–637. Boyce, W. T., & Boyce, J. C. (1983). Acculturation and changes in health among Navajo boarding school students. Social Science Medicine, 17, 219–226. Cabassa, L. J. (2003). Measuring acculturation: Where we are and where we need to go. Hispanic Journal of Behavioral Sciences, 25, 127–146. Chun, K. M., & Akutsu, P. D. (2003). Acculturation among ethnic minority families. In K. M. Chun, P. B. Organista, & G. Marin (Eds.), Acculturation: Advances in theory, measurement, and applied research (pp. 17–37). Washington, DC: American Psychological Association. Chung, R.H.G., Kim, B.S.K., & Abreu, J. M. (2004). Asian American multidimensional acculturation scale: Development, factor analysis, reliability, and validity. Cultural Diversity and Ethnic Minority Psychology, 10, 66–80. Cuellar, I. (2000). Acculturation as a moderator of personality and psychological assessment. In R. Dana (Ed.), Handbook of cross-cultural and multicultural personality assessment (pp. 113–129). Mahwah, NJ: Erlbaum. Cuellar, I., Arnold, B., & Maldonado, R. (1995). Acculturation rating scale for Mexican Americans—II: A revision of the original ARSMA scale. Hispanic Journal of Behavioral Sciences, 17, 275–304. Cuellar, I., Harris, L., & Jasso, R. (1980). An acculturation scale for Mexican American normal and clinical populations. Hispanic Journal of Behavioral Sciences, 2, 199–217. Dana, R. H. (1996). Assessment of acculturation in Hispanic populations. Hispanic Journal of Behavioral Sciences, 18, 317–328. Dana, R. H. (2000). An assessment-intervention model for research and practice with multicultural populations. In R. H. Dana (Ed.), Handbook of cross-cultural and multicultural personality assessment (pp. 5–16). Mahwah, NJ: Erlbaum.

ACCULTURATION AND MULTICULTURAL ASSESSMENT Delgado-Romero, E. A., Galvan, N., Maschino, P., & Rowland, M. (2005). Race and ethnicity in empirical counseling and counseling psychology research: A 10 year review. Counseling Psychologist, 33, 419–448. Fischer, A. R., & Moradi, B. (2001). Racial and ethnic identity: Recent developments and needed directions. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 341–370). Thousand Oaks, CA: Sage. Gamst, G., Dana, R. H., Der-Karabetian, A., Aragon, M., Arellano, L. M., & Kramer, T. (2002). Effects of Latino acculturation and ethnic identity in mental health outcomes. Hispanic Journal of Behavioral Sciences, 24, 479–504. Gelso, C. J., Betz, N. E., Friedlander, M. L., Helms, J. E., Hill, C. E., Patton, M. J., et al. (1988). Research in counseling psychology: Prospects and recommendations. Counseling Psychologist, 16, 385–406. Gordon, M. M. (1964). Assimilation in American life: The role of race, religion, and national origin. New York: Oxford University Press. Helms, J. E. (1990). Introduction: Review of racial identity terminology. In J. E. Helms (Ed.), Black and White racial identity: Theory, research, and practice (pp. 3–8). Westport, CT: Greenwood Press Helms, J. E. (1994). Toward a methodology for measuring and assessing racial as distinguished from ethnic identity. In G. R. Sodowsky & J. C. Impara (Eds.), Multicultural assessment in counseling and clinical psychology (pp. 143–192). Lincoln, NE: Buros Institute of Mental Measurement. Helms, J. E., & Talleyrand, R. M. (1997). Race is not ethnicity. American Psychologist, 52, 1246–1247. Ibanez, G. E., Kuperminc, G. P., Jurkovic, G., & Perilla, J. (2004). Cultural attributes and adaptations linked to achievement motivation among Latino adolescents. Journal of Youth and Adolescents, 33, 559–568. Kim, B.S.K., & Abreu, J. M. (2001). Acculturation measurement: Theory, current instruments, and future directions. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 394–424). Thousand Oaks, CA: Sage. Kohatsu, E. L. (2005). Acculturation: Current and future directions. In R. J. Carter (Vol. Ed.), Handbook of racial-cultural psychology and counseling: Vol. 1, Theory and research (pp. 207–231). Hoboken, NJ: Wiley. LaFromboise, T., Coleman, H.L.K., & Gerton, J. (1993). Psychological impact of biculturalism: Evidence and theory. Psychological Bulletin, 114, 395–412. Landrine, H., & Klonoff, E. A. (1994). The African American acculturation scale: Development, reliability, and validity. Journal of Black Psychology, 20, 104–127. Liebkind, K. (2006). Ethnic identity and acculturation. In D. L. Sam & J. W. Berry (Eds.), The Cambridge handbook of acculturation psychology (pp. 78–96). Cambridge: Cambridge University Press.

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90 HANDBOOK OF MULTICULTURAL ASSESSMENT Marin, G. (1992). Issues in the measurement of acculturation among Hispanics. In K. F. Geisinger (Ed.), Psychological testing of Hispanics (pp. 235–251). Washington, DC: American Psychological Association. Marin, G., & Gamba, R. J. (1996). A new measurement of acculturation for Hispanics: The bidimensional acculturation scale for Hispanics (BAS). Hispanic Journal of Behavioral Sciences, 18, 297–316. Marin, G., & Gamba, R. J. (2003). Acculturation and changes in cultural values. In K. M. Chun, P. B. Organista, & G. Marin (Eds.), Acculturation: Advances in theory, measurement, and applied research (pp. 83–93). Washington DC: American Psychological Association. Organista, P. B., Organista, K., & Kuraski, K. (2003). The relationship between acculturation and ethnic minority health. In K. M. Chung, P. B. Organista, & G. Marin (Eds.), Acculturation: Advances in theory, measurement, and applied research (pp. 139–161). Washington DC: American Psychological Association. Persky, I., & Birman, D. (2005). Ethnic identity in acculturation research: A study of multiple identities of Jewish refugees from the former Soviet Union. Journal of Cross-Cultural Psychology, 36, 557–572. Phinney, J. S. (1990). Ethnic identity in adolescents and adults: Review of research. Psychological Bulletin, 108, 499–514. Phinney, J. S. (1996). When we talk about American ethnic groups, what do we mean? American Psychologist, 51, 918–927. Phinney, J. S. (2003). Ethnic identity and acculturation. In K. M. Chun, P. B. Organista, & G. Marin (Eds.), Acculturation: Advances in theory, measurement, and applied research (pp. 63–81). Washington, DC: American Psychological Association. Phinney, J. S., & Flores, J. (2002). ‘‘Unpacking’’ acculturation: Aspects of acculturation as predictors of traditional sex role attitudes. Journal of Cross-Cultural Psychology, 33, 320–331. Ponterotto, J. G., Gretchen, D., & Chauhan, R. V. (2001). Cultural identity and multicultural assessment: Quantitative and qualitative tools for the clinician. In L. A. Suzuki, J. G. Ponterotto, & P. J. Meller (Eds.), Handbook of multicultural assessment: Clinical, psychological, and educational applications (2nd ed., pp. 67–99). San Francisco: Jossey-Bass. Redfield, R., Linton, R., & Herskovits, M. (1936). Memorandum on the study of acculturation. American Anthropologist, 38, 149–152. Rogler, L. H., Cortes, D. E., & Malgady, R. G. (1991). Acculturation and mental health status among Hispanics. American Psychologist, 46, 585–597. Roysircar-Sodowsky, G., & Maestas, M. V. (2000). Acculturation, ethnic identity, and acculturative stress: Evidence and measurement. In R. H. Dana (Ed.), Handbook of cross-cultural and multicultural personality assessment (pp. 131–172). Mahwah, NJ: Erlbaum. Ryder, A. G., Alden, L. E., & Paulhus, D. L. (2000). Is acculturation unidimensional or bidimensional? A head-to-head comparison in the prediction of personality,

ACCULTURATION AND MULTICULTURAL ASSESSMENT self-identity, and adjustment. Journal of Personality and Social Psychology, 79, 49–65. Sam, D. L., & Berry, J. W. (Eds.). (2006). The Cambridge handbook of acculturation psychology. Cambridge: Cambridge University Press. Snowden, L. R., & Hines, A. M. (1999). A scale to assess African American acculturation. Journal of Black Psychology, 25, 36–47. Suinn, R. M., Rickard-Figueroa, K., Lew, S., & Vigil, P. (1987). The Suinn-Lew Asian self-identification scale: An initial report. Educational and Psychological Measurement, 47, 401–407. Szapocznik, J. Kurtines, W. M., & Fernandez, T. (1980). Bicultural involvement and adjustment in Hispanic-American youths. International Journal of Intercultural Relations, 4, 353–365. U.S. Census Bureau. (2004). Projected population of the United States, by race and Hispanic origin: 2000 to 2050. Retrieved April 26, 2006, from http://www.census.gov/ ipc/www/usinterimproj/natprojtab01a.pdf Valencia, E. Y., & Johnson, V. (2006). Latino students in North Carolina: Acculturation, perception of school environment, and academic aspirations. Hispanic Journal of Behavioral Sciences, 28, 350–367. Yao, E. L. (1979). The assimilation of contemporary Chinese immigrants. Journal of Psychology, 101, 107–113. Zane, N. & Mak, W. (2003). Major approaches to the measurement of acculturation among ethnic minority populations: A content analysis and an alternative empirical strategy. In K. M. Chun, P. B. Organista, & G. Marin (Eds.), Acculturation: Advances in theory, measurement, and applied research (pp. 39–60). Washington, DC: American Psychological Association. Zea, M. C., Asner-Self, K. K., Birman, D., & Buki, L. P. (2003). The abbreviated multidimensional acculturation scale: Empirical validation with two Latino/Latina samples. Cultural Diversity and Ethnic Minority Psychology, 9, 107–126.

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CHAPTER SIX

Multicultural Issues in Computer-Based Assessment Muninder K. Ahluwalia

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dvancements in technology have had a unique impact on the landscape of assessment. Computerized testing has been viewed as a method to enhance and advance the field of assessment; however, concerns about application to multicultural populations continue to arise. This chapter provides information on the use of computers in testing, the use of computerized tests with multicultural populations, and computer-based assessment in educational and clinical settings.

USE OF COMPUTERS IN ASSESSMENT Computerized assessment encompasses all procedures that involve computer assistance in evaluating educational and behavioral goals (McCullough and Miller, 2003). It uses a variety of tools and products: standardized measures, questionnaires, interviews, automated test scoring, analysis and interpretation programs, computer-adaptive testing, instructional delivery systems, technology assistance, computer simulations, and electronic portfolios. In the first half of the twentieth century, tests were based on classical test theory, which measures aspects of how tests perform. It helps in determining whether they are ‘‘useful, accurate, or better or worse than one another’’ (Parshall, Spray, Kalohn, and Davey, 2002, p. 210). Classical test theory focuses on test scores rather than individual test items that make up the score, and examinees are

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managed in aggregate (for example, in groups) rather than as individuals. In the 1940s and 1950s, paper-and-pencil measures, typically based on classical test theory, were popular. In the 1970s, with an increasing emphasis on computerized measurement, computers were used to score tests and process score reports. In the 1980s, the use of computers expanded to the administration of tests (Wainer, 1990). Computer-based administration, scoring, interpretation, and report-generating programs are now available in all areas of assessment. The Code of Fair Testing Practices in Education (Joint Committee on Testing Practices, 2004) highlights fairness as a primary consideration in all aspects of the testing process. The Code is a guide for professionals in education using paper-and-pencil tests, computer-based tests, and performance tests to provide and use tests that are fair to all test takers, regardless of age, gender, disability, race, ethnicity, national origin, religion, sexual orientation, linguistic background, or other personal characteristics. The Code is intended to be consistent with Standards for Educational and Psychological Testing (American Educational and Research Association, American Psychological Association, and the National Council on Measurement in Education, 1999). This chapter examines computer-based testing procedures and their application to multicultural populations in educational and clinical settings. As areas of diversity, it highlights gender, racial and ethnic minorities in the United States, international populations, and individuals with disabilities.

COMPUTER-BASED TESTING Computer-based testing (CBT) refers broadly to the use of computers in test administration, scoring, and interpretation of results. In much of the research and literature on assessment, the label CBT is often used interchangeably with computerized fixed tests (CFT; Parshall et al., 2002). CBT, however, can refer to any assessment that is computerized (including adaptive tests), whereas CFT refers solely to ‘‘linear’’ or nonadaptive tests, which are tests that are uniformly used with all examinees and do not respond to the level of test taker (for example, in skill or ability). The formats of CFT are most similar to paper-and-pencil tests. With CBT, administration, scoring, and interpretation are done with greater ease than with paper-and-pencil tests. Assessments are computer administered, with the test items stored on the computer. The test taker views the monitor screen and interacts with the test through the keyboard and mouse. CBT parallels paper-and-pencil tests in development, and items are similarly evaluated on content, difficulty, and fairness (Parshall, 2002). The difference lies in the ability to quantify the speed at which examinees respond to items.

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94 HANDBOOK OF MULTICULTURAL ASSESSMENT While paper-and-pencil tests can rely on only the number of items that remain unanswered at the end of the test, CBT response times can be generated for each item, as well as overall average response time. Another benefit of computer-based testing is in the honesty of examinees. In a meta-analytical study on the effect of computerized testing on the candidness of self-reports, the researchers found that asking questions (particularly sensitive ones) using CBT elicited more candid responses than traditional assessment methods (Feigelson and Dwight, 2000). For example, clients using computerized tests may be more willing to disclose symptoms that seem embarrassing than they would if they were assessed using a face-to-face interview.

Computer-Adaptive Testing Adaptive testing is an assessment procedure that adjusts to the level (such as ability) of the examinee, and computer-adaptive testing uses computer administration to achieve this. As Weiss (2004) explains, the principle of adaptive tests was used initially by Alfred Binet in the development of the Binet IQ test (Binet and Simon, 1905, as cited in Weiss, 2004). Binet’s test administration was adaptive: (1) it had a precalibrated test item bank, (2) it was individually administered by a psychologist and probed for the level of difficulty that was appropriate for individual examinees, (3) it had a variable starting option set to an approximation of the ability level of the examinee, (4) there was a defined scoring method, (5) it had an item selection rule (branching) that determined which item was given next to the examinee, and (6) it used a predefined termination rule whereby a ceiling (the age level at which the examinee incorrectly answers all items) and basal level (the age level at which the examinee correctly answers all items) had been identified (Weiss, 2004). Computer-adapted testing (CAT) is a more effective administration of psychological and educational tests through the use of interactive computers rather than paper and pencil. The test adapts to the test taker and has a computer program that ‘‘determines how to begin the test for a given examinee, selects items based on the examinee’s scored responses to previous items, and applies one or more rules to terminate an examinee’s test’’ (Weiss, 2004, p. 72). Some of the early CATs had problems that were decreased through the use of item response theory (IRT), which identifies how people interact with test items based on a family of mathematical models (Embretson and Reise, 2000). IRT has developed over the past forty years and extends the ideas of classical test theory to individual examinees and test items.

Computer-Based Instruction Computer-based instruction (CBI) is the use of computers in teaching, learning, and testing in any subject area. CAT and CBI work similarly in that the

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computer stores information on the individual test taker’s level of mastery over the material. With CBI, students can move through the instruction at their own pace and are provided with immediate feedback, which increases their motivation and learning (McCullough and Miller, 2003). CBI also promotes computer mastery during the learning process, and examinees using CBT therefore increase their familiarity with the testing medium.

USE OF COMPUTERIZED TESTS WITH MULTICULTURAL POPULATIONS The implications of each step in the use of computers in testing are important to consider. Prior to the decision about whether to use computer-based tests with multicultural populations, it is important to determine whether these populations have had sufficient access to and experience with computers. If not, then factors unrelated to those being tested can have a bearing on administration, scoring, and interpretation. For example, in administration, if individuals are familiar with computers, computer-related anxiety will decrease, delivering a better assessment of the examinee’s skills or traits.

Test Design and Development of CBT Lee (2003) noted the importance of a culturally responsive approach to design. In the evaluation of computer-based tools in learning, methods often ‘‘do not take into consideration differential effects for groups that differ by ethnicity, race, language use, or class’’ (p. 58). She argues for the need to attend to the cultural worlds of students who have been traditionally underserved by public education and have often been denied access to cutting-edge computer-based technologies by putting culture at the center. Computer-based test construction needs to preemptively consider the needs of different groups being served and design tests that will constitute a fair assessment of skills, traits, or something else. Test designers also should consider the issue of fairness or, as Helms (2006) defines it, ‘‘the removal from test scores of systematic variance, attributable to the test takers’ psychological characteristics, developed in response to socialization practices or environmental conditions’’ (p. 847). Eliminating cultural bias in testing requires attention to whether items are contextually based and what aspects of culture are embedded in test items (Banks, 2006). This can be problematic when populations are not monocultural. Often components of White, European American culture are embedded in computer-based assessments in such a way that there is only one clear ‘‘right’’ answer from that perspective, while from African American, Latino, Asian American, or Native American cultures, there may be more than one answer or a different one.

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96 HANDBOOK OF MULTICULTURAL ASSESSMENT Moshinsky and Kazin (2005) studied a computer-based test designed for college applicants with disabilities in Israel. To help universities in the selection of undergraduates, the Israeli National Institute for Teaching and Evaluation (NITE) administered a psychometric entrance test, similar to the SAT in the United States. It developed a computerized adaptive psychometric test for administration to individuals with disabilities (other students still take the paper-and-pencil test). Rather than adding on accommodations for individuals with disabilities, the test incorporated the principles of universal test design to anticipate what would work for people with differing needs and built this into the design. Development of the CAT included a valid computerized IRT base, validation of the CAT in comparison to paper-and-pencil tests, and ensuring the suitability of the CAT for examinees with disabilities. Moshinsky and Kazin investigated the comparability of the CAT with the paper-and-pencil version of the test and found no difference. Similar to Lee’s argument (2003) for explicitly taking culture into account rather than adding on to test development, Bennett (1999) suggests a movement toward full inclusion and generalized accommodation for computer-based testing in higher education. One such accommodation would be increased flexibility with time as a way of achieving more equitable assessment (Bennett, 1999; Gordon, 1999).

Computer Administration of Tests Computer administration may be more helpful to certain groups (for example, by reducing stereotype threat) and alleviate some of the disparities between groups. For example, computerized administration may be better for minorities and worse for females (this will be elaborated on later in the chapter). Again, issues such as computer familiarity and anxiety also need to be taken into account. Computerized test administration presents potential benefits for individuals with disabilities. The 1973 Rehabilitation Act, Section 504 and the related implementation regulations were directives to end discrimination of individuals with disabilities in all programs that received federal funds. This required that tests accurately reflect the capabilities of individuals with disabilities and not their impairments. Furthermore, when testing is problematic, it must be validated with individuals with disabilities, and there is a prohibition against inquiry about the individual’s disability status (Bennett, 1999). A problematic assumption embedded in this process was that tests could simply be modified and would produce scores comparable to traditional administrations. Through the Americans with Disabilities Act of 1990, testing provisions were extended, and questions once again arose about comparability. These acts of legislation changed the practice of testing in general and CBT in particular.

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Research suggests that there are no differences in attitudes toward computers between students with and without learning disabilities (Brown, Boscardin, and Sireci, 2001). Bennett (1999) noted that CBT improved testing for many examinees with disabilities. In fact, computers have become lifestyle accommodations for individuals with disabilities (Bennett, 1999). For example, a number of alternative devices for getting information in and out of computers have been used by those who have motor impairments; for example, individuals who have difficulty using a pencil can turn to the word processor, individuals with visual impairments can use braille printers, and individuals with limited mobility can use virtual programs. Computers may be a more natural mode of testing for this population because they are already central in the lives of individuals with disabilities. When assessments are administered, they are often timed. Information regarding how long examinees take to complete particular items may or may not be indicative of their skills or traits. For students with disabilities, extra time is the most often used form of accommodation in testing. Allowing extra time for some examinees and not others, however, affects the standardization of tests; thus, CAT can be a useful solution for testing individuals with disabilities.

Scoring and Interpretation of CBT Knauss’s discussion of computerized psychological and psychoeducational assessment (2001) suggests that ethical issues are important in that they may weigh heavily on the accuracy of results. Whether tests are computerized or not, the results are only as accurate as their appropriate scoring and interpretation. She states, ‘‘Tests can now be administered, scored and interpreted without human contact’’ (p. 237). Computer-generated results and reports, then, may not be as individually tailored as results from paper-and-pencil tests. Psychologists must be well versed in the instrument being used and take responsibility for the interpretation of results, as opposed to relegating interpretation exclusively to the computer or individuals not fully trained in this medium, such as supervisees. Furthermore, when there are disparities between computer-generated and more subjective assessments of clients, clinical judgment must weigh in. It remains important for those interpreting results to be competent in the use of the instruments being administered and their application, both in general and with respect to the particular populations being served. When making interpretations, examiners must have an understanding of an individual’s identities and context, including the interaction of the individual with the examiner and setting. Stereotype threat (Steele, 1997) is a situational predicament whereby ‘‘negative stereotypes targeting a social identity provide a framework for interpreting behavior in a given domain, the risk of being judged by, or treated in terms of, those negative stereotypes can evoke a disruptive

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98 HANDBOOK OF MULTICULTURAL ASSESSMENT state among stigmatized individuals’’ (Davies, Spencer, and Steele, 2005, p. 277). Stereotype threat can undermine stigmatized individuals from performing in any domain. For example, it may be a contributor to lower scores achieved by minorities on paper-and-pencil high-stakes tests. These discrepancies are often lowered using a computer-based test. Explanations of differing results on paper-and-pencil tests versus computer-based tests suggest that stereotype threat may be a contributor to scores for minorities and women (Gallagher, Bridgeman, and Cahalan, 2002). It appears that racial and ethnic minorities may experience less stereotype threat in a computer-based environment where examinees are isolated from the examiner and from each other. Females, however, may experience greater stereotype threat when using the computer. In their review of response time analysis in research on computer-based assessment, Schnipke and Scrams (2002) found racial and ethnic group differences. It is important to consider that there are cultural differences in the perception of time and emphasis placed on quick performance. Cultural perception, language (language skills and English as a primary language), and familiarity with computers all bear on speed, finishing rates, and test-taking strategies, which can have a detrimental effect on scores (Schnipke and Scrams, 2002). Although many assessments have computer interpretation of test results, clinicians and educators need to be careful using only this form of interpretation. The computer-based interpretation can disadvantage some groups while favoring others. For example, in the process of making an interpretation, computers cannot appropriately contextualize response times and speed for particular groups (for example, minorities and females) on each assessment. Computer testing programs do not always take into consideration demographics and certainly do not acknowledge cultural context variables in their interpretations. For example, computers do not differentiate among women, men, Whites, and racial and ethnic minorities; thus, computerized interpretations are not contextually driven and may not take into consideration cultural factors that may affect test performance.

COMPUTER-BASED TESTING IN EDUCATIONAL AND CLINICAL SETTINGS Application of computer-based tests has been extensive in a variety of settings. Some of the more popular areas of use are skills-based tests and entrance examinations. The Scholastic Assessment Test (SAT) and Graduate Record Examination (GRE) are entrance examinations that have CBT formats. Computer use in college and university settings, as well as in secondary schools, has increased, and particular issues arise that are specific to the populations

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studied. In this section, we review recent research on CBT in schools and universities in the United States and abroad, as well as information on the use of computers in clinical assessment.

Computer-Based Testing in Schools In a seminal review of literature on equity and use of computers in schools, Sutton (1991) suggested that computerized testing in schools has maintained or even exaggerated inequities in education. If there is to be equity in highstakes computerized testing, certain issues need to be addressed. Computerrelated competence is influenced by prior experience using computers, setting of computers (such as the presence of other people when using computers), and the amount of time required to take a test. Expectancies and test-wiseness (the degree to which construct-irrelevant testing strategies are employed in test taking) may also influence examinee results on computerized tests and must be considered. Sutton also discusses two assumptions relevant to equity in computerized testing: (1) that equivalencies between paper-and-pencil and computer-administered tests focus on group rather than individual differences and (2) that the status quo, conventional testing, is assumed to be an acceptable baseline; that is, possible inequities in conventional tests themselves are not considered. Signer (1991) describes the use of Microcomputer Adaptive Testing High-Risk Urban Students, a computerized assessment tool that was used as part of a remedial math program. The author measured the amount of on-task versus off-task time, observed behavior, math achievement, and attitudes. Participants in this study were not consistently in school; included in the definition of ‘‘at risk’’ is poor attendance, so the number of participants in each area varied. Participants who took the attitude scale included predominantly Black high school students (female, n = 6, and male, n = 9). Results found that only 5 percent of students’ time was off task. In addition, through observation, the author found that when answers were incorrect, students reviewed their answers and persisted in engagement with the computer program to learn the concept. Because of the unstable student population with inconsistent attendance, the assessment measured individual student performance on repeated tests; Signer found a ‘‘substantial and consistent improvement’’ (p. 6). Of the forty-four retests, forty-one showed an improvement. Finally, the author found that girls were more definitive and reported higher levels of self-confidence than the boys did. The author suggests that at-risk high school students can benefit from computer-assisted instruction; the result is increased motivation, self-confidence, and self-discipline. Interestingly, gender differences were found within the student sample, with girls exhibiting greater self-esteem toward using computers than did boys. Due to the small sample size in this study, generalizability to high-risk urban students is limited.

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100 HANDBOOK OF MULTICULTURAL ASSESSMENT CBT, CAT, and CBI have also been applied in schools in countries outside the United States. A study conducted with ten-year-old English children, for example, assessed the children’s performance on a paper-and-pencil test versus a computer-based mathematics assessment (Hargreaves, Shorrocks-Taylor, Swinnerton, Tait, and Threlfall, 2004). Two groups of 130 participants were studied using a matched-pair design. Results indicate that the scores on the computer tests were better than on the paper-and-pencil tests, although this was not statistically significant for all participants. The authors state that the computer assessment was found to have a generally positive effect on children’s performance in that they achieved higher scores using the computer. No demographics (for example, race, ethnicity, or socioeconomic status) were given regarding the population studied, so caution must be taken in applying these findings to diverse populations beyond the individuals in the study. Park (2005) studied the effectiveness of a computerized testing system in promoting learning of social studies with sixth-grade students in Seoul, Korea, through two mechanisms: the promotion of recall (rather than recognition) and immediate feedback after the test. The sample consisted of 160 participants divided into groups that took either the computer-modified multiple-choice test or the traditional multiple-choice format. The computerized test was found to be more effective in enhancing memory retention than a more traditional multiple-choice test. Although the test content was culturally appropriate (Korean history was covered, for example) to the population studied, the author did not address any other differences that may have influenced the participants’ experiences of implementation or interpretation, such as socioeconomic status. Hippisley, Douglas, and Houghton (2005) administered written and computer-based interactive arithmetic subtests of the Key Math Test to rural Aboriginal (ages seven to fourteen) and suburban non-Aboriginal students (ages six to twelve) in Australia. The results from the written test were significantly better for the non-Aboriginal children than the Aboriginal, but this was not true for the computer-based test. Aboriginal children performed better on the computer-based interactive test than on the written test. Thus, the computer-based test exhibited less cultural bias against the Aboriginal children than the written test did and was a fairer method of assessing their arithmetic skills.

CBT in University Settings First-year students in college often self-report a high level of Internet proficiency skills, even when other assessments, for example, by faculty, do not support this claim (O’Hanlon, 2002). In addition, because of the increasing reliance of computers in university settings, it is important to consider the possibility of variability in computer access and mastery in different populations.

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Access to computers prior to college is not the same for all students. For first-year students, technological preparedness varies by a number of factors, including race, class, gender, and academic background (O’Hanlon, 2002; Sax, Ceja, and Teranishi, 2001). In fact, ‘‘racial/ethnic differences in experience with technology persist despite controls for key explanatory variables including parental income, parental education, and high school type’’ (Sax et al., 2001, p. 363). In studies with university students, minorities and women felt less prepared and less confident to use technology than their White and male counterparts respectively (Sax et al., 2001). Universities need to be aware of these discrepancies because of the rapid increase of computer use in admissions, curriculum, class registration, and student life. Legg and Buhr (1992) studied university examinees’ attitudes toward computerized adaptive testing. The mathematics, reading, and writing subtests of the College Level Academic Skills Test measured the skills required by the sophomore year of college in Florida. Participants were aged seventeen to fifty-five years and were White (63.5 percent), Black (9.7 percent), Hispanic (20.7 percent), and Asian (3.5 percent); males were 57.8 percent of the sample and females 42.2 percent. Differences between groups did not bear on participants’ performance on the test, with the exception of reading problems on the reading test and computer anxiety. Specifically, a feeling of anxiety in the testing situation was related to participants’ prior experience with computers, ability, ethnicity, and gender. Interpretation of these results was complex because those with less prior experience with computers may have been individuals who also belonged to ethnic minority groups. Performance on a number of professional and entrance measures has been examined by gender, racial, and ethnic group to determine whether a shift from paper-and-pencil format to CBT posed a disadvantage for women or racial and ethnic minorities (Gallager et al., 2002). Data from large studies that included the following assessments were examined: • Graduate Record Examination (GRE) General Test: CBT, n = 78,257; paper-and-pencil test, n = 11,178 • Graduate Management Admissions Test (GMAT): Sample sizes were n = 3,465 for GMAT 1 and n = 773 for GMAT 3 • SAT I: Reasoning Test: n = 1,401 • Praxis: Professional Assessment for Beginning Teachers: Reading subtest, n = 39,027; writing subtest, n = 40,257; mathematics subtest, n = 40,325 Samples included individuals from diverse racial and ethnic backgrounds, but actual numbers were not given. The authors found that across assessments, African American and Hispanic examinees performed as well as or better on CBT in comparison to paper-and-pencil tests. Thus, they seemed

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102 HANDBOOK OF MULTICULTURAL ASSESSMENT to benefit from the CBT format. Females (in particular, White females) did better on the paper-and-pencil tests. In addition to the mode of administration being different, it is important to note that in this study, the computer-based tests were also adaptive tests, whereas the paper-and-pencil tests were not. With the use of computers comes attention to tools used in assessment, such as the keyboard or mouse. Oltman and Educational Testing Service (1994) investigated the impact of the complexity of mouse manipulation on performance in computerized testing with college students. The data were collected from a pilot test for the Computer-Based Academic Skills Assessments of the Praxis Series: Professional Assessments for Beginning Teachers and contained three forty-item forms focused on reading and mathematics. This test required a number of mouse response modes varying in difficulty from simple to complex (for example, selection of a multiple-choice response to highlighting and selecting stimuli). Difficulty in negotiating the screens with a mouse was measured by the numbers of clicks made or amount of time taken to complete items. Although the author states that minority students were ‘‘recruited to oversample beyond those who would have been otherwise represented’’ (p. 3) and sampling occurred at four colleges, including a historically Black college and a college with a high number of Latino and Native American students, no numbers or percentages were given for race and ethnicity in the study. Oltman hypothesized that more complex requirements for mouse response would lead to some participants being at a relative disadvantage. Results revealed very little evidence of differential effects of mouse manipulation across gender and ethnicity. Care needs to be taken, however, in interpreting these results in isolation.

Computer-Based Testing in Clinical Settings Butcher, Perry, and Hahn (2004) provide a review of the use of computers in clinical assessment, although they made no mention of cultural issues that potentially may affect results. In the 1960s, one of the first personality assessments to be computer-based was the MMPI. A number of personality and neuropsychological assessments are available on the computer and are practical considerations that must be attended to (see Butcher, 2002). Currently the MMPI-2 comes in a computer-based format for scoring and interpretation, and it is popular for use as well as for research purposes. Butcher et al. (2004) discuss a number of advantages of using computerized reports in clinical assessment that Butcher (2002) outlines, including the large amount of data available immediately for incorporation into treatment objectives, reports that are more comprehensive and more objective than those done by clinicians, interpretations that are often more reliable than those conducted by clinicians, and cost-effectiveness.

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As with ability assessments, CAT can be used to abbreviate the amount of time needed for test administration of personality tests, but item pools are not large enough, so the test is not comprehensive or extensive enough, and CAT does not always provide the ‘‘most accurate and defensible’’ assessment possible (Butcher et al., 2004, p. 229), which is key in some settings, among them forensic. Thus, while CBT may be used in personality assessment, CAT is rarely used. Interest in Internet-based personality assessment has increased. Butcher et al. (2004) address this topic in their review of computers in clinical assessment. Although the accessibility to assessment would increase with this form of personality assessment, there are a number of issues to consider, including assurance of equivalence of test-taking attitudes, test norms that are appropriate for an Internet application, and test validity. In addition, there are test security issues, including the security of test items and the actual test. In addition, confidentiality of client information must be ensured. There are a number of examples of innovative computer use in testing. Gonzalez et al. (1997) evaluated a computerized speech recognition (voice-interactive) program for screening depression in English and Spanish. Thirty-two English speakers (66 percent male: European American, 66 percent; African American, 6 percent; American Indian, 6 percent; Latino, 6 percent; and other, 16 percent) and twenty-three Spanish speakers (52 percent male, all of Mexican ancestry) participated in this study. The authors administered the Short Acculturation Scale and then the Center for Epidemiological Studies-Depression Scale in one of two formats: using a speech recognition program (computer based with the use of a telephone) and face-to-face with an interviewer. They were then asked to express initial reactions and rate the assessment on a scale from 1 to 10. At the end, the Beck Depression Inventory was given as a paper-and-pencil test. Results indicated that both voice-interactive and face-to-face methods were highly rated by both English- and Spanish-speaking groups. The Spanish-speaking group, which had low acculturation levels, did not have a preference, while the English-speaking group preferred the face-to-face method. The authors suggest that computer-based measures can act as a valuable supplement to other forms of clinical assessment. Furthermore, although interest is increasing in computerized clinical assessment, care must be taken when using it with diverse populations. Computer scoring and interpretation are becoming more routine and do have advantages such as objectivity, but clinicians should not use reports as substitutes for clinical judgment. Unlike cognitive and ability testing, there has been little research on multicultural issues that arise in the use of clinical assessment. Many of the same considerations, however, can be applied.

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CONCLUSION The use of computers in assessment will increase in the coming years. Computer-based testing can range from computer administration to computer interpretation of scores. The implications of each step in the use of computers are important to consider. Access to computers may be differential for particular subgroups, including women, ethnic minority groups, and individuals with low socioeconomic status, which can result in differences in scores on computerized assessments. Research findings suggest that some groups may score better on computerized versions of traditional measures. Test examiners’ interpretive and clinical judgment, particularly in the case of individual and group differences, remains invaluable.

References American Educational and Research Association, American Psychological Association, and National Council on Measurement in Education. (1999). Standards for educational and psychological testing. Washington, DC: American Psychological Association. Banks, K. (2006). A comprehensive framework for evaluating hypotheses about cultural bias in educational testing. Applied Measurement in Testing, 19 (2), 115–132. Bennett, R. W. (1999). Computer-based testing for examinees with disabilities: On the road to generalized accommodation. In S. J. Messick (Ed.), Assessment in higher education: Issues of access, quality, student development, and public policy (pp. 181–191), Mahwah, NJ: Erlbaum. Brown, C. R., Boscardin, M. L., & Sireci, S. G. (2001). Computer attitudes and opinions of students with and without learning disabilities. Journal of Educational Computing Research, 24, 183–204. Butcher, J. N. (2002). How to use computer-based reports. In J. N. Butcher (Ed.), Clinical personality assessment: Practical approaches (2nd ed., pp. 109–125). New York: Oxford University Press. Butcher, J. N., Perry, J., & Hahn, J. (2004). Computers in clinical assessment: Historical developments, present status, and future challenges. Journal of Clinical Psychology, 60(3), 331–345. Davies, P., Spencer, S., & Steele, C. (2005). Clearing the air: Identity safety moderates the effects of stereotype threat on women’s leadership aspirations. Journal of Personality and Social Psychology, 88(2), 276–287. Embretson, S. E., & Reise, S. P. (2000). Item response theory for psychologists. Mahwah, NJ: Erlbaum. Feigelson, M. E., & Dwight, S. A. (2000). Can asking questions by computer improve the candidness of responding? Consulting Psychology Journal: Practice and Research, 52 (4), 248–255.

MULTICULTURAL ISSUES IN COMPUTER-BASED ASSESSMENT Gallagher, A., Bridgeman, B., & Cahalan, C. (2002). The effect of computer-based tests on racial-ethnic and gender groups. Journal of Educational Measurement, 39 (2), 133–147. Gonzalez, G. M., Costello, C. R., La Tourette, T. R., Joyce, L. K., & Valenzuela, M. (1997). Bilingual telephone-assisted computerized speech-recognition assessment: Is a voice-activated computer program a culturally and linguistically appropriate tool for screening depression in English and Spanish? Cultural Diversity and Mental Health, 3 (2), 93–111. Gordon, E. W. (1999). Human diversity and equitable assessment. In S. J. Messick (Ed.), Assessment in higher education: Issues of access, quality, student development, and public policy (pp. 203–211). Mahwah, NJ: Erlbaum. Hargreaves, M., Shorrocks-Taylor, D., Swinnerton, B., Tait, K., & Threlfall, J. (2004). Computer or paper? That is the question: Does the medium in which assessment questions are presented affect children’s performance in mathematics? Educational Research, 46 (1), 29–42. Helms, J. (2006). Fairness is not a validity or cultural bias in racial-group assessment: A quantitative perspective. American Psychologist, 61 (8), 845–859. Hippisley, J., Douglas, G., & Houghton, S. (2005). A cross-cultural comparison of numeracy skills using a written and an interactive arithmetic test. Educational Research, 47 (2), 205–215. Joint Committee on Testing Practices. (2004). Code of fair testing practices in education. Washington DC: Joint Committee on Testing Practices. Retrieved January 21, 2007, from http://www.apa.org/science/fairtestcode.html. Knauss, L. K. (2001). Ethical issues in psychological assessment in school settings. Journal of Personality Assessment, 77 (2), 231–241. Lee, C. D. (2003). Toward a framework for culturally responsive design in multimedia computer environments: Cultural modeling as a case. Mind, Culture, and Activity, 10 (1), 42–61. Legg, S., & Buhr, D. C. (1992). Computerized adaptive testing with different groups. Educational Measurement: Issues and Practice, 11 (2), 23–27. McCullough, C. S., & Miller, D. C. (2003). Computerized assessment. In C. R. Reynolds & R. W. Kamphaus (Eds.), Handbook of psychological and educational assessment of children: Intelligence, aptitude and achievement (2nd ed., pp. 628–670). New York: Guilford Press. Moshinsky, A., & Kazin, C. (2005). Constructing a computerized adaptive test for university applicants with disabilities. Applied Measurement in Education, 18 (4), 381–405. O’Hanlon, N. (2002). Net knowledge: Performance of new college students on an Internet skills proficiency test. Internet and Higher Education, 5, 55–66. Oltman, P., & Educational Testing Service. (1994). The effect of complexity of mouse manipulation on performance in computerized testing. Retrieved February 1, 2007,

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106 HANDBOOK OF MULTICULTURAL ASSESSMENT from the ERIC database http://www.eric.ed.gov/ERICDocs/data/ericdocs2/content storage 01/0000000b/80/26/54/97.pdf. Park, J. (2005). Learning in a new computerized testing system. Journal of Educational Psychology, 97 (3), 436–443. Parshall, C. G. (2002). Item development and pretesting in a CBT environment. In C. M. Mills, M. T. Potenza, J. J. Fremer, & W. C. Ward (Eds.), Computer-based testing: Building the foundation for future assessments (pp. 119–142). Mahwah, NJ: Erlbaum. Parshall, C. G., Spray, J. A., Kalohn, J. C., & Davey, T. (2002). Practical considerations in computer-based testing. New York: Springer-Verlag. Sax, L. J., Ceja, M., & Teranishi, R. T. (2001). Technological preparedness among freshman: The role of race, class, and gender. Journal of Educational Computing Research, 24 (4), 363–383. Schnipke, D. L., & Scrams, D. J. (2002). Exploring issues of examinee behavior: Insights gained from response-time analyses. In C. N. Mills, M. T. Potenza,J. J. Fremer, & W. C. Ward. (Eds.), Computer-based testing: Building the foundation for future assessments (pp. 237–266). Mahwah, NJ: Erlbaum. Signer, B. R. (1991). CAI and at-risk minority urban high school students. Journal of Research on Computing in Education, 24 (2), 189–203. Steele, C. M. (1997). A threat in the air: How stereotypes shape intellectual identity and performance. American Psychologist, 52, 613–629. Sutton, R. E. (1991). Equity and computers in the schools: A decade of research. Review of Educational Research, 61 (4), 475–503. Wainer, H. (1990). Computerized adaptive testing: A primer. Mahwah, NJ: Erlbaum. Weiss, D. J. (2004). Computerized adaptive testing for effective and efficient measurement in counseling and education. Measurement and Evaluation in Counseling and Development, 37, 70–84.

CHAPTER SEVEN

Clinical Diagnosis in Multicultural Populations Richard H. Dana

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rior to DSM-IV, the clinical diagnostic process was culturally biased; invariance in symptoms and disorders across cultures was assumed. In preparation for the most recent diagnostic and statistical manual (DSM-IV; American Psychiatric Association, 1994), cultural differences in expressions of psychological distress were described for diagnostic categories (Mezzich, Kleinman, Fabrega, and Parron, 1996; Mezzich, Kirmayer, Kleinman, Fabrega, Parron, and Good et al., 1999). DSM-IV acknowledged cultural differences by including an outline for preparation of Cultural Formulations and presenting a limited Glossary of Culture-Bound Syndromes. DSM-IV-TR (2000) a revised edition, furthered the description of individual client uniqueness by multidimensional data collection and integration of a clinical presentation format. DSM-IV and DSM-IV-TR (2000) contributed to professional awareness of cultural psychiatry (Alarcon, Westermeyer, Foulks, and Ruiz, 1999) and resulted in cultural formulation training for students and behavioral health professionals. These trainings were supported by case examples in Culture, Medicine and Psychiatry (Lewis-Fernandez, 1996) and other published materials (Dana, 2002a; Draguns, 2000; Paniagua, 2000, 2001). In the second edition of this book, this chapter examined remedies for cultural bias in clinical diagnostic assessment using standard assessment instruments such as the MMPI-2, Rorschach, and Thematic Apperception Test (Dana, 2001). Research documentation of instrument bias (Van de Vijver, 2000; Van de Vijver and Tanzer, 1997) has not curtailed misapplications

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108 HANDBOOK OF MULTICULTURAL ASSESSMENT of standard instruments. Similarly, although adaptations recommended for this purpose are ethically mandatory (for example, credible service delivery styles, adding moderators for cultural/racial identity information, and employing cultural knowledge for inferences from assessment data), they have not been widely adopted (Dana, 1993). Standard instruments have limited utility beyond simply calling attention to the necessity for cultural competency training, recommending cautious interpretation, and advocating available practice desiderata (Dana, 2005a) including adaptations, instrument-specific interpretation guidelines, and examples. As a result, new instruments designed for all clinical populations, including ethnic minorities, provide an impetus for ethical and responsible multicultural assessment (for example, the Tell-Me-a-Story Test/TEMAS; Costantino, Dana, and Malgady, 2007). Preparing DSM cultural formulations (Dana, 2002a) requires difficult new learning experiences for White students and clinicians whose training did not explicitly include multicultural assessment. Multicultural assessment training is well received by ethnic minority students (Dana, Aguilar-Kitibutr, Diaz-Vivar, and Vetter, 2002). Nonminority students, however, often perceive such training as an unnecessary burden because they have not been exposed to courses in psychometrics and culture-specific information resources (Dana, 1998a; Jackson, 1999). Multicultural assessment training thus remains an infrequent and incomplete training option. As a result, professional psychology students lack necessary skill sets (Allen, 2002) and routine supervision of assessment practice with ethnic minority clients (Allen, 2007). These unresolved issues in clinical diagnosis and behavioral health care for ethnic minorities now potentially affect one-third of the entire population and half of the child population. Persons of color are already majority populations in California and Texas as well as in urban schools nationally; their representation in counseling psychology has reached a 30 percent critical ratio, and graduate psychology students now exceed 27 percent (Norcross, Kohout, and Wicherski, 2005). DSM-IV/DSM-IV-TR recognized that multicultural populations not only exhibit culture-general conditions in conventional DSM psychopathologies but also frequently experience culture-bound syndromes. For examples, neurasthenia in Chinese Americans (Zheng et al., 1997), panic attacks in Southeast Asian refugees (Hinton, Pich, and Pollack, 2005), and ataque de nervios in Hispanics (Lewis-Fernandez, Guarnaccia, Patel, Lizardi, and Diaz, 2005) occur with much greater frequencies than anticipated in all ethnic minority populations (Dana, 2002a). Cultural issues now have relevance for clinical diagnosis, although less biased and more reliable descriptions of all psychopathologies are still needed to increase the use and adequacy of available services. Despite providing an augmented awareness of cultural issues in clinical diagnosis,

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the DSM versions have not affected ethnic and cultural disparities in access to equitable and unbiased behavioral health services (Snowden and Yamada, 2005). The magnitude and importance of cultural issues in human distress exceeds the DSM-IV capacity to provide access to adequate and complete classification or relevant interventions for pathological and nonpathological sources of human distress.

PATHOLOGY/MENTAL HEALTH AND NONPATHOLOGY/BEHAVIORAL HEALTH An exclusive medical-psychiatric illness paradigm limits awareness of the differentiation between psychopathology and legitimate nonpathological sources of distress. These sources of distress have persisted over time and across generations with high frequencies but have not been routinely addressed in mainstream managed care settings. In order to implement change in these settings, a dramatic enlargement of the potential scope and availability of culture-specific assessment and intervention services is now required. Nonpathological sources of distress in multicultural populations include problemsin-living, oppression-induced effects, and acculturation stress. Problems-in-living are essentially social disorders (Albee and Ryan-Finn, 1993) with variations in kind, frequency, and severity across ethnic minority groups. Some problems have received DSM attention (among them are alcohol and drug abuse, personality disorders, and posttraumatic stress disorder), although their inclusion as disorders has reduced the likelihood of an expanded range of culturally appropriate and potentially beneficial interventions. Classifications systems for relational problems have been recommended in psychiatry (Committee on the Family, Group for Advancement of Psychiatry, 1995), psychology (Teicher, 1995), and social work (Williams, Karls, and Wandrei, 1991). To exemplify the cultural distinctiveness of problems-in-living for American Indians/Alaska Natives, relational problems, chronic alcohol and drug abuse, damaged sense of self, marginal cultural orientation status, and lack of skills were identified (Dana, 1998b). In indigenous populations, these problems are affected by acculturation status and are responsive to culture-specific interventions (Dana, 2000a). Oppression-induced effects occur across generations in all ethnic minority populations and exacerbate cultural idioms of distress (Bulhan, 1985; Malgady, Rogler, and Cortes, 1996). The White behavioral health establishment ignored the continuing relevance of oppression-relevant problems for persons of color in the United States until counseling psychologists advocated a racial-cultural

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110 HANDBOOK OF MULTICULTURAL ASSESSMENT psychology incorporating issues of equity, social justice, and racism (Carter, 2005; D. W. Sue, 2003; Holiday and Holmes, 2003; Ponterotto, Casas, Suzuki, and Alexander, 2001; Toporek, Gerstein, Fouad, Roysircar and Israel, 2005). Interventions for these sources of chronic distress are available and could readily be incorporated in culture-specific, nonclinical services within behavioral health facilities. Stress-related emotional distress frequently accompanies the acculturation process for immigrants and refugees (Slavin, Rainer, McCreary, and Gowda, 1991). Immigrants and refugees display a broad range of problem domains, including holistic health and acculturation. These problems require comprehensive assessment and interventions that exceed the available medical model assessment and intervention options for psychopathology nationally and internationally (Allen, Vaage, and Hauff, 2006). As a result, these individuals may receive less benefit from behavioral health services than resident ethnic minorities in host societies due to limited language skills, divergent beliefs about health and illness, and incomplete acculturation. These populations require assessment and intervention options for holistic health and healing or adaptation to restore psychological meaning, stimulate direct coping with trauma, provide new problem-solving skills and competencies, support protective factors for resilience, and attend to physical, mental, and spiritual balance (Dana, 2007a). The distinction between pathology/mental health and nonpathology/behavioral health resources occurs as one consequence of an increasing consensus on the need to incorporate cultural issues into assessment and intervention resources in contemporary systems of care.

ASSESSMENT AND INTERVENTION A review of the status of assessment and intervention suggests why DSM-IV has not served to facilitate access by ethnic minorities to culturally responsible behavioral health services. DSM-IV did not enhance assessment practice with either standard or new instruments to provide access to both standard and culturally relevant interventions for racial/ethnic populations. The cultural relevance and adequacy of standard interventions is under research scrutiny, although culture-specific interventions have received less attention. Guidelines for assessment and intervention research with racial/ethnic populations are now available. However, there is disagreement among professionals concerning the scientific credibility of some instruments as well as the nature of psychological science. As a result there is limited implementation of these guidelines, although a recent conceptual model specifying components of an overall research perspective may facilitate consensus and provide a responsible bridge from research to behavioral health practices.

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Assessment DSM diagnostic practices were developed from a Western worldview, personality theories, and medical model illness conceptualizations (Fernando, 2001). This model originated in Western scientific assumptions and cultural biases that restricted and distorted recognition of psychopathology in ethnic minority populations (Mezzich et al., 1996). The ostensibly culture-general or universal DSM-IV/DSM-IV-TR psychopathologies do not necessarily contain sufficient diagnostic information for reliable categorization of racial/cultural group members because the entire multiaxial system is affected by cultural and racial inferences (Mezzich et al., 1999). Axes I through V, respectively, refer to mood and personality disorders, physical symptoms, psychosocial stressors, and overall functioning in the cultural context of life events. This cultural context affects the experience and report of distress; influences the contents, configurations, meaning, and expression of symptoms; and provides structure and credibility for an interpersonal construction of the diagnostic assessment-interview process (Buckley and Franklin-Jackson, 2005). Medical model assessment was not conceived as comprehensive and evaluative but primarily as diagnostic in function (Elfant, 1985). These limitations were exacerbated by cultural issues in standardized, time-limited test samples using measures providing static outcome scores rather than process variables (Suzuki, Kugler, and Aguiar, 2005). The DSM-IV/DSM-IV-TR Glossary information provides limited and incomplete descriptions, range, prevalence, and major references for culture-bound syndromes (Simons and Hughes, 1985). Culture-bound syndromes occur typically among immigrants, refugees, students, and other sojourners who maintain traditional cultural values and beliefs as well as first languages. These syndromes may persist across generations for these new residents and for cultural minorities espousing a traditional worldview. For example, American Indians and Alaska Natives often retain a traditional worldview and resist acculturation in order to survive in an alien society. Their culture-bound disorders have phenomenological reality and cultural validity due to different conceptions of the self and belief in physical monism rather than mind-body dualism (Dana, 1993, 1998a, 2005a). Assessment should routinely consider the high prevalence rates of culture-bound disorders in these populations. Thus, DSM-IV culture-general pathologies and culture-bound syndromes fail to cover the full spectrum of potential human distress. These pathological disorders and syndromes should be supplemented by conceptualizations for culture-specific and identity-specific conditions requiring interventions combining culture-general and culture-specific elements as well as interventions that are exclusively culture-specific or identity-specific interventions. In order to facilitate comprehensive assessment, information on ethnicity/ racial identity and acculturation status should always be included during

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112 HANDBOOK OF MULTICULTURAL ASSESSMENT intake for all behavioral health services. Additional information may be necessary for preparation of culture-specific and identity-specific conceptualizations for psychological distress with origins in problems-in-living rather than psychopathology. Assessors should be familiar with culture-specific assessment instrument resources germane to these problems-in-living (Jones, 1996) in addition to instruments applicable to all racial/cultural populations such as the Scale to Assess World Views and the Cultural Identity Checklist (Lonner and Ibrahim, 2002). Medical model assessment in managed care has curtailed the use of comprehensive batteries of standard instruments and excludes available instruments for evaluating nonpathological sources of distress (Dana, 2003; Dana, 2007b). Brief screening measures and symptom checklists are employed instead, although these instruments generally have unknown applicability for ethnic minorities in the absence of documented cross-cultural validity with new populations. Better screening instruments now exist for diagnostic and planning information relevant to a broad spectrum of interventions (for example, StepOne for Parents; Conner, 2005), but these instruments also lack cultural validity. Managed care is unlikely to appreciably increase assessment time, although essential cultural sensitivity can be provided by abbreviated measures, new instruments, and provider training. First, brief measures of acculturation status of ethnic minorities can be employed prior to all diagnostic and intervention decisions (Van de Vijver and Phalet, 2004). Systems of care can embed these new abbreviated measures within the service delivery process to facilitate access and provide adequate care for multicultural populations. Second, new instruments can provide diagnostic assessment of psychopathology, describe nonpathological conditions, employ short forms for specific consumer populations, and employ normative data incorporating group-specific acculturation status data. Guidelines for new instruments designed for all consumer populations are now available (Costantino et al., 2007; Dana, 2007a). Third, it is imperative to employ empirically derived and documented cultural competency assessment of providers (Gamst, Dana, Der-Karabetian, Aragon, Morrow, and Martensen, 2004) as a basis for training (Dana, Gamst, and Der-Karabetian, 2006). Cultural competence assessment and training influences behavioral health systems and fosters knowledge, attitude, and clinical skill components in all mental health providers and acknowledges sociocultural diversities in disabled, senior, lesbian, gay, heterosexual, or low-economic-status consumers.

Intervention Dramatic increases in the range, variety, and evaluation of interventions for all behavioral health populations are required for quality care. The clinical

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diagnostic process and the systems of care responsible for delivery of services continue to require substantial elaboration to serve the needs of multicultural populations. Quality care is now predicated on an expanded range of available interventions for pathological and nonpathological conditions (Weisz, Sandler, Durlak, and Anton, 2005). Racial/cultural issues affect the validity of pharmacological, cognitivebehavioral, and psychosocial interventions. In the new arena of ethnopsychopharmacology, for example, genetic and nutritional factors contribute to differential racial and ethnic responses affecting the selection, dosage, and side effects of standard pharmacological interventions (Ng, Lin, and Smith, 2005). Ethical guidelines suggest that neither empirically supported therapies nor culturally sensitive therapies with ethnic minorities have consistent efficacy (Hall, 2001). Cognitive-behavioral therapy applications (Tanaka-Matsumi, Higginbotham, and Chang, 2002; Vera, Vila, and Alegria, 2003) and standard psychosocial interventions are available with adaptations for each cultural group, as well as for specific diagnoses (Miranda et al., 2005; Weisman, 2005; Wong, Kim, Zane, Kim, and Huang, 2003). These adaptations of standard interventions for ethnic minority populations require evaluation for effectiveness before routine use.

PSYCHOLOGICAL SCIENCE The current status of assessment and intervention suggests supplementary diagnostic and treatment alternatives predicated on gradual changes in psychological science. A brief history of psychological science introduces an emerging research paradigm and a conceptual model for behavioral health research. An enlarged scientific perspective endorses ethnic science as good science that can serve the entire population as an eventual basis for practice standards. Psychology imported a selected version of European science based on quantitative, laboratory-derived data used for prediction, control, and general laws of human behavior (Boring, 1929). This positivist empiricist version of science was legitimized in the scientist-practitioner, or Boulder, model of clinical training. The Boulder model and the science it represented were White male dominated and originally sexist and racist in some graduate programs. In my Boulder model doctoral program of approximately 250 students during the early 1950s, there were neither women nor ethnic minorities on the faculty or among students (see Dana, 2005b)! A competing Vail, or professional, model introduced somewhat later had community-oriented goals with gender and ethnic minority representation. A sociocentric training metaphor enlarged the scientific perspective, emphasized understanding as a primary objective, and necessitated more diverse methodologies (Goldman, 1978; Howard, 1993;

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114 HANDBOOK OF MULTICULTURAL ASSESSMENT Polkinghorne, 1983). The Boulder and Vail training models, chronicled in many sources (Dana and May, 1987), became less distinctive over time and now represent two approaches to Boulder model training emphasizing either science or practice within the same overall scientific ideology (Dana, 1992). This increasing program similarity between training models is undergoing modification as a result of more flexible American Psychological Association accreditation practices. Historically the Boulder model empowered psychologists as scientists, but it also contributed to an applied human science with limited applicability to individual and cultural differences as well as primary prevention (Dana, 1987). A diminished and incomplete image of humanity, particularly within clinical psychology, fostered a limited research paradigm characterized by low inference interpretation and disinterest in methodologies available in other social science and psychology specializations. This scientific perspective stimulated controversy concerning the scientific legitimacy of projective techniques for personality assessment (Wood, Nezworski, Lilienfeld, and Garb, 2003). An internal disagreement regarding the nature of clinical psychological science has poorly served the needs of the entire population in systems of care (Society for Personality Assessment, 2005). Psychology, a profession with many components and specializations, is now moving toward a coalescence of research and practice as intertwined and coextensive components of a human science (Dana, 2006). A pathology preoccupation, represented by DSM, can now be supplemented by a recovery vision incorporating nonpathological pathways to quality behavioral health care (Anthony, 2000). A recovery vision emphasizes hope, optimism, self-determination, and independent living consistent with positive psychology, a science of positive experience, individual traits, and institutions (Seligman and Csikszentmihalyi, 2000). Positive psychology emphasizes psychological assessment (Lopez and Snyder, 2003) and recognizes that emotional states stimulate good health and personal well-being (Salovey, Detweiler, Steward, and Rothman, 2000). A developing interdisciplinary holistic developmental science perspective includes developmental psychology, developmental biology, molecular biology, physiology, neuropsychology, social psychology, sociology, and anthropology (Bergman, Cairns, Nielson, and Nystedt, 2000).

RESEARCH GUIDELINES AND A CONCEPTUAL MODEL Following a long history of relative disinterest in the behavioral health needs of African Americans (Dana, 2002b), we still lack an adequate empirical basis for culturally sensitive research with all racial/ethnic populations. A consensual

CLINICAL DIAGNOSIS IN MULTICULTURAL POPULATIONS

research basis can provide sufficient scientific persuasiveness to stimulate systematic changes in policy that can ultimately accelerate access and use of relevant services for these populations in existing systems of care. Available multicultural research guidelines (Council of National Psychological Associations for the Advancement of Ethnic Minority Interests, 2000) include ‘‘(a) careful and detailed description of ethnicity/race/tribe, (b) recognition of the magnitude of within-group differences or heterogeneity, (c) necessity for always assessing and reporting acculturation status, (d) an understanding of the effects of oppression, (e) communication style and response sets, (f) an understanding of cultural worldview, and (g) the reporting of participant language status and fluency’’ (Dana, 2005a, p. 56). To date, these guidelines have not been routinely emphasized in training professional psychologists or consistently implemented by journal editors as a result of controversy concerning the nature and substance of psychological science. Sue (1999) questioned the uneven nature, low level, and funding inequities commensurate with ‘‘selective enforcement of the principles of science’’ (p. 1070) leading to insufficient quality research and deficiencies in how psychological science is practiced. As a consequence, all phases of research have been affected: planning, defining variables, selecting measures, determining translations and conceptual equivalence, selecting and sampling participants, gaining cooperation, and applying culturally sound research designs and strategies and interpretation of data (Sue and Sue, 2003). Legitimization of cultural knowledge by transformation of distal referents into concrete operations using proximal research linkages is mandatory (Sue and Zane, 1987). Demographic variables, such as ‘‘culture,’’ ‘‘race,’’ and ‘‘ethnicity’’ employed distally continue to serve as proxy variables for underlying culturally based personality processes mediating cultural differences. These distal referents are burdened by surplus meaning and lack consensual definitions, and thus they obfuscate research-based conclusions (American Psychological Association, 2003). Resolution of the distal-proximal issue was initiated by Malgady’s recommendation (1996) to reverse the null hypothesis of no cultural bias to specify bias and alter the practical implications of type 1 and 2 errors. In addition to good ethnic science, a new conceptual model can contribute to the development of behavioral health care research standards and ultimately inform national policy. This model, developed at the Center for Research on Latino Mental Health and Other Health Disparities specifies components of an overall research perspective. These components include multicultural research guidelines, linguistic skills and appropriateness, as well as culturally competent assessments and interventions facilitating evidence-based practice within a community aegis.

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Multicultural Research Guidelines Guidelines can facilitate and structure the planning and design of research programs with ethnic minority populations by ensuring supplementation of conventional research methodologies consistent with informed expectations for competent psychological science. Good ethnic science requires an understanding of standard research fundamentals, as well as explicit training for application of multicultural research guidelines.

Linguistics Communication adequacy stems from the properties, characteristics, and vocabularies structured by the cultural credibility of the social etiquette employed throughout the research process. Researchers should recognize that both English and first- or native-language fluencies of participants should be examined by preliminary evaluation, especially for those who are bilingual (Altarriba and Santiago-Rivera, 1994). These linguistic issues do not differ from criteria for adequate clinician-consumer communication (Malgady and Zayas, 2001). Whenever a research process is conducted in English with those who are bilingual, for example, limited English among participants can result in perceived lack of cooperation due to negative self-effacing attitudes, stress-induced speech disturbances and motor patterns, flattened affect erroneously interpreted, and reduced self-presentation construed as low intelligence. Accurate communication with research participants can reduce bias due to miscommunication and misunderstanding.

Assessment New culturally appropriate assessment instruments are needed with normative data that incorporate acculturation status for immigrant, refugee, and sojourner populations (Costantino et al., 2007; Dana, 2007b). Standard instruments should be employed with bicultural and assimilated resident ethnic minorities as well as with many marginal individuals. However, routine intake acculturation status evaluations are necessary for decisions concerning the use of these instruments with all ethnic minorities. Standard instrument adaptations or modified interpretations should be applied with caution prior to research demonstrations of cross-cultural equivalence (Dana, 2005a) employing culturally appropriate methodology (Allen and Dana, 2004; Allen and Walsh, 2000; Van de Vijver, 2000).

Interventions Culture-general interventions, examined for cross-cultural validity, may require adaptations to reduce bias for each ethnic minority group. However, there has been no consensus to date on the extent and kinds of required adaptations

CLINICAL DIAGNOSIS IN MULTICULTURAL POPULATIONS

(Bernal and Scharron-Del-Rio, 2001; Vera et al., 2003; Weisman, 2005; Wong et al., 2003). Moreover, changes in service delivery and services are needed to incorporate and subsequently evaluate these interventions in behavioral health care practice.

Evidence-Based Practice An empirical basis for practice can result in good ethnic science. Evidence-based practice has been broadly defined as ‘‘the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences’’ (American Psychological Association Presidential Task Force on Evidence-Based Practice, 2006, p. 273.) This definition is consistent with Stricker’s research-informed practice (2006) because all information contained in research literature is informed by practitioner judgment and experience. Evidence-based practice, defined in this manner, is consistent with the emerging model of science described in this chapter.

Community Model A community approach signals a shift away from after-the-fact attempts to reconstitute persons using clinical diagnosis and medicalized interventions exclusively in systems of care. Snowden (2005) described the need for community level change by employing the term population thinking to encourage a transition from individuals to population characteristics. Since behavior is embedded in community social and cultural contexts (Trickett, 1997), preventive interventions can shape nonpathological future behavior patterns. Sensitization to underlying structures and processes of social change in communities is thus necessary and can be accomplished by preventive intervention programs. However, nearly half of 177 preventive intervention programs described by Durlak and Wells (1997) omitted ethnic/racial characteristics. These programs also generally failed to employ culturally competent research methodology (Manson, 1997). Genuine population thinking requires knowledgeable cooperation and interface across the behavioral health professions. Social change mechanisms affect public policy and thus provide a focus for behavioral health practices that have applications for healthy populations nationally and internationally.

Cultural Competence Cultural competence is essential for quality care (Abe-Kim and Takeuchi, 1996) with therapists as designated change agents (Goh, 2005; Sue, 1998). Cultural competence is now part of behavioral health training (Pope-Davis, Coleman, Liu, and Toporek, 2003). This training is mandatory for all behavioral health

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118 HANDBOOK OF MULTICULTURAL ASSESSMENT researchers and practitioners (Costantino et al., 2007; Dana, 2007b; Dana and Allen, in preparation; Dana et al., 2006; Rogler, 1989; Sue and Sue, 2003). Historically a general cultural competency model for training (D. W. Sue et al., 1982) led to operationalizing constructs representing attitudes and beliefs, knowledge, and skills in a number of instruments. Despite the high level of discourse regarding these cultural competency constructs, there are unanswered questions and a continuing need for adequate definition and empirical study (Sue, 2001). This model only partially met evaluation criteria (Mollen, Ridley, and Hill, 2003), and more valid instruments using empirically identified items were desirable to bridge the gap between training and evaluation of clinical outcomes (Atkinson and Israel, 2003). To address these limitations, a new instrument, the California Brief Multicultural Competence Scale (CBMCS; Gamst, Dana, Der-Karabetian, Aragon, Morrow, and Martensen, 2004), was constructed from four earlier cultural competency scales. The CBMCS was derived from the responses of 1,244 California mental health practitioners using principal component analysis with item content validation by an expert panel and confirmatory factor analysis. CBMCS subscales coincided roughly with the three original constructs and added a new construct, Sociocultural Diversities, to tap a new multicultural competency domain that encompasses disabilities, gender, seniors, sexuality, and low socioeconomic status. These CBMCS constructs were applied as modules within several editions of a training manual beginning in 2002 (Dana et al., 2006), pilot-tested with trainers (Gamst and Der-Karabetian, 2005), and endorsed by the California Department of Mental Health for statewide in-service training. This new instrument is part of the Multicultural Assessment-Intervention Process (MAIP) model. The cultural responsiveness hypothesis anticipated positive effects on clinical outcomes by matching clients and providers, although routine racial/ethnic, language, and gender matching has been largely unsupported (Karlsson, 2005; Maramba and Hall, 2002; Shin et al., 2005). However, a history of ‘‘ethnic glosses,’’ or broad categories separating groups, compromises the match literature by obfuscating ethnicity and failing to specify the magnitude of within-group variation (Trimble, Helms, and Root, 2003). Nonetheless, there is limited support for effects of cultural variables on clinical outcomes for some groups with specific diagnoses in one community setting (Gamst, Dana, Der-Karabetian, and Kramer, 2000, 2001, 2004; Gamst et al., 2003). Consumer-provider match, however, is simply one cultural responsiveness ingredient empirically linked with consumer cultural identity and provider cultural competency as determinants of clinical outcomes evaluated positively by structural equation modeling (Gamst, Dana, Der-Karabetian, Meyers, and Guarino, 2007; Gamst, Rogers, Der-Karabetian, and Dana, 2006).

CLINICAL DIAGNOSIS IN MULTICULTURAL POPULATIONS

Each discipline has taken a different and independent route toward providing culturally competent services for ethnic minority populations (see Costantino et al., 2007). The disciplines of medicine, psychiatry, nursing, social work, and psychology developed limited or extensive ethnic-minority agendas relevant for their own professional objectives. These disciplines infrequently communicate or work together to provide an interdisciplinary basis for research, training, and practice. This has occurred as a result of differing professional objectives that structure science-practice relationships and are predicated on distinctive psychological science perspectives. Collectively these perspectives can nourish a stronger and more inclusive basis for behavioral health care, although the legitimacy of specific components in an overall model of science for human beings remains controversial.

PRACTICE MODELS Culturally competent systems of care are still described as unfinished business and even visionary in the United States despite recognition that behavioral health services should provide individualized care in assessment, intervention, training, and evaluation for all children and adolescents (Huang et al., 2005; Tolan and Dodge, 2005). Culturally competent practice models have been endorsed historically, particularly for children and adolescents (Evans, Delphin, Simmons, Omar, and Tebes, 2005). Criteria for model programs include diminishing access barriers, increasing replicability, and providing accountability (Roberts, 1994). Pumariega, Rogers, and Rothe (2005) state that ‘‘culturally competent practice can only occur within a system of care that has internalized and integrated cultural competence principles into every aspect of its organization and functioning’’ (p. 550). These authors also suggest integrating traditional healers as service providers, an absolute necessity for traditional refugees and immigrants (see Dana, 2007b). The California Department of Mental Health-Office of Multicultural Services (CDMH-OMD: Dana, Aragon, and Kramer, 2002) and the Connecticut Department of Mental Health and Addiction Services (DMHAS; Evans et al., 2005) have recently mobilized their resources to restructure their systems of care for all consumers. The DMHAS and MAIP practice models represent the contemporary coalescence of psychological science and practice applications in the United States. Evans et al. (2005) describe the DMHAS program at practitioner, program, and policy levels. This program serves sixty thousand people annually: 61 percent White and 39 percent racial/ethnic minorities. At the practitioner level,

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120 HANDBOOK OF MULTICULTURAL ASSESSMENT the sixteen-module cultural competence training for practitioners requires two days a week for sixteen weeks over seven months. All programs develop cultural competence plans for client access, engagement, and retention congruent with best practice dimensions emphasizing access to services; culturally appropriate, quality-of-life assessment for case management; treatment; and rehabilitation planning with bilingual staff for consumers who are non-English speakers. These services are linked to discharge plans, and culturally competent self-help and network supports provide self-ratings on these dimensions to identify strengths and needs and prioritize goals and objectives for review and recommendations. Culture-specific community outreach programs for new clients and those not remaining in treatment address specific issues such as HIV/AIDS and substance abuse with bilingual-bicultural providers. At the policy level, the DMHAS infrastructure supports cultural competence philosophy in state-funded provider contracts for accountability of their cultural competence plans. A two-day process includes client focus groups, interviews with director and staff, and record-keeping review, and a checklist for rating agency compliance with best practices is used. California has also implemented the MAIP model training components for mandated culturally competent services (Costantino et al., 2007). The MAIP model, described in the second edition of this handbook (Dana, 2001), is revisited here as a necessary DSM diagnostic supplement and an exemplar of culturally competent, cost-effective research and practice. The MAIP model is predicated on good ethnic science that employs proximal research linkages to transform cultural knowledge into concrete operations within behavioral health settings. Examples include use of culture-specific service delivery social etiquette in all phases of service delivery, employing moderators and acculturation status intake information, respecting cultural norms in interpretation of assessment data, using available cultural formulations and conceptualizations for clinical diagnosis and nonclinical evaluation, and applying a consensual definition of evidence-based practice to culture-general, combined, and culture-specific interventions. Quality care requires applicable conceptualizations for culture-specific conditions resulting from cross-cultural interaction stress with origins in prejudice, discrimination, and oppression and identity issues (Dana, 1998b). Such conceptualizations lead toward relevant and available interventions that include combinations of culture-general and culture-specific components or culture-specific components exclusively (see Figure 7.1) implemented in behavioral health settings (Figure 7.2). Figure 7.1 illustrates when and how cultural issues delineated by the MAIP model can be embedded in behavioral health services. This figure is predicated on available empirical knowledge and is consistent with managed care process, outcome, evaluation, and cost-effectiveness objectives.

CLINICAL DIAGNOSIS IN MULTICULTURAL POPULATIONS

Yes

Q1 Etic Instrument No

Q2 Cultural Orientation

Cultural Orientation

Anglo

Assimilated

Bicultural

Marginal

Transitional

Traditional

Q3 Diagnosis Necessary

Yes

Q5 Anglo Norms

Yes

No

Q4 Emic Instrument No Yes Yes

Instruments

Etic (Universal Standard)

Anglo Emic (Anglo Standard)

Modified Anglo Emic (Modified Standard)

Emic (Culture-Specific)

Q6 Cross-Cultural Intersection Stress

No

Conceptualization

Yes Culture-Specific Conceptualization

Formulation

Universal Diagnostic Formulation

Standard Anglo Diagnostic Formulation

Culture-Specfic Yes Diagnostic Formulation

Choice Depends on Clinical Judgment

Intervention

Emic (Identity-Specific)

Culture-Universal Cultural-General Intervention Intervention

Combined Culture-General and Culture-Specific Intervention

Identity-Specific Conceptualization

Q7 Diagnosis Necessary

No

Culture-Specific Intervention

Identity-Specific Intenvention

Figure 7.1. Original Multicultural Assessment-Intervention Process (MAIP) Model Source: From Handbook of Cross-Cultural and Multicultural Personality Assessment (p. 7), by R. H. Dana, 2000b, Mahwah, NJ: Lawrence Erlbaum Associates, Inc. Copyright 2000 by Lawrence Erlbaum Associates, Inc. Adapted with permission.

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122 HANDBOOK OF MULTICULTURAL ASSESSMENT Step

Component

Objective

1. Intake

Screening Information History Community Functioning Evaluation DSM-IV-TR Diagnosis Global Assessment of Functioning Other Initial Outcome Measures

Screening Guidelines

2. Match

Consumer – Provider/Ethnicity/Language

3. Acculturation/ Racial Identity Status

4. Cultural Competence Provider

5. Provider Training

6. Cultural Components Embedded in Services

7. Outcome Measures

Assess

No

Yes or No

Yes

Acculturated

Bicultural/Marginal

Traditional

Low

Medium/High

High

CBMCS

No

Yes

Yes

Training Manual

None

Some

Primarily

Access Brochure

Other Outcome Measures Service Satisfaction Measures

Figure 7.2. Schematic Flowchart of MAIP Model Components

Measures

Evaluation Research

CLINICAL DIAGNOSIS IN MULTICULTURAL POPULATIONS

PERORATION This chapter described unresolved psychological science issues in DSM-IV clinical diagnosis contributing to inadequate social policy and continuing inequities in behavioral health services for racial/ethnic populations. Introduced and clarified by assessment, intervention, and research considerations, these unresolved issues suggest a more central and salient role for culture in future DSM versions. However, the societal stakes in clinical diagnostic procedures are now higher than in the 1992 and 2000 DSM-IV publications. Psychological disturbance and emotional distress now occur at younger ages, are more prevalent, are widely dispersed globally, and are chronic, particularly for ethnic minority populations (see Costantino et al., 2007). This chapter suggests that remedial clinical diagnostic and treatment opportunities are now imperative. Parallel and interactive culturally competent assessment-intervention processes for diagnosis of psychopathology and evaluation of nonpsychiatric problems-in-living are necessary for the entire population. The DMHAS and CDMH-OMD suggest alternative approaches in two states to resolve the dilemma of access and use of culturally competent behavioral health services for ethnic minority populations. The MAIP model offers a variety of culture-general and culture-specific formulations and conceptualizations for access to culture-general, combined, and culture-specific interventions. These behavioral health system modifications can provide continuously evaluated outcomes of services within flexible, cost-effective, and culturally competent systems of care. Access and credible services for ethnic minorities can be ensured only by continuous evaluation of culturally sensitive services and service providers to bridge the gap between research and practice. Simultaneous and interactive efforts of all relevant professional disciplines are needed to inform social policy in a democratic society. These disciplines can employ available research guidelines and a recent conceptual model in their efforts toward consensus on the scientific basis of their shared and distinctive activities.

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126 HANDBOOK OF MULTICULTURAL ASSESSMENT Dana, R. H. (2005b). A report on myself: The science and/or art of assessment. In S. Strack & B. N. Kinder (Eds.), Pioneers of personality science: Autobiographical perspectives (pp. 86–111). New York: Springer. Dana, R. H. (2006, March). An international, interdisciplinary, culturally-relevant science of human assessment: Ingredients, perspectives, and prospects. In S. N. Strack (Chair), Pioneers of personality science discuss lessons learned and ideas for the future. Symposium conducted at the midwinter meeting of the Society for Personality Assessment, San Diego, CA. Dana, R. H. (2007a). Refugee assessment practices and cultural competency training. In J. P. Wilson & C. Tang (Eds.), The cross-cultural assessment of psychological trauma and posttraumatic stress disorder (pp. 91–112). New York: Springer-Verlag. Dana, R. H. (2007b). Culturally competent school assessment: Performance measures of personality. Psychology in the Schools, 44, 229–241. Dana, R. H., Aguilar-Kitibutr, A., Diaz-Vivar, N., & Vetter, H. (2002). A teaching method for multicultural assessment: Psychological report contents and cultural competence. Journal of Personality Assessment, 79, 207–215. Dana, R. H., & Allen, J. (in preparation). Professional training for practicing in a global society. New York: Springer. Dana, R. H., Aragon, M., & Kramer, T. (2002). Public sector mental health services for multicultural populations: Bridging the gap from research to clinical practice. In M. N. Smyth (Ed.), Health care in transition (Vol. 1, pp. 1–13). Hauppauge, NY: Nova Science. Dana, R. H., Gamst, G., & Der-Karabetian, A. (2006). The California Brief Multicultural Competency Training Program: A manual for trainers. La Verne, CA: University of La Verne Press. Dana, R. H. & May, W. T. (1987). Internship training in professional psychology. New York: Hemisphere. Draguns, J. G. (2000). Psychopathology and ethnicity. In J. A. Aponte & J. Wohl (Eds.), Psychological interventions and cultural diversity (2nd ed., pp. 40–58). Needham Heights, MA: Allyn & Bacon. Durlak, J. A., & Wells, A. M. (1997). Primary prevention mental health programs for children and adolescents: A meta-analytic review. American Journal of Community Psychology, 25, 115–152. Elfant, A. (1985). Psychotherapy and assessment in hospital settings: Ideological and professional conflicts. Professional Psychology: Research and Practice, 16, 55–63. Evans, A. C. Jr., Delphin, M., Simmons, R., Omar, G., & Tebes, J. (2005). Developing a framework for culturally competent systems of care. In R. T. Carter (Ed.), Handbook of racial-cultural psychology and counseling (pp. 492–513). Hoboken, NJ: Wiley. Fernando, S. (2001). Mental health, race, and culture (2nd ed.). New York: Palgrave. Gamst, G., Aguilar-Kitibutr, A., Herdina, A., Hibbs, S., Kristal, E., Lee, R., Roberg, R., Ryan, E., Stephens, H., & Martensen, L. (2003). Effects of racial match on Asian

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128 HANDBOOK OF MULTICULTURAL ASSESSMENT Jackson, L. C. (1999). Ethnocultural resistance to multicultural training: Students and faculty. Cultural Diversity and Ethnic Minority Psychology, 5, 27–36. Jones, R. L. (Ed.). (1996). Handbook of tests and measures for Black populations. Hampton, VA: Cobb & Henry. Karlsson, R. (2005). Ethnic match between therapist and patient in psychotherapy: An overview of findings, together with methodological and conceptual issues. Cultural Diversity and Ethnic Minority Psychology, 11, 113–129. Lewis-Fernandez, R. (1996). Cultural formulation of psychiatric diagnosis. Culture, Medicine, and Psychiatry, 20, 133–144. Lewis-Fernandez, R., Guarnaccia, P. J., Patel, S., Lizardi, D., & Diaz, N. (2005). Ataque de nervios: Anthropological, epidemiological, and clinical dimensions of a cultural syndrome. In A. M. Geogiopoulos & J. F. Rosenbaum (Eds.), Perspectives in cross-cultural psychiatry (pp. 63–85). Philadelphia: Lippincott Williams & Wilkins. Lonner, W. J., & Ibrahim, F. A. (2002). Appraisal and assessment in cross-cultural counseling. In P. Pedersen, J. G. Draguns, W. J. Lonner & J. E. Trimble (Eds.), Counseling across cultures (pp. 355–379). Thousand Oaks, CA: Sage. Lopez, S. J., & Snyder, C. P. (Eds.) (2003). Positive psychological assessment: Handbook of models and measures. Washington, DC: American Psychological Association. Malgady, R. G. (1996). The question of cultural bias in assessment and diagnosis of ethnic minority clients: Let’s reject the null hypothesis. Professional Psychology: Research and Practice, 27, 73–77. Malgady, R. G., Rogler, L. H., & Cortes, D. E. (1996). Cultural expression of psychiatric symptoms: Idioms of anger among Puerto Ricans. Psychological Assessment, 8, 265–268. Malgady, R. G., & Zayas, L. H. (2001). Cultural and linguistic considerations in psychodiagnosis with Hispanics: The need for an empirically informed process model. Social Work, 46, 40–49. Manson, S. M. (1997). One small step for science, one giant step for prevention. American Journal of Community Psychology, 25, 215–219. Maramba, G. G., & Hall, G.C.N. (2002). Meta-analyses of ethnic match as a predictor of dropout, utilization, and level of functioning. Cultural Diversity and Ethnic Minority Psychology, 8, 290–297. Mezzich, J. E., Kirmayer, L. J., Kleinman, A., Fabrega, H. Jr., Parron, D. L., Good, B. J., et al., (1999). The place of culture in DSM-IV. Journal of Nervous and Mental Disease, 187 (8), 457–464. Mezzich, J. E., Kleinman, A., Fabrega, H. Jr., & Parron, D. L. (Eds.) (1996). Culture and psychiatric diagnosis: A DSM-IV perspective. Washington, DC: American Psychiatric Press. Miranda, J., Bernal, G., Lau, A., Kohn, L., Hwang, W-C., & LaFromboise, T. (2005). State of the science on psychosocial interventions for ethnic minorities. Annual Review of Clinical Psychology, 1, 113–142.

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130 HANDBOOK OF MULTICULTURAL ASSESSMENT Snowden, L. R. (2005). Racial, cultural and ethnic disparities in health and mental health: Toward theory and research at the community level. American Journal of Community Psychology, 35, 1–8. Snowden, L. R., & Yamada, A-M. (2005). Cultural differences in access to care. Annual Review of Clinical Psychology, 1, 143–166. Society for Personality Assessment. (2005). The status of the Rorschach in clinical and forensic practice: An official statement by the board of trustees. Falls Church, VA: Author. Stricker, G. (2006). The local clinical scientist: Evidence-based practice and personality assessment. Journal of Personality Assessment, 86, 4–9. Sue, D. W. (2003). Overcoming our racism: The journey to liberation. San Francisco: Jossey-Bass. Sue, D. W., Bernier, J. E., Durran, A., Feinberg, L., Pedersen, P., Smith, E. J., et al. (1982). Position paper: Cross-cultural counseling competencies. Counseling Psychologist, 10, 45–52. Sue, D. W., & Zane, N. (1987). The role of culture and cultural techniques in psychotherapy. American Psychology, 42, 37–45. Sue, S. (1998). In search of cultural competence in psychotherapy and counseling. American Psychologist, 53, 440–448. Sue, S. (1999). Science, ethnicity, and bias. American Psychologist, 54, 1070–1077. Sue, S. (2001, November). Cultural competency: Is it politically correct? APPIC Newsletter, 26 (2), 1, 4, 32–34. Sue, S., & Sue, L. (2003). Ethnic science is good science. In G. Bernal, J. E. Trimble, A. K. Burlew, & F. T. Leong (Eds.), Handbook of racial and ethnic minority psychology (pp. 198–207). Thousand Oaks, CA: Sage. Suzuki, L. A., Kugler, J. F., & Aguiar, L. J. (2005). Assessment practices in racial-cultural psychology. In R. T. Carter (Ed.), Handbook of racial-cultural psychology and counseling: Training and practice (Vol. 2, pp. 297–315). Hoboken, NJ: Wiley. Tanaka-Matsumi, J., Higginbotham, H. N., & Chang, R. (2002). Cognitive-behavioral approaches to counseling across culture: A functional analytic approach for clinical applications. In P. Pedersen, J. G. Draguns, W. J. Lonner, & J. E. Trimble (Eds.), Counseling across cultures (5th ed.), pp. 337–354. Thousand Oaks, CA: Sage. Teicher, A. (1995). Proposal for a psychological classification system. Independent Practitioner, 15 (2), 82–84. Trickett, E. J. (1997). Ecology and primary prevention: Reflections on a meta-analysis. American Journal of Community Psychology, 25, 197–205. Trimble, J. E., Helms, J. E., & Root, M.P.P. (2003). Social and psychological perspectives on ethnic and racial identity. In G. Bernal, J. E. Trimble, A. K. Burlew, & F.T.L. Leong (Eds.), Handbook of racial and ethnic minority psychology (pp. 239–275). Thousand Oaks, CA: Sage.

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CHAPTER EIGHT

A Cultural Assessment Framework and Interview Protocol Ingrid Grieger

Luis, a twenty-six-year-old Mexican American M.B.A. student on a predominantly White campus, presented at the university counseling center with symptoms of anxiety and depression. He also reported experiencing considerable, and at times debilitating, levels of guilt that he believed were related to his growing certainty about his homosexuality. His therapist, a thirty-year-old Anglo gay male, was well versed in cognitive behavioral therapy (CBT) as well as lesbian, gay, and bisexual affirmative counseling (Croteau, Bieschke, Phillips, and Lark, 1998). He viewed Luis as a perfect candidate for these orientations, given his intense feelings of guilt, anxiety, and depression, which appeared to be precipitated by internalized homophobia and other irrational beliefs regarding his sexual orientation. Furthermore, the therapist had used CBT within a gay affirmative model successfully with other clients who presented with similar lesbian-gay-bisexual-transgender (LGBT) concerns. He was also aware that clients who are members of visible racial and ethnic minority groups tend to prefer more directive approaches to treatment, which also rendered CBT an appropriate orientation. The therapist ascertained that Luis was interested in exploring his sexual orientation in treatment. Therefore, much of the first session was spent with the therapist actively and vigorously challenging Luis’s beliefs about ‘‘the wrongness of being gay’’ and his ‘‘catastrophizing’’ about how this was ‘‘destroying’’ his life. At the end of the session, the therapist encouraged Luis to continue the process of disputing his dysfunctional beliefs regarding his sexual orientation as homework prior to the next session. The therapist believed that he had made a good connection with the client, as they appeared to have a great deal in common; both were well-educated, intelligent,

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A CULTURAL ASSESSMENT FRAMEWORK AND INTERVIEW PROTOCOL verbal, young gay men. His recollections of his own process of coming out to family members and peers when he was in high school only served to intensify the therapist’s feeling of empathy for his client. Confident that the session had been very helpful to Luis and that a therapeutic alliance had been forged, the therapist concluded that progress had already been made in ameliorating some of the client’s negative feelings about his sexual orientation. He was therefore very surprised when Luis cancelled the next session and declined to schedule another appointment. What had gone wrong? Here was a seemingly competent (and certainly wellintentioned) clinician who had successfully worked with many clients around the issues of sexual orientation using a CBT and gay affirmative approach, and yet this client terminated after one session. Clearly the critical piece that was missing for this therapist was his failure to conduct a thorough cultural assessment with this client. For example, although the therapist did appropriately focus on an important aspect of Luis’s personal and cultural identity, his sexual orientation, he did not explore the intersection of multiple cultural identities, which is particularly salient for this client (Grieger and Ponterotto, 1995; Lowe and Mascher, 2001; Yeh and Hunter, 2005). Furthermore, though noting that Luis was a member of a visible racial ethnic minority group, the therapist responded to this information superficially and failed to fully appreciate its significance. Specifically, the therapist did not inquire about such issues as his client’s own perception and articulation of his cultural identity, level of acculturation, connection to family members and their level of acculturation, or his religious and spiritual beliefs; nor did he inquire as to what the client would find helpful in the therapeutic process. Had the therapist completed an in-depth cultural assessment, he would have discovered that Luis is a first-generation Mexican American whose parents hold traditional values, beliefs, and expectations for their children. Furthermore, the therapist would have learned that Luis is a practicing Roman Catholic and that his religious and spiritual beliefs are a guiding force in his life. For Luis, the prospect of engaging in behaviors that are clearly prohibited within his religion and, even more significant, his going down a path that would deeply hurt, disappoint, and shame his parents created an existential crisis of overwhelming proportions. By failing to appreciate the magnitude of Luis’s concerns within his own cultural context, the therapist missed an important opportunity to therapeutically engage his client and assist him to explore and grapple with the most significant issues in his life. In addition, as an essential part of conducting a comprehensive and systematic cultural assessment, it was ethically and clinically incumbent on the therapist to be involved in his own ongoing process of self-appraisal regarding such variables as determining his level of multicultural clinical competence and being aware of his own racial and cultural identity, as well as how it may interact with that of the client to facilitate or impede the therapeutic relationship (American Psychiatric Association, 2000; Dana, 1998, 2005; Grieger and Ponterotto, 1998; Helms and Cook, 1999; Ridley, Li, and Hill, 1998). Had the therapist been rigorously engaged in this process, he would have been able to more accurately determine whether he in fact possessed the skills to deliver culturally sensitive and competent assessment and treatment, or whether this client might be better served by a referral to a more culturally skilled

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134 HANDBOOK OF MULTICULTURAL ASSESSMENT clinician. In either case, a premature termination and a missed therapeutic opportunity might have been averted.

This vignette clearly underscores the clinical and ethical imperatives to conduct a coherent cultural assessment in order to ascertain those variables that have the most salient implications for diagnosis, case conceptualization, and treatment within the client’s worldview. Furthermore, it illustrates the difficulty in establishing a strong therapeutic alliance, as well as credibility with a client, when the therapist does not ‘‘understand and incorporate culturally responsive approaches’’ (Ancis, 2004, p. 13) or fails to focus ‘‘on the cultural complexities that exist between the clinician and the client’’ (Ridley et al., 1998, p. 862). This chapter presents a rationale for implementing a cultural assessment interview as being foundational for all other clinical activities. It also sets out arguments asserting the importance of situating all clients within their cultural context. It contains a conceptual framework for cultural assessment that builds on my previous work in this area (Grieger and Ponterotto, 1995) and a structured protocol for conducting a cultural assessment interview. For the purposes of this chapter, the terms multicultural and cultural are defined as broadly as possible to include such variables as race, ethnicity, gender, sexual orientation, religion, socioeconomic status, disability status, age, and nationality.

RATIONALE FOR CULTURAL ASSESSMENT Consistent with the case vignette, it has been well established in the research literature that approximately 50 percent of visible racial/ethnic minority clients terminate therapy after one session, as compared with 30 percent of White clients (S. Sue, Fujino, Hu, Takeuchi, and Zane, 1991). This disheartening statistic has been variously attributed to the Eurocentric nature of counseling and psychotherapy in both process and content; the failure to acknowledge Eurocentric biases in the conduct of clinical assessment, diagnosis, and treatment; the preponderance of White middle-class clinicians; and the lack of specific multicultural clinical competence on the part of many clinicians (Dana, 2000, 2001; Lim, 2006; Lonner and Ibrahim, 2008; Paniagua, 1998; Ridley et al., 1998; D. W. Sue and Sue, 2003; Suzuki, Ponterotto, and Meller, 2001). Dana (2005) summarized this state of affairs by asserting that ‘‘cultural malpractice is a harsh term, but it serves to focus attention on historic and current inequities in psychological services available for multicultural populations’’ (p. 50). Over the past twenty-five years, however, much groundbreaking work has been done within the mental health profession to address the issue of ‘‘cultural malpractice.’’ Chief among this work has been the development of a specific theory of multicultural counseling and therapy (Sue,

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Ivey, and Pedersen, 1996) as well as the delineation of specific multicultural counseling competencies. Initially D. W. Sue et al. (1982) developed eleven such competencies, which over time were expanded to thirty-four competencies (Sue et al., 1998). The competency model is organized along three major dimensions: counselor awareness of own assumptions, values, and biases; knowledge about the worldview of culturally diverse clients; and developing appropriate intervention skills and techniques. Furthermore, the Sue et al. (1998) model of awareness, knowledge, and skills has been adapted for all health care providers and has been articulated in a document entitled ‘‘Principles and Recommended Standards for Cultural Competence Education of Health Care Providers’’ (California Endowment, 2003). Various quantitative paper-and-pencil instruments have been developed to operationalize and test the clinical significance of the competencies (see reviews in Constantine and Ladany, 2001; Constantine and Wilton, 2005; D. W. Sue and Torino, 2005). Paralleling recent advancements in delineating specific multicultural competencies have been systematic efforts by professional organizations in counseling, psychology, and psychiatry to infuse multicultural considerations into their operating ethical standards and guidelines for practice. The revised ethical principles of the American Psychological Association (2002), and particularly, of the American Counseling Association (2005) address more fully and completely matters of cultural competence in practice (see also the ethical positions in Caldwell and Tarver, 2005; Ibrahim and Cameron, 2005; Pack-Brown and Williams, 2003; Toporek and Williams, 2006; Trimble and Fisher, 2006). Significantly, the Association for Assessment in Counseling (a division of the American Counseling Association) promulgated thirty-four standards for multiculturally competent assessment and the appropriate use of standardized tests (Prediger, 1994). In addition, a major position paper put forth by the American Psychological Association, ‘‘Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists’’ (2003), clearly states that ‘‘psychologists are encouraged to apply culturally appropriate skills in clinical and other applied psychological practices’’ (p. 390). Highlighted within this guideline is the need for clinicians to understand clients within a cultural context and to provide culturally relevant assessment and intervention. With regard to the American Psychiatric Association, the Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revision, 2000; DSM-IV-TR) provides clinicians with important guidelines for developing a cultural formulation and understanding a limited sample of twenty-five culture-bound syndromes. Specifically, the DSM-IV-TR states: The cultural formulation provides a systematic review of the individual’s cultural background, the role of the cultural context in the expression and evaluation of

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136 HANDBOOK OF MULTICULTURAL ASSESSMENT symptoms and dysfunction, and the effect that cultural differences may have on the relationship between the individual and the clinician. . . . In addition the cultural formulation . . . provides an opportunity to describe systematically the individual’s cultural and social reference group and ways in which the cultural context is relevant to clinical care [p. 897].

The DSM-IV-TR suggests five categories as an outline for promulgating cultural formulations: cultural identity of the individual, cultural explanations of the individual’s illness, cultural factors related to psychosocial environment and levels of functioning, cultural elements of the relationship between the individual and the clinician, and overall cultural assessment for diagnosis and care. Furthermore, the DSM-IV-TR Case Book (Spitzer, Gibbon, Skodol, Williams, and First, 2002) offers a variety of international cases that clearly demonstrate the clinical relevance and usefulness of rendering cultural diagnostic formulations across a variety of specific and diverse cultural contexts. Ton and Lim (2006) have noted several clinical advantages of engaging in the assessment of cultural identity, including the identification of sources of strength and support that may enhance treatment, the identification of potential sources of cultural conflict, gaining greater clarity regarding the client’s or patient’s worldview and perspective on his or her own problems, and the enhancement of rapport as the clinician seeks to understand the client or patient more deeply and completely as a ‘‘whole person’’ rather than as an ‘‘ill person.’’ Ridley et al. (1998) have posited a three-phase assessment model: identifying cultural data, interpreting cultural data, and incorporating cultural data. Among the cultural variables to be identified, these writers have included level of acculturation, socioeconomic status, history of oppression, racism and prejudice, immigrant or citizenship status, religious beliefs, family systems, and cultural values. Finally, Grieger and Toliver (2001) have advocated the use of ‘‘more culturally relevant frameworks and models for assessment, case conceptualization, and diagnosis. These should include considerations of worldview, level of acculturation, racial/ethnic identity development, emotional intelligence, language dominance, and the equivalency of psychological constructs in the client’s culture’’ (p. 834).

CULTURAL ASSESSMENT FOR ALL CLIENTS Adapting an inclusive definition of the terms cultural and multicultural suggests that engaging in a cultural assessment, at least in part, is appropriate for all clients. As Sue and Sue (2003) have stated, ‘‘We believe that each of us is born into a cultural context of existing beliefs, values, rules, and practices. . . . Reference groups related to race, ethnicity, sexual orientation, gender, age, and socioeconomic status exert a powerful influence over us and influence our

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worldviews’’ (p. 7). More specifically, Ridley et al. (1998) have asserted that ‘‘culture is always relevant to psychological assessment. . . . The question for the clinician is never ‘Is culture relevant to a particular client?’ A better question is this: ‘How is culture relevant to understanding this client?’’’ (p. 857). Taking an inclusive perspective with regard to cultural or multicultural assessment does not suggest that all individual and group differences related to culture are equivalent in terms of socioeconomic, psychological, and quality-of-life consequences. Clearly members of visible racial and ethnic minority groups are far more likely than are members of the dominant culture to experience nonprivilege, racism, bias, and their toxic sequelae. Neville, Worthington, and Spanierman (2001) have posited that ‘‘the recursive relationship between ideological and structural racism manifests itself as a set of systemic practices and corresponding ideological beliefs (i.e., stereotypes of racial superiority and inferiority) resulting and perpetuating a racial hierarchy in which White individuals as a group are garnered privileges from which racial and ethnic minority groups are systematically excluded’’ (p. 260). With regard to the privileges garnered by Whites, McIntosh (1988) has acknowledged that ‘‘I have come to see White privilege as an individual package of unearned assets, which I can count on cashing in every day, but about which I was ‘meant’ to remain oblivious’’ (p. 1). Sue and Sue (2003) have noted that not only do White European Americans often deny the existence of White privilege, they sometimes actually deny being White, a phenomenon that Sue and Sue have labeled ‘‘the invisible Whiteness of being.’’ They further note that although Whites prefer to identify themselves by nationality (for example, Irish, Italian, German), in general, they have not really thought about their cultural heritage with any depth or about the role it may play in shaping their lives. For White clients, therefore, an inquiry regarding the various dimensions of their racial and cultural identities may create new avenues of awareness about the self that can be constructed only within a cultural matrix (Helms and Cook, 1999). Furthermore, although a commonality among White persons is indeed their individual and collective gleaning of benefits resultant of White privilege, a moment’s reflection makes it clear that within-group differences may nevertheless be profound. Consider, for example, the worldview and lived experience of a young fourth-generation White Protestant, heterosexual, affluent male, as compared to an elderly, orthodox Jewish, urban female who is a Holocaust survivor, or to a poor White male, rural teenager, or to a newly arrived monolingual Italian immigrant, or to a physically disabled young White lesbian. Although all of these individuals are members of the dominant culture, it is likely that they hold relative degrees of privilege and in some cases may even be viewed as marginalized. In fact, Arredondo (2002) has suggested that in addition to members of racial/ethnic minority groups, individuals who are poor,

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138 HANDBOOK OF MULTICULTURAL ASSESSMENT disabled, gay or lesbian, or female have also been marginalized and therefore endure similar negative psychological consequences and ‘‘daily life stressors.’’ Furthermore, Arredondo notes that ‘‘when an individual self-identifies as a member of a marginalized group or has that status attributed to him or her, this suggests that he or she holds a worldview that clinicians need to recognize and understand’’ (p. 244). In sum, whether they are of high or low salience for the client, whether extensively thought about or out of the client’s awareness, issues related to culture must be assessed for each client in order that an accurate and useful diagnosis, case conceptualization, and treatment plan be promulgated. Whether the client is a member of the dominant culture or of a visible racial/ethnic group, his or her psychological development, conceptualization of the self, and worldview (the lens through which all experiences are filtered and interpreted) have been forged within a cultural context and, in fact, within multiple, interdependent, and multilayered cultural contexts (Coleman, Norton, Miranda, and McCubbin, 2003), all of which the clinician should assess and understand.

DEVELOPMENT OF A CONCEPTUAL FRAMEWORK AND INTERVIEW PROTOCOL FOR CULTURAL ASSESSMENT Grieger and Ponterotto (1995) have developed a preliminary framework for assessment in multicultural counseling. Based on the critical constructs of worldview and acculturation, they delineated six components as being fundamental to culturally situating the client and conceptualizing the client’s concerns within a relevant cultural context: (1) the client’s level of psychological-mindedness, (2) the family’s level of psychological-mindedness, (3) the client’s and family’s attitudes toward helping and counseling, (4) the client’s level of acculturation, (5) the family’s level of acculturation, and (6) the family’s attitude toward acculturation. Illustrative clinical vignettes were presented for each of these components, and it is recommended that Grieger and Ponterotto (1995) be read as a companion piece to this chapter. Over the past ten years, I have used this framework to inform my own clinical work, as well as to train and supervise students and interns. In continuing to apply the model, reflect on it, and investigate the evolving literature on multicultural assessment, I realized that a number of critical components were missing. For example, the construct of racial and cultural identity development was lacking as a critical underlying variable and organizing principle (Carter, 1995; Constantine, Watt, Gainor, and Warren, 2005; Cross and Vandiver, 2001; Helms, 1995).

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In the current framework that I present here, the level of racial and cultural identity development of both the clinician and the client is assessed. In fact, Helms (1995) has pointed out that ‘‘the racial identity model was originally proposed as a framework for promoting better psychotherapy relationships’’ (p. 195). Among the advantages of assessing the level of racial identity of both the clinician and the client, Helms has noted the potential for ‘‘more relevant interventions for ameliorating race-related symptoms,’’ reducing ‘‘the emphasis on changing clients who are people of color to adapt to White theorists’ interpretations of such clients’ ‘aberrant’ behavior,’’ and ‘‘replacing victim-blame perspectives with the capacity to promote modification of unhealthy racial identity development’’ (pp. 195–196). Helms further posits that ‘‘racial identity models will make it feasible to train therapists who can be responsive to intrapersonal as well as interpersonal racial dynamics both within and outside the therapy relationship’’ (p. 196). It became apparent that experiences related to the process of immigration, particularly for refugees and asylum seekers, as well as exposure to racism and other forms of prejudice, are of critical salience in understanding the client within a cultural context (Allen, Vaage, and Hauff, 2006; Ancis, 2004; Arredondo, 2005; Comas-Diaz and Jacobsen, 2001; Lee, 1990; Lu, Lim, and Mezzich, 1995; Paniagua, 2001; Sue and Sue, 2003; Utsey, Bolden, and Brown, 2001; Utsey, Lanier, Williams, Bolden, and Lee, 2006; Wade, 2005). In fact, the research literature that has emerged in recent years has confirmed that the psychologically traumatizing nature of these experiences is akin to other forms of trauma, such as rape and other examples of interpersonal violence, which in turn has implications for diagnosis and treatment (Bryant-Davis and Ocampo, 2005a, 2005b; Carter, Forsyth, Mazzula, and Williams, 2005; Prendes-Lintel, 2001; Ton and Lim, 2006). For example, Utsey et al. (2001) have noted that ‘‘symptoms associated with race-related trauma include recurring thoughts and/or nightmares regarding the traumatic event, anxiety, fear, sleeplessness, and depression. Race-related trauma is not a pathological reaction per se but a logical and predictable response to racism and oppression’’ (p. 322). Issues related to religion and spirituality have also emerged as being particularly salient for working with clients across cultures, and therefore these variables have been incorporated, as well (Constantine, 1999; Fukuyama and Sevig, 1999). It is currently acknowledged within the profession that spirituality and religion, once viewed as being antithetical to the conduct of psychological inquiry and treatment, ‘‘are primary mechanisms for meaning making that are inseparable from perceptions of wellness for many individuals’’ (Smith and Richards, 2005, p. 139). Certainly the work of pioneering multicultural scholars writing in the area of multicultural assessment has profoundly broadened, deepened, and refined my own conceptual framework. Among the assessment scholarship

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140 HANDBOOK OF MULTICULTURAL ASSESSMENT that has closely informed my current conceptualization are Dana’s Multicultural Assessment-Intervention Process Model (2005), Berg-Cross and Chinen’s Person-in-Culture Interview (1995), Ponterotto, Gretchen, and Chauhan’s Holistic Idiographic Framework for Practice (2001), and Ridley et al.’s Multicultural Assessment Procedure (1998). On a more basic and pragmatic level, questions from students, interns, and colleagues arose as to how to assess such variables as psychological-mindedness, level of acculturation, family attitudes toward acculturation, and level of racial and cultural identity development within the context of a clinical interview. Therefore, in order to assist the clinician, both seasoned and newly emerging, in implementing a conceptual framework for cultural assessment, I developed a specific interview protocol that I present here. It should be noted that the Cultural Assessment Interview Protocol (CAIP) is part of a larger, more comprehensive assessment and diagnostic process. Its purpose is to guide clinicians in situating clients within the relevant cultural context, which will assist in the selection of more formal assessment measures, both emic and etic, if appropriate, and in the formulation of a more accurate diagnosis, case conceptualization, and treatment plan. (For a discussion of etic instruments that may be appropriate for culturally diverse populations, see Paniagua, 1998. For a review of emic instruments, see Dana, 2005; Fischer and Moradi, 2001; Kim and Abreu, 2001; and Ponterotto, Utsey, and Pedersen, 2006.) This protocol is an idiographic, phenomenological, qualitative assessment tool that precedes yet is inextricably intertwined with the clinical assessment process.

A CURRENT CONCEPTUAL FRAMEWORK AND CULTURAL ASSESSMENT INTERVIEW PROTOCOL The conceptual framework for cultural assessment presented here contains eleven categories: (1) Problem Conceptualization and Attitudes Toward Helping, (2) Cultural Identity, (3) Level of Acculturation, (4) Family Structure and Expectations, (5) Level of Racial/Cultural Identity Development, (6) Experience with Bias, (7) Immigration Issues, (8) Existential/Spiritual Issues, (9) Counselor Characteristics and Behaviors, (10) Implications of Cultural Factors Between the Counselor and the Client, (11) Summary of Cultural Factors and Implications for Diagnosis, Case Conceptualization, and Treatment. An overview of this conceptual framework in presented below in Exhibit 8.1. The first nine categories in the conceptual framework are included in the Cultural Assessment Interview Protocol (CAIP), presented at the conclusion of this section. For the most part, data are gathered within the first nine categories through a direct interview and inquiry process with the client. It

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Exhibit 8.1. Overview of Conceptual Framework for Cultural Assessment Part One: Gathering Cultural Data. Cultural data are gathered from the client using a direct inquiry process, guided by the Cultural Assessment Interview Protocol (CAIP) (contained in the Appendix). 1. Problem Conceptualization and Attitudes Toward Helping. • Client’s (and family’s) explanation for current concerns • Client’s (and family’s) views regarding what would be helpful in addressing concerns • Exploration of potentially negative feelings regarding seeking psychological help • Client’s initial goals 2. Cultural Identity. • Client’s (and family’s) cultural self-definitions and preferred designations • Most salient cultural factors for the client (and family) • Exploration of potential conflicts between the client and the family regarding cultural identity 3. Level of Acculturation. • Client’s (and family’s) relative degrees of comfort with aspects of mainstream American culture • Client’s (and family’s) language dominance • Exploration of potential bicultural strain for the client • Exploration of sources of help outside the family 4. Family Structure and Expectations. • Client’s definition of family and delineation of who is included • Client’s (and family’s) socioeconomic status • Client’s perception of authority figures and other important persons in the family • Client’s role in the family • Family values and expectations regarding significant issues • Exploration of possible consequences for the client if family expectations are violated 5. Level of Racial/Cultural Identity Development. • Salience of race/culture for the client • Positive and negative feelings about the client’s race/culture • Client’s social network • Client’s development as a member of her or his racial/cultural group 6. Experiences with Bias. • Examples of racism, sexism, homophobia, or other forms of oppression that the client (or family) may have experienced • Impacts of these experiences for the client (and the family) • Exploration of the potential relationship between these experiences and current concerns (continued overleaf )

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142 HANDBOOK OF MULTICULTURAL ASSESSMENT Exhibit 8.1. (continued) 7. Immigration Issues. • Client’s (and family’s) country of origin • Circumstances and experiences surrounding leaving the country of origin • Losses incurred as a result of leaving the country of origin • Exploration of the client’s (and family’s) adjustment and adaptation to the United States • Client’s (and family’s) legal status in the United States 8. Existential/Spiritual Issues. • Salience of religion and spirituality for the client (and family) • Exploration of religion as a potential source of help or of conflict for the client • Exploration of overarching goals and issues of primary importance to the client 9. Counselor Characteristics and Behaviors. • Aspects of the counselor’s cultural identity that are of importance to the client • Exploration of the client’s perception of positive and negative behaviors on the part of the counselor • Explorations of the client’s perception of how the counselor can be helpful to the client Part Two: Integrating Cultural Data. The clinician is asked to integrate data based on her or his cultural self-appraisal and on the data gathered from the client in categories 1 through 9 into a coherent cultural formulation. 10. Implications of Cultural Factors Between the Counselor and the Client. • Identification of cultural factors for both the client and the counselor that could positively or adversely affect the therapeutic relationship • Identification of potential intraethnic or interethnic transference and/or countertransference • Disposition regarding the viability of the therapeutic relationship 11. Summary of Cultural Factors and Implications for Diagnosis, Case Conceptualization, and Treatment. • Comprehensive and systematic integration and analysis of critical cultural variables for the client, including sociopolitical and environmental variables that may be affecting the client’s level of functioning and may contribute to cultural explanations for the client’s problems • Implications of all salient cultural variables for determining next steps in the diagnostic process, as well as for case conceptualization, and the formulation of treatment goals and therapeutic interventions

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should be noted, however, that the clinician is expected to have engaged in an in-depth self-appraisal process with regard to each of these categories and that the self-appraisal process is ongoing (American Psychological Association, 2003; Sue et al., 1998). Of particular importance is the clinician’s awareness of her or his own level of racial/cultural identity development (category 5), which must be considered in concert with the client’s level of racial/cultural identity development as a critical factor in determining the viability of the clinician-client dyad (Helms and Cook, 1999). Furthermore, in assessing counselor characteristics and behaviors (category 9), as the clinician inquires as to the client’s views and preferences, these data must be incorporated into an honest appraisal of whether this clinician is the appropriate mental health care provider for this client (Dana, 2005; Ridley et al., 1998), a critical component of category 10. A thoughtful consideration of the cultural elements in the therapeutic dyad allows for the anticipation of potential areas of cultural conflict as well as interethnic and intraethnic transference and countertransference (Ton and Lim, 2006). Furthermore, as suggested by the DSM-IV-TR (American Psychiatric Association, 2000), the clinician must consider cultural elements in the therapeutic dyad as a part of her or his overall cultural formulation. In category 11 of the conceptual framework, the clinician is asked to summarize the culturally relevant data gleaned in the previous ten categories and integrate them into a coherent set of implications for diagnosis and for care of the client (American Psychiatric Association, 2000). Each of the eleven categories in the conceptual framework for cultural assessment will be addressed in turn.

1. Problem Conceptualization and Attitudes Toward Helping The first assessment category contains ten questions that address the client’s and his or her family members’ (for example, parents, partner or spouse, children) perception and understanding of the problem, as well as their attitudes about the client’s being in counseling. Implicit in these initial questions is an evaluation of the client’s (and the client’s family’s) level of psychological-mindedness, as he or she is asked to locate the presenting concern within a particular etiological context, for example, emotional or psychological, environmental, academic, physical, or spiritual or magical (Atkinson, Thompson, and Grant, 1993; Grieger and Ponterotto, 1995; Ponterotto et al., 2001). Furthermore, encouraging the client to articulate her or his own explanation as to possible causes of her or his problems can encourage the emergence of culture-specific factors (perhaps voodoo, demons, or spirits), as well as the presence of culture-bound syndromes (American Psychiatric Association, 2000). Also examined are the client’s traditional support systems, as well as his or her (and the family’s) beliefs about the path the helping process should take.

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144 HANDBOOK OF MULTICULTURAL ASSESSMENT This part of the inquiry also encourages the emergence of potential conflict between the client and his or her family around the issue of seeking psychological counseling (itself a Western, Eurocentric cultural construction). Furthermore, it presents an opportunity for the client to articulate how the counselor might assist in resolving this conflict. Finally, the client is asked to formulate early in the inquiry process what might be his or her goals for counseling.

2. Cultural Identity Ton and Lim (2006) have posited that ‘‘cultural identity can be understood as a multifaceted core set of identities that contribute to how an individual understands his or her environment’’ (p. 10). The cultural identity (using an inclusive definition of culture) of the client and family members is assessed by nine questions posited in this category. This segment of the inquiry encourages the client to give voice to those aspects of his or her culture that are most personally salient, as well as the preferred racial/ethnic/cultural designations for the client and for family members. The counselor can explore and attend to multiple cultural identities and their intersection, which have been shown to be significant for the provision of culturally competent assessment and treatment (Grieger and Ponterotto, 1995; Lowe and Mascher, 2001; Yeh and Hunter, 2005). Furthermore, questions in this category examine similarities and differences between the client’s and his or her family’s cultural identification in order to uncover potential conflicts or supports embedded within these similar or disparate cultural identifications. In addition to providing critical cultural data, the introduction of this topic early in the assessment process signals the client that cultural aspects of personal identity are important to the counselor and the therapeutic process. Particularly when there are significant cultural differences between the counselor and the client, directly addressing cultural issues has the potential to build rapport and facilitate the therapeutic alliance (Knox, Burkard, Johnson, Suzuki, and Ponterotto, 2003).

3. Level of Acculturation This category, which contains nine questions, focuses on assessing the client’s level of acculturation, as well as the level of acculturation of significant family members. Acculturation may be defined as a psychosocial and behavioral process by which individuals adapt to a new culture, most typically applied to immigrants adjusting to the host society (Ancis, 2004). Dana (2005) has noted that ‘‘all multicultural immigrant groups share involvement in an acculturation process requiring choices of preferences for acculturation outcomes that include assimilation, biculturality, marginality, and traditionality’’ (p. 23).

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This set of questions also provides information regarding potential acculturative stress or bicultural strain emanating from different levels of acculturation and biculturalism among various family members (for an in-depth discussion of acculturation stress and its sequelae, see Berry, 2006). For example, firstand second-generation Americans tend to be more acculturated, assimilated, or bicultural than are their immigrant parents or grandparents, creating potential conflicts in values, expectations, beliefs, and accepted behaviors, which may become a focus of treatment (Grieger and Ponterotto, 1995). Furthermore, immigrants may adapt a more traditional orientation for themselves by which they remain separate from the dominant culture (Dana, 2005), while being either more or less tolerant of their children’s becoming assimilated to the dominant culture. The attitude of the immigrant generation toward their children’s level of acculturation has strong implications for the possibility of negotiating cultural differences between these generations, as well as affecting the possible consequences of violating traditional norms (Grieger and Ponterotto, 1995). Issues of language strengths (for example, being fully bilingual) and challenges such as language code switching (client switching back and forth between English and native language culture-specific idioms during sessions) for the client and for her or his family are also discussed. Persons outside the immediate family may be identified as resources for the mediation of potential cultural conflicts.

4. Family Structure and Expectations The thirteen questions in this category assist the client in reflecting on her or his family structure and the constellation of familial expectations in which the client operates. The client’s perceptions of what and who constitute her or his family is assessed, as is the family’s socioeconomic level (Berg-Cross and Takishi-Chinen, 1995; Caraballo et al., 2006; Paniagua, 1998; Ridley et al., 1998). This aspect of the inquiry process challenges Western assumptions about nuclear families and encourages the client to provide his or her own definition of family, which may include extensive kinship networks, as well as individuals who are not biologically related to the client (Sue and Sue, 2003). Exploring socioeconomic status and eliciting the client’s description of his or her neighborhood and home may provide relevant data regarding environmental stressors that may be contributing to the client’s distress. The status and expected roles of family members are also explored, based on such variables as authority, power, gender, and sibling birth order. Decision-making processes commonly employed in the family are discussed, and the family’s usual mechanisms for addressing family conflict are reviewed. The client’s specific roles in the family are examined, as are expectations for

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146 HANDBOOK OF MULTICULTURAL ASSESSMENT the client in terms of life tasks such as education, career planning, dating and marriage, and offering various types of support to the family. Of particular importance within this category is the careful assessment of consequences for the client if family expectations are violated. It is critical for the clinician to understand that consequences can fall along a continuum that may vary from mild disappointment at one end, to rejection and banishment from the family, to the threat of physical violence against the client at the other end. It is clearly harmful for the clinician to ignore (or fail to explore) potentially serious and even dire consequences for the client in the naive and culturally encapsulated belief that everyone has the freedom ‘‘to do their own thing.’’ The failure to critically examine potential consequences with a client is a powerful example of what has been referred to as ‘‘cultural malpractice.’’

5. Level of Racial/Cultural Identity Development The ten questions in this category address the client’s level of racial/cultural identity, beginning with an assessment of whether this variable is of low or high salience to the client (Cross and Vandiver, 2001). The client’s feelings about his or her racial/cultural group are queried, including whether group membership serves as a source of strength and support or a source of potential confusion or shame (Atkinson, Morten and Sue, 1998; Helms, 1995). Attitudes toward interacting with others both inside and outside one’s racial and cultural group are also explored. With regard to this category, the counselor must honestly and rigorously assess her or his level of racial/cultural identity development and consider its interaction with the client’s level of racial/cultural identity development. Helms and Cook (1999) have delineated four categories of counselor/client interaction—parallel, progressive, regressive, and crossed—that can facilitate or impede the therapeutic alliance. It should be noted that levels of racial/cultural identity development within the clinician-client dyad are significant even when both parties are members of the same racial or ethnic group (Helms and Cook, 1999).

6. Experiences with Bias This category contains six questions that explore the client’s and her or his family’s experiences with bias, prejudice, and oppression, which may include acts of racism, sexism, homophobia, classism, and so forth. The impact that these experiences have had and are having on the client’s sense of well-being and level of functioning is assessed. The issue of whether and how these bias experiences are affecting the client’s presenting concerns is also examined. In

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this category, the issue of race-related and other culturally related traumas can be uncovered and explored (Utsey et al., 2001).

7. Immigration Issues The immigration history and current status of the client and his or her family are examined in depth in this category through nine questions. Family members’ adjustment levels and losses, such as loss of friends, other family members, status, property, and cultural support, are discussed (Caraballo et al., 2006; Lee, 1990; Prendes-Lintel, 2001; Ridley et al., 1998). The current relationships that family members have with the country of origin and loved ones still there are explored. Importantly, current issues with regard to immigration, such as any legal concerns for family members, are reviewed. Most significant, in examining the circumstances surrounding the departure of the country of origin, potentially traumatizing experiences can be assessed and examined.

8. Existential/Spiritual Issues This category has eight questions directed at exploring the level of importance the client places on spirituality or religious beliefs. Spirituality and religion are assessed as possible sources of support or potential conflict. Clinicians should be aware that for some clients, non-Western constructions of religious or spiritual beliefs may include those that are viewed as magical from a Eurocentric perspective. Belief in witchcraft, voodoo, spells, spirits, or demons, for example, may be culturally consistent and therefore may not necessarily represent symptoms of psychopathology. Existential questions concerning important life tasks and goals are also explored, which yields important information about the client’s fundamental values, individual versus collective orientation, and other significant data related to worldview (Dana, 2005). This category concludes by affording the client an opportunity to add information about her or his beliefs, values, cultural identity, and family history that may be salient to diagnosis and treatment.

9. Counselor Characteristics and Behaviors The last assessment category that yields information directly from the client asks five questions about the client’s perception of potential counselor behaviors that he or she would find helpful or unhelpful. Aspects of the counselor’s identity and worldview that are of importance to the client at the start of counseling are discussed. This category assists the clinician in the process of determining the impact of relevant cultural factors on the viability of the therapeutic relationship (American Psychiatric Association, 2000).

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10. Implications of Cultural Factors Between the Counselor and the Client Based on information about the client gleaned from the CAIP and the counselor’s own ongoing process of cultural self-appraisal, he or she is asked to make a determination as to which cultural factors are most salient for the quality and even the viability of the therapeutic relationship. Among the cultural factors that would adversely affect the therapeutic relationship are divergent and incompatible schemas regarding the etiology of the client’s problems and concerns (Ton and Lim, 2006); regressive or crossed relationships between the client and counselor resultant from their disparate levels of racial identity development (Helms and Cook, 1999); inadequate knowledge about the client’s culture; inadequate multicultural intervention skills; language barriers; or incompatible values, religious beliefs, and worldviews. Negative interethnic or intraethnic transference or countertransference are of particular salience to the therapeutic relationship (Caraballo et al., 2006; Comas-Diaz and Jacobsen, 1991; Ton and Lim, 2006). Examples of interethnic transference are distrust, overcompliance, or hostility; examples of interethnic countertransference are the denial of cultural factors, guilt, or overprotection of the client. Intraethnic transference may be characterized by idealizing or, alternatively, underestimating the therapist’s level of competence, or viewing him or her as a traitor or ‘‘sell-out.’’ Intraethnic countertransference may include overidentification with or, alternatively, distancing oneself from the client and frustration, impatience, or anger toward the client (Comas-Diaz and Jacobsen, 1991). The clinician is ethically bound to scrupulously and rigorously assess the presence of potentially incompatible cultural factors in order to determine whether it is appropriate to continue to treat this client, and if so, whether cultural consultation or a cultural informant is needed to provide culturally competent treatment (Caraballo et al., 2006; Sue and Sue, 2003). Furthermore, the clinician must determine whether a referral to another clinician with greater insight about the client’s cultural background or a higher level of multicultural clinical skills is the appropriate course of action (see American Psychiatric Association, 2000).

11. Summary of Cultural Factors and Implications for Diagnosis, Case Conceptualization, and Treatment In the final category of the conceptual framework for cultural assessment, the clinician is asked to summarize the cultural factors that most closely inform diagnosis, case conceptualization, and treatment. Of particular importance are understanding and integrating the client’s cultural identity, her or his

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explanatory model for what is causing the client’s current problems, and the client’s view regarding helpful interventions and appropriate behaviors on the part of the clinician. Immediate environmental stressors, including bias and oppression, historical sociopolitically based trauma, and acculturative stress, should be viewed as particularly significant factors contributing to the client’s symptomotology and level of functioning. Therefore, the utility of gathering and integrating these cultural data prior to formal psychological testing or rendering a DSM diagnosis should be clear: the cultural formulation of the clinician must inform the selection of diagnostic instruments and create the cultural context in which an accurate diagnosis can be made. Similarly, the clinician cannot formulate a useful case conceptualization absent a complete and rich understanding of the client’s worldview. Most significant, appropriate treatment cannot be provided, or positive therapeutic outcomes achieved, without the clinician’s appreciating those cultural factors that are most salient for the client. For example, the failure to incorporate the client’s spiritual beliefs, cultural values, or fundamental individualistic versus collectivistic orientation may well lead to ineffective treatment, a poor therapeutic alliance, and premature termination. Furthermore, the failure to appreciate the consequences for the client’s violation of cultural norms and expectations can lead to considerable harm. The clinician is therefore urged to promulgate a thoughtful and meticulous cultural formulation in order to select therapeutic goals, orientations, and interventions that are most helpful and useful for the client and that reflect best practices with regard to multicultural clinical competence. In order to assist the clinician in achieving that end, the Cultural Assessment Interview Protocol is presented in the chapter appendix.

SUGGESTIONS FOR IMPLEMENTATION This chapter concludes with suggestions for incorporating the CAIP into clinical practice: • As would be the case with any assessment tool, the clinician should take care to establish rapport with the client, paying particular attention to culturally appropriate styles of communication. • Prior to engaging in the CAIP inquiry process, the client should be educated and prepared as to its purpose and should be given the opportunity to provide informed consent. • In using the CAIP, the clinician need not ask each question precisely as it is formulated or in its exact order. • In using the CAIP, the clinician need not ask every question of every client or feel compelled to complete the inquiry process in one session.

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150 HANDBOOK OF MULTICULTURAL ASSESSMENT • In deciding how much cultural information to gather regarding the client’s family, the clinician should consider the client’s level of acculturation, age, and current attachment to and involvement with the family. • Care should be taken that the CAIP inquiry process be a conversation between the clinician and the client rather than an interrogation of the client. Therefore, the clinician should pay close attention to the client’s verbal and nonverbal cues as to his or her comfort level with the inquiry process. • The clinician should make sure that the client understands the questions that are posed and should provide an appropriate interpreter for the client if necessary. • The clinician should be satisfied at the conclusion of the inquiry process that she or he has gathered sufficient information for constructing a complete cultural formulation of the client. • In considering a diagnosis for the client, the clinician should take care to avoid overpathologizing by ignoring cultural factors and, conversely, should avoid underdiagnosing by overattributing symptoms to cultural factors. • In order to make best use of the CAIP or other culturally appropriate inquiry tools, the clinician must engage in a continuous process of cultural self-appraisal and self-awareness, continue to learn about a particular client’s cultural background, and continue to refine his or her multicultural clinical skills. Finally, it is important to remember that the CAIP is a part of the diagnostic assessment process; it should precede more formal psychological assessment and the rendering of a DSM diagnosis. The ethical and clinical imperative to engage in a meticulous and comprehensive process of multicultural assessment in order to fully understand the individual client within his or her own cultural context has been eloquently summarized by Dana (2005): ‘‘Knowledge, or what has been called cultural literacy, is absolutely necessary for assessors. However, neglect of experiential-phenomenological understanding in pursuit of this knowledge can lead to stereotyping clients by identifying them exclusively with their cultures rather than as culturally identified individuals with varying admixtures of dimensions, contents, and boundary characteristics of a cultural self’’ (p. 76). Engaging in the experiential-phenomenological inquiry process delineated in the Cultural Assessment Interview Protocol can facilitate the emergence of the client’s authentic cultural self, which will inform the highest level of care for every client.

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APPENDIX: THE CULTURAL ASSESSMENT INTERVIEW PROTOCOL 1. Problem Conceptualization and Attitudes Toward Helping. 1. How do you define/view/conceptualize the problem that brought you into counseling (e.g., emotional/psychological, behavioral, professional, religious-spiritual/magical, academic, interpersonal, physical illness, environmental stressors, cultural, bias-related)? 2. What do you think is causing your current problem? 3. How is this problem affecting you/your life? 4. Who do you typically turn to for help in solving your problems? Have you previously turned to professional sources of help in solving your problems? 5. Are members of your family (i.e., parents, partner/spouse, children) aware of this problem? If so, how do they define/view/conceptualize the problem? 6. What do you think would be helpful in resolving your problem? 7. What does your family think would be helpful in resolving your problem? 8. Is your family aware that you are seeking counseling? How do they feel about that? 9. If your family has (or would have) a negative feeling about your seeking counseling, does this affect your level of comfort in seeking counseling? If yes, what do you need in order to feel comfortable in counseling? 10. What are your goals for counseling? 2. Cultural Identity. 1. How do you identify yourself culturally (e.g., race, biracial, ethnicity, nationality, religion, sexual orientation, age, physical challenges or any other delineation that the client cares to make)? 2. Is there a particular term/designation that you prefer? (If the client identifies as biracial: Do you identify more with one race than the other? With both equally?) 3. What aspects of your culture are most important to you? 4. Are there aspects of your cultural identity that would be especially important for me (your counselor) to know about?

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152 HANDBOOK OF MULTICULTURAL ASSESSMENT 5. Are there any aspects of how you identify culturally that cause problems for you or your family? 6. How does your family identify itself culturally? 7. Do you see any differences between your own cultural identity and that of your family? If yes, does that create problems, issues, or concerns for you? 8. What aspects of your culture are most important to your family? 9. Do you see differences between the aspects of your culture that are important to you and those that are important to your family? If so, does this cause problems, issues, or concerns for you? 3. Level of Acculturation. 1. How comfortable do you feel with the mainstream American culture? 2. How comfortable do members of your family feel with the mainstream American culture? 3. Do you see differences between how comfortable you feel with the mainstream American culture and how comfortable your family feels? If so, does this create problems, issues, or concerns for you? 4. What language(s) is spoken in your family? 5. Are you bilingual? If yes, which language do you prefer to speak? 6. Are there aspects of your culture with which you don’t ‘‘fit in’’? If yes, what are they? 7. With regard to cultural differences that may exist between yourself and your family, how are they handled? 8. If there is a conflict with regard to cultural issues between you and your family, how is it resolved? 9. Are there resources outside of your immediate family (e.g., other relatives, family friends, godparents, members of the clergy, and indigenous sources of helping) who might be useful in resolving cultural conflicts? 4. Family Structure and Expectations. 1. Who do you consider to be the members of your family? 2. Who lives in your/your family’s household? 3. How would you describe your/your family’s socioeconomic status? 4. How would you describe your/your family’s home and neighborhood?

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5. Who is the most important member of your family to you? How is this person of importance to you (e.g., emotional or financial support, role model, confidant)? 6. Who is the authority figure in your family who makes major decisions? 7. What happens in the family if someone disagrees with a decision? 8. Who takes care of whom in your family? 9. Are there differences between how males and females are treated in your family? 10. What is your birth order among your siblings (if any)? What is your role in the family? 11. What are some important expectations (e.g., academics, career, helping out the family, dating, gender roles, choice of spouse, etc.) that your family has for you? 12. What criteria would your family use in determining whether you are ‘‘successful’’? 13. If you were to choose to do something that goes against your family’s beliefs, values, or expectations, what would be the consequences? How do you feel about that? 5. Level of Racial/Cultural Identity Development.1 1. How important is membership in your particular racial/cultural group to you? 2. How important is membership in your particular racial/cultural group to your family? 3. What does it mean to you to be a member of your racial/cultural group? 4. What strengths do you derive from your membership in/affiliation with your racial/cultural group? 5. Are there negative aspects of being a member of your particular racial/cultural group? 6. Are there negative feelings that you have about being a member of your particular racial/cultural group? 7. Are there particular experiences that you have had that have heightened your awareness of your membership in your racial/cultural group? 8. Do you prefer to spend time mostly with members of your own racial/cultural group? If yes, how is that important to you? If not, why is this the case? 9. In general, who is in your social network?

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154 HANDBOOK OF MULTICULTURAL ASSESSMENT 10. In terms of your personal growth, how do you see yourself developing further as a member of your racial/cultural group? 6. Experiences with Bias. 1. Are there experiences related to bias, prejudice, or oppression (e.g., racism, sexism, physical disabilities, homophobia, nonprivilege) that you would like to discuss? 2. What effect have these experiences had on you? 3. Are there experiences related to bias, prejudice, or oppression that your family has experienced? 4. What effect have these experiences had on you and on your family members? 5. Do you believe that your current concern is related to these experiences? 6. Is there anything else with regard to experiences that you may have had with bias or prejudice that would be useful for me (your counselor) to know? 7. Immigration Issues. 1. What is your/your family’s country of origin? 2. When did you/your family emigrate from your/their country of origin? 3. What were the circumstances surrounding your/your family leaving your country of origin (e.g., voluntary, escaping political oppression, war, torture or other trauma)? 4. Is there anything significant about the actual process of coming to the United States that you would like me (your counselor) to know? 5. Did your entire family emigrate to the United States at the same time? Were you separated from family members during the process of emigration? If yes, what was that like for you? 6. How have you/your family adjusted to life in the United States? 7. Are there losses that you/your family incurred as a result of leaving your country of origin (e.g., family members, friends, work, property, cultural support, status)? 8. Do you or members of your family go back and forth between the United States and your country of origin? Ultimately, do you and your family intend to settle here? 9. Are there any problems related to the immigration process or to your current legal status in the United States that would be useful for me (your counselor) to know about?

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8. Existential/Spiritual Issues. 1. How important are spiritual or religious beliefs to you? 2. How important are spiritual or religious beliefs to your family? 3. How might your spiritual or religious beliefs and/or those of your family be helpful with regard to resolving your current problem? 4. Are there ways in which your religious or spiritual beliefs and/or those of your family might make it difficult for you to resolve your current problem? 5. What are the things in life that are most important to you? 6. Ultimately what are the most important goals that you have for your life? 7. What criteria would you use to determine whether you are ‘‘successful’’? 8. Are there any other aspects of your culture, values, beliefs and experiences that would be important for me (your counselor) to know about? 9. Counselor Characteristics and Behaviors. 1. Are there aspects of my (your counselor’s) identity (e.g., race, ethnicity, gender, language spoken, religious and spiritual beliefs, nationality, sexual orientation, age) that are important to you? 2. If yes, what are they? 3. What behaviors on my part (on the part of your counselor) would be important and useful for you? 4. Are there behaviors on my part (on the part of your counselor) that you would view negatively? 5. What are some ways that I (your counselor) can be helpful to you in reaching your goals?

Note 1. In this category, the counselor’s own level of racial/cultural identity development is assessed, as is the interaction between the client’s level of racial/cultural identity development and that of the counselor. Stages of racial identity development for racial/cultural minority persons are conformity, dissonance and appreciation, resistance and immersion, introspection, and integrative awareness (Atkinson et al., 1998). Stages (also called statuses) of racial identity development for Whites are contact, disintegration, reintegration, pseudo-independence, immersion/emersion, and autonomy (Helms, 1995). The types of relationships between the counselor and the client based on their respective levels of racial/cultural identity development are parallel, regressive, progressive, and crossed (Helms and Cook, 1999).

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References Allen, J., Vaage, A. B., & Hauff, E. (2006). Refugees and asylum seekers in societies. In D. L. Sam & J. W. Berry (Eds.), The Cambridge handbook of acculturation psychology (pp. 218–232). Cambridge: Cambridge University Press. American Counseling Association. (2005). Code of ethics. Alexandria, VA: Author. American Psychiatric Association. (2000). The diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author. American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060–1073. American Psychological Association. (2003). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist, 58, 377–402. Ancis, J. R. (2004). Culturally responsive practice. In J. R. Ancis (Ed.), Culturally responsive interventions: Innovative approaches to working with diverse populations (pp. 3–21). New York: Brunner-Routledge. Arredondo, P. (2002). Counseling individuals from marginalized and underserved groups. In P. B. Pedersen, J. G. Draguns, W. J. Lonner, & J. E. Trimble (Eds.), Counseling across cultures (5th ed., pp. 233–250). Thousand Oaks, CA: Sage. Arredondo, P. (2005). Immigration and transition: Implications or racial-cultural counseling and clinical practice. In R. T. Carter (Ed.), Handbook of racial-cultural psychology and counseling: Training and practice (Vol. 2, pp. 392–409). Hoboken, NJ: Wiley. Atkinson, D. R., Morten, G., & Sue, D. W. (1998). Counseling American minorities (5th ed.). New York: McGraw-Hill. Atkinson, D. R., Thompson, C., & Grant, S. (1993). A three-dimensional model for counseling racial/ethnic minorities. Counseling Psychologist, 21, 257–277. Berg-Cross, L., & Takishi-Chinen, R. (1995). Multicultural training models and the Person-in-Culture interview. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. Alexander (Eds.), Handbook of multicultural counseling (pp. 333–356). Thousand Oaks, CA: Sage. Berry, J. W. (2006). Stress perspectives on acculturation. In D. L. Sam & J. W. Berry (Eds.), The Cambridge handbook of acculturation psychology (pp. 43–57). Cambridge: Cambridge University Press. Bryant-Davis, T., & Ocampo, C. (2005a). Racist incident-based trauma. Counseling Psychologist, 33, 479–500. Bryant-Davis, T., & Ocampo, C. (2005b). The trauma of racism: Implications for counseling, research, and education. Counseling Psychologist, 33, 574–578. Caldwell, L. D., & Tarver, D. D. (2005). An ethical code for racial-cultural practice: Filling gaps and confronting contradictions in existing ethical guidelines. In R. T. Carter (Ed.), Handbook of racial-cultural psychology and counseling: Training and practice (Vol. 2, pp. 514–527). Hoboken, NJ: Wiley.

A CULTURAL ASSESSMENT FRAMEWORK AND INTERVIEW PROTOCOL California Endowment. (2003). Principles and recommended standards for cultural competence education of health care professionals. Woodland Hills, CA: California Endowment. Retrieved January 15, 2007, from http://www.calendow.org/reference/ publications/pdf/cultural/TCE0215-2003 Principles and.pdf. Caraballo, A., Hamada, H., Lee, J. R., McQuery, J. D., Rho, Y., Kramer, E. J., et al. (2006). A residence guide to cultural formulation. In R. F. Lim (Ed.), Clinical manual of cultural psychiatry (pp. 243–269). Washington, DC: American Psychiatric Publishing. Carter, R. T. (1995). The influence of race and racial identity in psychotherapy: Toward a racially inclusive model. Hoboken, NJ: Wiley. Carter, R. T., Forsyth, J. M., Mazzula, S. L., & Williams, B. (2005). Racial discrimination and race-based traumatic stress: An exploratory investigation. In R. T. Carter (Ed.), Handbook of racial-cultural psychology and counseling: Vol. 2, Training and practice (pp. 447–476). Hoboken, NJ: Wiley. Coleman, H.L.K., Norton, R. A., Miranda, G. E., & McCubbin, L. (2003). An ecological perspective on cultural identity development. In D. B. Pope-Davis, H.L.K. Coleman, W. M. Liu, & R. L. Toporek (Eds.), Handbook of multicultural competencies in counseling and psychology (pp. 38–58). Thousand Oaks, CA: Sage. Comas-Diaz, L., & Jacobsen, F. M. (1991). Ethnocultural transference and countertransference in the therapeutic dyad. American Journal of Orthopsychiatry, 61, 392–402. Comas-Diaz, L., & Jacobsen, F. M. (2001). Ethnocultural allodynia. Journal of Psychotherapy Practice and Research, 10, 246–252. Constantine, M. G. (1999). Spiritual and religious issues in counseling racial and ethnic minority populations: An introduction to the special issue. Journal of Multicultural Counseling and Development, 27, 179–181. Constantine, M. G., & Ladany, N. (2001). New visions for defining and assessing multicultural counseling competence. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 482–498). Thousand Oaks, CA: Sage. Constantine, M. G., Watt, S. K., Gainor, K. A., & Warren, A. K. (2005). The influence of Cross’s initial Black racial identity theory on other cultural identity conceptualizations. In R. T. Carter (Ed.), Handbook of racial-cultural psychology and counseling: Vol. 1, Theory and research (pp. 94–114). Hoboken, NJ: Wiley. Constantine, M. G., & Wilton, L. (2005). The role of racial and cultural constructs in the history of the multicultural counseling movement. In R. T. Carter (Ed.), Handbook of racial-cultural psychology and counseling: Vol. 1, Theory and research (pp. 64–77). Hoboken, NJ: Wiley. Cross, W. E., Jr., & Vandiver, B. J. (2001). Nigrescence theory and measurement: Introducing the Cross Racial Identity Scale (CRIS). In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 371–393). Thousand Oaks, CA: Sage.

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158 HANDBOOK OF MULTICULTURAL ASSESSMENT Croteau, J. M., Bieschke, K. J., Phillips, J. C., & Lark, J. S. (1998). Moving beyond pioneering: Empirical and theoretical perspectives on lesbian, gay, and bisexual affirmative training. Counseling Psychologist, 26, 707–711. Dana, R. H. (1998). Understanding cultural identity in intervention and assessment. Thousand Oaks, CA: Sage. Dana, R. H. (Ed.). (2000). Handbook of cross-cultural and multicultural personality assessment. Mahwah, NJ: Erlbaum. Dana, R. H. (2001). Clinical diagnosis of multicultural populations in the United States. In L. A. Suzuki, J. G. Ponterotto, & P. J. Meller (Eds.), Handbook of multicultural assessment: Clinical, psychological, and educational applications (2nd ed., pp. 101–131). San Francisco: Jossey-Bass. Dana, R. H. (2005). Multicultural assessment: Principles, applications, and examples. Mahwah, NJ: Erlbaum. Fischer, A. R., & Moradi, B. (2001). Racial and ethic identity: Recent developments and needed directions. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 341–370). Thousand Oaks, CA: Sage. Fukuyama, M. A., & Sevig, T. D. (1999). Integrating spirituality into multicultural counseling. Thousand Oaks, CA: Sage. Grieger, I., & Ponterotto, J. G. (1995). A framework for assessment in multicultural counseling. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (pp. 357–374). Thousand Oaks, CA: Sage. Grieger, I., & Ponterotto, J.G. (1998). Challenging intolerance. In C. C. Lee & G. R. Walz (Eds.), Social action: A mandate for counselors (pp. 17–50). Alexandria, VA: American Counseling Association. Grieger, I., & Toliver, S. (2001). Multiculturalism on predominantly White campuses: Multiple roles and functions for the counselor. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 825–848). Thousand Oaks, CA: Sage. Helms, J. E. (1995). An update of Helms’s White and people of color racial identity models. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (pp. 181–189). Thousand Oaks, CA: Sage. Helms J. E., & Cook, D. A. (1999). Using race and culture in counseling and psychotherapy: Theory and process. Needham Heights, MA: Allyn & Bacon. Ibrahim, F. A., & Cameron, S. C. (2005). Racial-cultural ethical issues in research. In R. T. Carter (Ed.), Handbook of racial-cultural psychology and counseling: Vol. 1, Theory and research (pp. 391–413). Hoboken, NJ: Wiley. Kim, B.S.K., & Abreu, J. M. (2001). Acculturation measurement: Theory, current instruments, and future directions. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 394–424). Thousand Oaks, CA: Sage.

A CULTURAL ASSESSMENT FRAMEWORK AND INTERVIEW PROTOCOL Knox, S., Burkard, A. W., Johnson, A. J., Suzuki, L. A., & Ponterotto, J. G. (2003). African American and European American therapists’ experiences of addressing race in cross-racial psychotherapy dyads. Journal of Counseling Psychology, 50, 466–481. Lee, E. (1990). Assessment and treatment of Chinese-American immigrant families. In G. W. Saba, B. M. Carrer, & K. V. Hardy (Eds.), Minority and family therapy (pp. 191–202). New York: Haworth. Lim, R. F. (Ed.). (2006). Clinical manual of cultural psychiatry. Washington, DC: American Psychiatric Association. Lonner, W. J., & Ibrahim, F. A. (2008). Assessment and appraisal in cross-cultural counseling. In P. B. Pedersen, J. G. Draguns, W. L. Lonner, & J. E. Trimble (Eds.), Counseling across cultures (6th ed., pp. 37–55). Thousand Oaks, CA: Sage. Lowe, S. M., & Mascher, J. (2001). The role of sexual orientation in multicultural counseling: Integrating bodies of knowledge. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 755–778). Thousand Oaks, CA: Sage. Lu, F. G., Lim, R. F., & Mezzich, J. E. (1995). Issues in the assessment and diagnosis of culturally diverse individuals. In J. M. Oldham & M. B. Riba (Eds.), American Psychiatric Press review of psychiatry (Vol. 14, pp. 477–510). Washington, DC: American Psychiatric Press. McIntosh, P. (1988). White privilege and male privilege: A personal account of coming to see correspondences through work in women’s studies. Wellesley, MA: Wellesley College, Center for Research on Women. Neville, H. A., Worthington, R. L., & Spanierman, L. B. (2001). Race, power, and multicultural counseling psychology: Understanding White privilege and color-blind racial attitudes. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 257–288). Thousand Oaks, CA: Sage. Pack-Brown, S. P., & Williams, C. B. (2003). Ethics in a multicultural context. Thousand Oaks, CA: Sage. Paniagua, F. A. (1998). Assessing and treating culturally diverse clients: A practical guide (2nd ed.). Thousand Oaks, CA: Sage. Paniagua, F. A. (2001). Diagnosis in a multicultural context: A casebook for mental health professionals. Thousand Oaks, CA: Sage. Ponterotto, J. G., Gretchen, D. E., & Chauhan, R. (2001). Cultural identity and multicultural assessment: Quantitative and qualitative tools for the clinician. In L. A Suzuki, J. G. Ponterotto, & P. J. Meller (Eds.), Handbook of multicultural assessment: Clinical, psychological, and educational applications (2nd ed., pp. 67–99). San Francisco: Jossey-Bass. Ponterotto, J. G., Utsey, S. O., & Pedersen, P. B. (2006). Preventing prejudice: A guide for counselors, educators, and parents (2nd ed.). Thousand Oaks, CA: Sage.

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160 HANDBOOK OF MULTICULTURAL ASSESSMENT Prediger, D. J. (1994). Multicultural assessment standards: A compilation for counselors. Measurement and Evaluation in Counseling and Development, 27, 68–73. Prendes-Lintel, M. (2001). A working model in counseling recent refugees. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 729–752). Thousand Oaks, CA: Sage. Ridley, C. R., Li, L. C., & Hill, C. L. (1998). Multicultural assessment: Reexamination, reconceptualization, and practice application. Counseling Psychologist, 26, 827–910. Smith, T. B., & Richards, P. S. (2005). The integration of spiritual and religious issues in racial-cultural psychology and counseling. In R. T. Carter (Ed.), Handbook of racial-cultural psychology and counseling: Vol. 1, Theory and research (pp. 132–160). Hoboken, NJ: Wiley. Spitzer, R. L., Gibbon, M., Skodol, A. E., Williams, J.B.W., & First, M. B. (Eds.). (2002). DSM-IV-TR casebook: A learning companion to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Publishing. Sue, D. W., Bernier, J. B., Durran, M., Feinberg, L., Pedersen, P., Smith, E., & Vazquez-Nuttal, E. (1982). Position paper: Cross-cultural counseling competencies. The Counseling Psychologist, 10, 45–52. Sue, D. W., Carter, R. T., Casas, J. M., Fouad, N. A., Ivey, A. E., Jensen, M., LaFromboise, T., Manese, J. E., Ponterotto, J. G., & Vazquez-Nutall, E. (1998). Multicultural counseling competencies: Individual and organizational development. Thousand Oaks, CA: Sage. Sue, D. W., Ivey, A. E., & Pedersen, P. B. (1996). A theory of multicultural counseling and therapy. Pacific Grove, CA: Brooks/Cole. Sue, D. W., & Sue, D. (2003). Counseling the culturally diverse: Theory and practice (4th ed.). Hoboken, NJ: Wiley. Sue, D. W., & Torino, G. C. (2005). Racial-cultural competence: Awareness, knowledge, and skills. In R. T. Carter (Ed.), Handbook of racial-cultural psychology and counseling: Vol. 2, Training and practice (pp. 3–18). Hoboken, NJ: Wiley. Sue, S., Fujino, D. C., Hu, L., Takeuchi, D. T., & Zane, N.W.S. (1991). Community mental health services for ethnic minority groups: A test of the cultural responsiveness hypothesis. Journal of Consulting and Clinical Psychology, 59, 533–540. Suzuki, L. A., Ponterotto, J. G., & Meller, P. J. (Eds.). (2001). Handbook of multicultural assessment: Clinical, psychological, and educational applications (2nd ed.). San Francisco: Jossey-Bass. Ton, H., & Lim, R. F. (2006). The assessment of culturally diverse individuals. In R. F. Lin (Ed.), Clinical manual of cultural psychiatry (pp. 3–31). Washington, DC: American Psychiatric Publishing. Toporek, R. L., & Williams, R. A. (2006). Ethics and professional issues related to the practice of social justice in counseling psychology. In R. L. Toporek, L. H. Gerstein, N. A. Fouad, G. Roysircar, & T. Israel (Eds.), Handbook for social justice in counseling psychology: Leadership, vision, and action (pp. 17–34). Thousand Oaks, CA: Sage.

A CULTURAL ASSESSMENT FRAMEWORK AND INTERVIEW PROTOCOL Trimble, J. E., & Fisher, C. B. (Eds.). (2006). The handbook of ethical research with ethnocultural populations and communities. Thousand Oaks, CA: Sage. Utsey, S. O., Bolden, M. A., & Brown, A. L. (2001). Visions of revolution from the spirit of Franz Fanon: A psychology of liberation for counseling African Americans confronting societal racism and oppression. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 311–336). Thousand Oaks, CA: Sage. Utsey, S. O., Lanier, Y., Williams, III, O., Bolden, M. A., & Lee, A. (2006). Moderator effects of cognitive ability and social support on the relation between race-related stress and quality of life in a community sample of Black Americans. Cultural Diversity and Ethnic Minority Psychology, 12, 334–346. Wade, J. C. (2005). The issue of race in counseling psychology. Counseling Psychologist, 33, 538–546. Yeh, C. J., & Hunter, C. D. (2005). The socialization of self: Understanding the shifting and multiple selves across cultures. In R. T. Carter (Ed.), Handbook of racial-cultural psychology and counseling: Vol. 1, Theory and research (pp. 121–137). Hoboken, NJ: Wiley.

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SECTION TWO

ASSESSING IMMIGRANTS AND REFUGEES

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he three chapters in this section focus on assessment issues of immigrants, refugees, and asylum seekers. The authors of this section, a new addition to the Handbook, represent experts working in the field in the United States and abroad. The chapters set out a number of illustrative cases that enable readers to gain a glimpse of the experiences of refugees and torture survivors. Topics include overall assessment considerations, cultural adaptation and translation of measures, and using interpreters in delivery of services. Chapter Nine, by Judy B. Okawa, describes critical issues pertaining to refugees and asylum seekers, integrating issues of culture in the evaluation process, and considerations in the selection of psychological instruments. Issues of trauma are addressed along with specific cultural issues that may influence the assessment process, such as body language, grooming and attire, orientation to time, cognitive functioning, and nonverbal communication. Chapter Ten, by Mary Fabri, discusses modifications and adjustments required to provide appropriate services to the ‘‘displaced, the traumatized, and the ethnically diverse.’’ The author’s work in Rwanda since the 1994 genocide provides a context for the work done in adapting and translating measures. Particular attention is given to the translation process of the Harvard Trauma Questionnaire.

164 HANDBOOK OF MULTICULTURAL ASSESSMENT Chapter Eleven, by Maria Prendes-Lintel and Francisca Peterson, is based on the authors’ experiences as founders of the For Immigrants and Refugees Surviving Torture Project, located in Lincoln, Nebraska. The authors discuss interpreter selection and training, provide materials regarding ethics and a training curriculum, and share dilemmas they have faced in using interpreters in mental health treatment.

CHAPTER NINE

Considerations for the Cross-Cultural Evaluation of Refugees and Asylum Seekers Judy B. Okawa

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he cultural and ethnic landscape of the United States is becoming increasingly diverse, with people from all over the world entering the United States legally at the rate of approximately 400,000 per year (Batalova, 2006). The ethnic and cultural makeup of the country is changing so rapidly that according to the 2000 census data, half of all Americans will belong to an ethnic minority group within fifty years (Hall, 2005). Among the new arrivals is a subset consisting of refugees and asylum seekers who, unlike immigrants who come here by choice, have fled their home countries because of persecution. In 2005 alone, over 53,000 people were granted refugee status and resettled in the United States (Jeffreys, 2005).1 Since 1990, nearly 345,000 foreign nationals have been granted asylum in the United States, an average of approximately 27,500 a year (U.S. Department of Homeland Security, 2005).2 With the face of the United States changing so rapidly, mental health professionals face significant challenges in determining ethical and culturally appropriate strategies for the psychological evaluation of such a diverse client group. The purpose of this chapter is threefold: (1) to describe briefly what refugees and asylum seekers are, what types of experiences they may have had, and why they may choose or be referred for evaluation; (2) to discuss considerations about cultural differences that clinicians engaged in the cross-cultural psychological evaluation of these clients must keep in mind; and (3) to discuss issues related to the selection of psychological instruments for use with refugees and asylum seekers.

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REFUGEES AND ASYLUM SEEKERS A refugee is defined in U.S. law as a person who is outside his or her country and ‘‘is unable or unwilling to return to, and is unable or unwilling to avail himself or herself of the protection of that country, because of persecution or a well-founded fear of persecution’’ on account of one of five grounds: race, religion, nationality, membership in a particular social group, or political opinion’’ (Immigration and Nationality Act b101(a)(42)(A), cited in Jefferys, 2005, p. 1). Refugees are interviewed abroad, usually in the country to which they have fled and where they may reside in refugee camps. If they qualify for refugee status according to U.S. law, they are allowed to relocate to the United States, where they are eligible for refugee services and benefits for a limited period of time. Asylum seekers must also meet the definition of a refugee. However, unlike refugees, asylum seekers come to the United States seeking a safe harbor and request asylum once they arrive. The U.S. government may grant asylum at its discretion if the asylum seeker meets the refugee definition and can demonstrate that past persecution or fear of future persecution is sufficient to make him or her eligible for asylum. In addition, the asylum seeker must meet the ‘‘nexus requirement,’’ which is to demonstrate that the persecution was on account of race, religion, nationality, membership in a particular social group, or political opinion (Physicians for Human Rights, 2001). After submitting an application for asylum, asylum seekers face a lengthy ordeal, sometimes lasting years, while their requests for asylum are adjudicated. During this time, they are ineligible for any benefits whatsoever and are forced to find a way to survive until they are eligible for work permits. The asylum process is particularly traumatic for the significant proportion of asylum seekers who have suffered torture in their countries. While waiting for their cases to be adjudicated, they live under constant fear of forced repatriation, in addition to the stresses resulting from not being allowed to work, such as inability to obtain housing, food, clothing, transportation, or medical care. Many asylum seekers, including unaccompanied minors, are imprisoned in detention centers when they arrive in the United States and must endure a lengthy wait for their cases to be adjudicated there. Often they are imprisoned in jails alongside common criminals in conditions that replicate their traumatic experiences in their countries (Keller, 2003). I once evaluated a South Asian asylum seeker who had been detained and tortured by both government and rebel forces in his country before fleeing to the United States. He was detained for five years in an overcrowded jail cell with common criminals before his case was heard by an immigration judge, who then denied him asylum. Keller

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reports in his aptly titled study, From Persecution to Prison, that detention has significant ill effects on asylum seekers’ mental health.

Trauma in the Lives of Refugees and Asylum Seekers Many refugees and asylum seekers have experienced significant trauma before arriving in the United States, such as political repression, economic instability because of their ethnic group or their religious or political affiliation, threats to their lives, detention, torture, war, rape, beatings, or the death of loved ones. Unlike immigrants, who may have had time to plan for their move to the United States and make arrangements for transferring their belongings, refugees and asylum seekers are more likely to have fled their homes quickly, leaving behind their worldly possessions, jobs, and supportive social networks. Sometimes they have no choice but to flee without their documents, which creates significant problems for them in the country in which they resettle. Refugees often face lengthy stays in refugee camps, where they struggle for food, firewood, clothing, and safety and may suffer symptoms of posttraumatic stress or depression long after the original trauma (Onyet et al., 2004). A fourteen-year-old adolescent Somali refugee, Filsan, gave me the following account of her experiences resulting from clan warfare in her country:3

Example of Refugee Trauma When Filsan’s house was shelled during the warfare among clans in Somalia, she and ten family members all ran in different directions. It took her days to locate her mother and two of her siblings. While she was looking for them, Filsan encountered a soldier on the street questioning a young man. Discontented with the boy’s answers, the soldier hammered a nail in the boy’s skull, killing him immediately. Farther down the road, she saw the body of a family friend lying on the street. A man with a machine gun was urinating on him; he then hacked off her neighbor’s genitals and stuffed them in his mouth. To escape this violence, Filsan and her family members traveled on foot across the country to reach a refugee camp in Kenya, at one point narrowly escaping an attack by a lion. Once they arrived in the refugee camp, Filsan said, they were still not safe. They faced starvation and lived in constant fear of rape and murder because of the level of violence in the camp. Filsan was severely traumatized by this experience and was having trouble studying in school, finding new friends, and adapting to a culture so different from her own.

Torture Trauma. It is important for clinicians to be aware of the possibility that the refugee or asylum seeker may have been subjected to torture. Estimates are that between 5 and 35 percent of refugees worldwide have suffered torture

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168 HANDBOOK OF MULTICULTURAL ASSESSMENT (Basoglu, Jaranson, Mollica, and Kastrup, 2001). The United Nations definition of torture is ‘‘any act by which pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity’’ (United Nations, 1999, cited in Gerrity, Keane, and Tuma, 2001, p. 6). Amnesty International (2000) reports that more than 150 countries in the world practice or condone torture as an instrument of political oppression. Although the exact proportion of people seeking asylum in the United States who have been tortured is not available, over 400,000 torture survivors are estimated to live in the United States (U.S. Department of Health and Human Services, 2006). Torture is a devastating trauma that encompasses a broad range of techniques (Basoglu, 1992; Gerrity et al., 2001; Jaranson and Popkin, 1998; van der Veer, 1998). Physical torture techniques can include, among others, beatings; asphyxiation; near drowning; suspension from ceiling fans, walls, or trees; burning; and electric shock applied to sensitive parts of the body. Psychological torture may include, among other techniques, humiliation, degradation, death threats, mock executions, being forced to violate taboos, forced confessions, being forced to reveal intimate personal information, and being forced to witness the torture of others, including family members. Sexual torture can include sexual humiliation, rape, gang rape, being forced to commit sexual acts with other prisoners or with family members, and forced abortion, among others. In addition, there are a number of debilitating forms of deprivation, including nutritional deprivation (being deprived of food and water, forced to eat food that has been despoiled, forced to eat substances that are not food), sensory deprivation (such as solitary confinement, being imprisoned in the dark, or being imprisoned in a cell where the light is never turned off), sleep deprivation, social deprivation (being deprived of human contact, being deprived of visitors, having no access to information about the outside world), hygiene deprivation (being kept in a filthy environment, unable to wash or bathe), and deprivation of medical care. Survivors of torture commonly report being subjected to a combination of these forms of torture (Basoglu, 1992). Torture can have a profound effect on the survivor physically, mentally, socially, and spiritually. As Sister Dianna Ortiz explains, ‘‘The consequences of torture are multidimensional and interconnected: no part of the survivor’s life is untouched’’ (Ortiz, 2001, p. 15).4

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Example of Torture Trauma John is a torture survivor from an African country who was arrested while participating in a student demonstration organized by a political party opposed to the current regime.5 Soldiers beat John badly with their gun butts and took him to police headquarters. There he was ordered to take off his clothes and was forced naked into a small, insect-infested cell with eighteen other inmates. There was so little room that in order to sleep, they had to rotate, with some standing while others sat. The toilet consisted of a small, overflowing bucket. John reported that the stench was so overwhelming that it remains with him to this day. John was taken from the cell to a torture room many times for interrogation about his political activities. During these interrogations, he was subjected to severe beatings with fists, truncheons, and gun butts. His feet were beaten on the soles until they were bleeding and so swollen that he could not walk (a form of torture called falanga or bastinade). The torturers cupped their hands over his ears and beat them, causing intense pain, dizziness, and ultimately hearing loss (a form of torture called telefono). ´ His worst experience was when he was hung by his wrists from a large ceiling fan and was sent swinging in circles through the air while his torturers beat him. John also described experiencing debilitating psychological torture. He was subjected to constant verbal humiliation, forced to dance naked with a naked male prisoner, and told that if he did not sign a false confession, his sister would be detained and tortured in front of him. When John arrived in the United States, he was suffering from most of the symptoms of posttraumatic stress disorder and major depression. He was unable to talk about what had happened to him without reliving it, which made it difficult for him to work with his attorneys on his asylum case.

The Trauma of Resettlement. The psychological stresses faced by many refugees and asylum seekers do not end when they reach the safety of the United States, where they must learn to navigate the complex legal and social systems of a new culture. The challenges of resettlement can be so overwhelming that they are sometimes almost as painful as the refugees’ or asylum seekers’ original trauma. As a physician from Latin America who suffered severe torture before seeking asylum in the United States told me, ‘‘Coming here was the second torture.’’ Many refugees and asylum seekers face difficulty finding affordable housing in safe neighborhoods and suffer from poverty, language barriers, inability to afford medical care, and discrimination. The challenge of finding employment commensurate with the refugees’ and asylum seekers’ training and experience is enormous, since academic degrees from their countries are usually not recognized in the United States. Thus, a physician may work in a fast food restaurant and an attorney as a parking lot attendant. Many newcomers to the United States have reported painfully, ‘‘I am nothing here.’’

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170 HANDBOOK OF MULTICULTURAL ASSESSMENT Refugees and asylum seekers also suffer from the loss of their culture. Ji, Zhang, and Nisbett (2004) describe culture as ‘‘the shared values, beliefs and norms among a group of people, who most often speak the same language and live in proximity to each other’’ (p. 59), and Weiss and Berger (2006) describe it as ‘‘the lens through which individuals perceive and interpret the world and create meaning about their lives and the world’’ (p. 197). The impact of the loss of this shared lens involved in creating meaning about their lives cannot be underestimated. Even if the refugee or asylum seeker speaks English, he or she still faces the challenges of communicating with Americans, whose behaviors, speech, body language, beliefs, and judgment are influenced by very different, and unspoken, cultural assumptions.

Referral for Psychological Evaluation Refugees and asylum seekers may seek or be referred to a mental health professional for psychological assessment for a variety of reasons. In some cases, they may be referred because of the sequelae of the traumatic experiences that they suffered in their country of origin and during the flight to safety, which can affect their daily functioning and ability to adapt to the host country. Refugee children may be referred for evaluation by the school system because of difficulty learning or because of problematic behavior, which may stem from the traumatic experiences they endured as refugees.6 Sometimes refugees become embroiled in the legal system and are referred for evaluation to determine if mental health issues exist that could explain behavior. A refugee or asylum seeker may be referred by social services departments, such as child protective services, because of difficulty parenting and lack of understanding of the forms of discipline that are acceptable in the United States. Attorneys representing asylum seekers may request a mental health evaluation to evaluate the sequelae of persecution or torture and provide evidence of the nexus between this persecution and the asylum seeker’s race, religion, nationality, membership in a particular social group, or political opinion (Physicians for Human Rights, 2001).7

Psychological Evaluation of Refugees and Asylum Seekers The psychological evaluation of a refugee or asylum seeker can be fraught with challenges, not only because of the severity of traumatic experiences. At every point in the evaluation, unspoken and not easily discernable cultural issues are embedded in the client’s responses, and the evaluator’s own cultural underpinnings will affect his or her assumptions and conclusions about those responses. It is essential that the mental health professional first become aware of the degree to which his or her own assumptions are shaped by looking through the American cultural lens when evaluating a refugee or asylum

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seeker because drawing erroneous conclusions can have a serious impact on the client’s life. Lack of understanding of cultural differences can result in misdiagnoses, inappropriate interventions, inappropriate tracking into special education or vocational classes (Padilla, 2001), or in children being separated from their parents, thereby compounding, and in some cases replicating, the family’s traumatic experiences as refugees. In the case of an asylum seeker who is a torture survivor, an inaccurate evaluation could result in an immigration judge’s decision to have a torture survivor deported to the country where he or she may stand a good chance of being arrested and tortured again or even killed. To avoid making such errors in the psychological evaluation of refugees and asylum seekers requires an ‘‘openness to the other’’ (Fowers and Davidov, 2006, p. 582) and what Padilla (2001) calls ‘‘an incessant, basic, and active preoccupation with the culture of the group or individual being assessed’’ (p. 7). The remainder of this chapter focuses on the identification of crosscultural issues that may affect an evaluation and on considerations in the choice of psychological instruments for the cross-cultural evaluation.

CROSS-CULTURAL ISSUES IN THE ASSESSMENT OF REFUGEES AND ASYLUM SEEKERS The refugee or asylum seeker being assessed comes to the evaluation with a set of orientations, beliefs, ways of thinking, and worldviews that reflect a frame of reference that may be quite different from that of the clinician. This section addresses the following areas in which cultural differences can influence the cross-cultural psychological evaluation: (1) the client’s familiarity with the psychological evaluation process; (2) body language, eye contact, and facial expressivity; (3) grooming and attire; (4) orientation to time; (5) differing sets of experiences; (6) culturally based beliefs; (7) cognitive functioning; and (8) language and nonverbal communication.

Client’s Familiarity with the Psychological Evaluation Process Many refugees and asylum seekers have little understanding about what a mental health professional does and what a psychological assessment entails. In many cultures, including African and Southeast Asian, there is little tradition of mental health treatment. Indeed, in contrast to the Western world, there are few or no mental health professionals in many countries. After the brutal genocide in Rwanda in 1994, for example, there were only two psychiatrists in the entire country. The limited mental health services available in many countries are for those who are severely mentally ill. As one refugee put it,

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172 HANDBOOK OF MULTICULTURAL ASSESSMENT ‘‘Only crazy people would go to such a doctor.’’ Many clients have described being afraid that the clinician might be trying to discover if they are ‘‘crazy.’’ Clinicians who are working with asylum seekers and refugees must carefully explain their role, what the evaluation procedures will entail, and the concept and limitations of confidentiality. Detailed explanations are particularly important with refugees and asylum seekers who have been tortured or otherwise severely traumatized, as their ability to trust a stranger or authority figure may well have been damaged by their experiences at the hands of other human beings. In addition, being in an unfamiliar situation may replicate the unpredictable, uncontrollable traumatic experiences of past trauma and exacerbate trauma symptoms.

Body Language, Eye Contact, and Facial Expressivity Body language can vary from culture to culture, with shrugs, hand gestures, and eye movements having culturally specific meanings. Nonverbal communication, such as sounds uttered in response to a clinician’s questions, may not be easily understood by the examiner. Ethiopians, for example, may indicate agreement with a sharp intake of breath. It is important for the clinician to make sure that he or she is accurately interpreting such movements and sounds by checking with the client. Maintenance of eye contact is often seen as a sign of openness and honesty in the United States, although this may vary according to ethnic groups (Aklin and Turner, 2006). In some Asian and African cultures, however, maintaining eye contact is a sign of disrespect, rudeness, or aggression. A young Sierra Leoneon refugee who had maintained eye contact with the clinician for some time suddenly averted her gaze when she began to talk about being raped by a band of rebels. When the clinician wondered afterward if this might bring the client’s veracity into question, the Sierra Leoneon interpreter reported that in the Sierra Leoneon culture, it would not have been appropriate for the young woman to speak of such an intimate assault while ‘‘staring’’ at an authority figure. The clinician’s assumption, which was based on subtle views held by her own cultural group, was not accurate. Traumatic experiences in the past can also affect a refugee’s or asylum seeker’s ability or desire to maintain eye contact. While working with a young victim of sex trafficking who was seeking asylum, I noticed that she was unable to maintain eye contact for much of the session. When I explored this with the client, she acknowledged that because I was an older, White, English-speaking female, I reminded her of the older, White, English-speaking woman who had locked her in a room for ten months and regularly sent men in for sex. Facial expressivity also varies across cultures. Camras, Chen, Bakeman, Norris, and Cain (2006) cite research reporting that Chinese mothers do not encourage the expression of emotion as much as European American

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mothers do. Facial expressivity is often an important consideration in a judge’s or asylum officer’s assessment of credibility in asylum cases. A Congolese torture survivor, for example, told me that the immigration judge had indicated that he did not believe her account of torture because she showed no emotion when recounting the heinous acts done to her. In spite of the fact that she was feeling severely depressed, she said, it would have been ‘‘shameful and not proper for a woman of [her] social class’’ to have cried in court. In performing a psychological evaluation for an asylum case, the evaluator must consider the relative contributions of cultural differences in facial expressivity and the profound numbing effect that torture and other forms of trauma could have had on the asylum applicant. A refugee or asylum seeker may have been so deeply affected by traumatic experiences that she or he is, as one Bosnian refugee said, ‘‘beyond tears.’’

Grooming and Attire Grooming and what is deemed to be appropriate dress for different occasions may also vary across cultures (Westermeyer, 1987). Sometimes clients from another culture may appear to be underdressed, overdressed, or inappropriately dressed for the evaluation. A Central American woman arrived for evaluation dressed in what impressed the clinician as a lacy party dress and fancy high heels. According to the clinician’s set of experiences and cultural standards, the client’s attire could be construed as inappropriate. Yet this attire was the client’s best outfit and represented her respect for the importance of the occasion. It is also important to remember that the refugee or asylum seeker may have no other clothes because of the conditions of his or her flight or may be dependent on others to provide clothing.

Orientation to Time Refugees and asylum seekers may have a different orientation to time from that of North Americans (Westermeyer, 1987). Depending on the refugees’ or asylum speakers’ cultures, they may date their experiences in terms of agricultural seasons, such as the rainy season. Some cultures measure time by the sun’s position rather than with watches (Westermeyer, 1987). Ji et al. (2004) cite Boroditsky’s (2001) study that revealed that ‘‘different ways of talking about time in English (as if it were horizontal) and in Mandarin (as if it were vertical) correspond to differences in how both English and Mandarin speakers think about time’’ (Ji et al., 2004, p. 58). Some cultures use different calendars, which can cause confusion in an interview when exploring dates of important events. The Ethiopian calendar, for example, is based on the Coptic calendar, which is between seven and eight years behind the Gregorian (Western) calendar, depending on which

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174 HANDBOOK OF MULTICULTURAL ASSESSMENT month it is. Thus, Ethiopian clients may appear to be uncertain about their birthdates or dates of important events merely because they have to translate dates from the Ethiopian to the Gregorian calendar. The clinician who is unaware of calendar differences could erroneously assume that the Ethiopian asylum seeker has memory problems or, worse, might be malingering because he or she is inconsistent about important dates. In addition, in many cultures, dates do not have the same value as in our number-driven society. They are thus not given the same attention and may not be well remembered. Another factor interfering with refugees’ or asylum seekers’ ability to recall dates and periods of time is the severity of the trauma that they experienced. This is a common problem with survivors of torture who, in addition to other forms of torture, have been detained in conditions designed to maximize their disorientation. They may have been stripped of their watches, kept awake, interrogated in the middle of the night, and kept in windowless cells in full darkness or constant light, where they cannot keep track of the passage of time. Refugees and asylum seekers from some cultures may speak in greater generalities about time than Americans do, focusing on ‘‘the afternoon,’’ for example, rather than an exact hour. Because of this difference in orientation to time, refugee or asylum seeker clients may arrive late for appointments. One African refugee who arrived two hours late for his appointment explained to his therapist that when she had said to come at 2:00 P.M., he had understood it to mean ‘‘in the afternoon,’’ which in his culture meant any time before 6:00 P.M.

Differing Sets of Experiences The sets of experiences and knowledge bases of refugees and asylum seekers are often quite different from those of the mental health professional and the mainstream American clients with whom the clinician usually works. This presents a clear problem for the use of evaluation instruments that were designed to assess the types of experiences and knowledge of an American population (Padilla, 2001). If clinicians are unaware of the types of life experiences that the refugee or asylum seeker may have had, their ability to ask the questions necessary to elicit information about these experiences may be limited. Lack of knowledge about a refugee’s or asylum seeker’s culture and experiences may make it difficult for the clinician to grasp the full meaning underlying the client’s words. When a Cameroonian asylum seeker says that every day he was taken out of his jail cell for ‘‘the morning coffee,’’ the clinician needs to know enough about torture in this client’s country to recognize that this is a euphemism commonly used by torturers for the brutal morning beating of prisoners. It is incumbent on clinicians to address the gaps between their experiences and those of their refugee or asylum seeker clients by seeking

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training, reading about the client’s culture, consulting with cultural experts, debriefing with interpreters, and, most important of all, asking the client. Making an accurate assessment of the traumatic experiences of refugees and asylum seekers requires skill and sensitivity. Clinicians asking a refugee to recount his multiple traumatic experiences must be aware that they are inviting the person not just to recall the trauma but perhaps also to relive it. Many survivors report being retraumatized by the psychological evaluation. One Iraqi torture survivor said, ‘‘I couldn’t sleep for a week afterward. It was like being tortured all over again.’’ Performing an evaluation in an asylum case requires not only skill in cross-cultural assessment but awareness of the legal issues posed by such cases, particularly the need to evaluate whether the asylum seeker may have suffered past persecution or fears future persecution on account of race, nationality, religion, membership in a particular social group, or political opinion.8

Culturally Based Beliefs Belief systems vary widely across cultures, reflecting what is important in the particular culture and what should be attended to, influencing the behaviors of group members and guiding them in making sense of the world around them. Clinicians must be alert to the underlying belief systems and assumptions that might be influencing a refugee’s or asylum seeker’s behaviors or causing the clinician to misinterpret what the client is trying to convey. In a thought-provoking paper, Nisbett, Peng, Choi, and Norenzayan (2001) argue that social differences among different cultures affect their beliefs about the nature of the world, causality, and about what is important to know. Ji et al. (2004) describe the Chinese as valuing interpersonal relationships and paying more attention to the social environment than do Americans, who value individual autonomy and freedom. Thus, behaviors or remarks that might appear to an American clinician as indicating ‘‘dependency’’ in an East Asian refugee or asylum seeker may well be indications of highly responsible behavior in that person’s culture. Differences in beliefs can appear in many forms during the evaluation of refugees or asylum seekers. What is believed to be an illness or a symptom of a mental health problem in the one culture, for example, may not be seen as such in another culture. People from many cultures, for example, express anxiety, depressive, and posttraumatic stress symptoms through their bodies, that is, through somatic symptoms. Another common example of cultural differences in beliefs is differences in beliefs about the significance of dreams. Westermeyer (1987) describes the ethnic Chinese refugee who was diagnosed by an American clinician as suffering from psychotic depression because of the client’s belief that her dead mother had traveled from the place of the dead

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176 HANDBOOK OF MULTICULTURAL ASSESSMENT to accompany her to the next world. Westermeyer (1987) reported that rather than seeing this as a symptom of psychosis, he and his colleagues interpreted this symptom ‘‘as a culturally consistent belief in a depressed woman who had recently begun to see her deceased mother in her dreams (a common harbinger of death in the dreams of some Asian patients)’’ (p. 471). Refugees and asylum seekers from African cultures have described being very frightened after dreaming of a deceased relative, because in their cultures, such a dream may be either a sign that the deceased person is trying to communicate with them or a portent of what lies ahead for the dreamer. A torture survivor from the Democratic Republic of the Congo who suffered nightmares about his torture reported feeling tormented by his dreams because he believed they were a sign that he was going to be deported to his country and tortured again. It is often not an effective intervention to merely explain Western beliefs or research findings on dreams (as if the American beliefs were the most scientifically sound). In addition to sounding condescending, such an intervention denies the person the opportunity to come to terms with the dreams in terms of his or her own belief systems. Straker (1994) describes an effective intervention using traditional South African beliefs about the meaning of dreams to ameliorate the posttraumatic stress disorder (PTSD) symptoms of three traumatized South African sisters whose father had been assassinated.

Cognitive Functioning Nisbett et al. (2001) report that basic cognitive processes such as attention and memory can vary significantly across cultures. Ji et al. (2004) concur, reporting that culture can shape how people reason and organize the world. Attention and Memory. Nisbett et al. (2001) postulate that social differences among cultures affect not only their beliefs but also what is important for them to know, pay attention to, and remember. A number of researchers have demonstrated that East Asians attend more to the field, or context, and to relationships between objects and the field than do Westerners, who tend to detach the object from its context and pay more attention to it and its properties (Ji et al., 2004; Maass, Karasawa, Politi, and Suga, 2006; Nisbett et al., 2001). What is attended to will affect what is remembered. Masuda and Nisbett (2001) demonstrated this in their study of Japanese and American subjects who watched animated fish in an underwater scene on a computer screen. The Japanese recalled more details about the context and the relationship between the fish and the background than did the Americans, who recalled more details about the fish. Thinking Patterns. In their studies of how subjects grouped objects, Ji et al. (2004) found that people from different cultures tended to focus on different

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things when they were thinking about objects. When given categorization tasks such as ‘‘monkey-panda-banana’’ and ‘‘shampoo-hair-conditioner’’ and told to indicate which two of the three were more closely related, they found that regardless of the language in which they were tested, bilingual Chinese grouped objects in a more relational way, focusing on the relationship between the objects (‘‘monkey-banana’’ and ‘‘shampoo-hair’’). European Americans tended to group objects in a categorical way, grouping ‘‘monkey-panda’’ and ‘‘shampoo-conditioner’’ and focusing on shared features or categorical relationships rather than relationships between objects. Research in African cultures has also revealed cultural differences in the performance of object-sorting tasks. Greenfield (1997) describes a classic example from Cole, Gay, Glick, and Sharp’s research (1971) with Liberians. The participants were asked to sort objects that belonged in the categories of foods, implements, containers, and clothing. Although the researchers expected the Liberians to sort the objects into these categories, the subjects instead persistently sorted them according to function, pairing ‘‘potato’’ and ‘‘knife’’ and explaining that ‘‘a wise man’’ could only ‘‘take the knife and cut the potato’’ (Greenfield, 1997, p. 1116). Finally, in frustration, the researchers asked the participants how a fool would sort the objects, and they responded by grouping the objects into the food, implements, containers, and clothing categories. Greenfield summarizes, ‘‘In short, the researchers’ criterion for intelligent behavior was the participants’ criterion for foolish; the participants’ criterion for wise behavior was the researchers’ criterion for stupid’’ (p. 1116). Abstract Concepts. Refugees and asylum seekers may differ in their ability to comprehend the type of abstract concepts assessed in Western evaluations, depending on their level of education and the sophistication of their languages. In their function analysis study of Rwandans and Ugandans, Bolton and Tang (2002) describe concerns over their subjects’ ability to comprehend abstract concepts, such as what a ‘‘normal person’’ is. Some languages are more concrete and functional in their vocabulary and do not contain many words for abstract concepts.

Differences in Language and Nonverbal Communication Language differences can present enormous challenges when evaluating a refugee or asylum seeker who does not speak English. There may be no equivalent in the client’s language for words that are commonly used by Western mental health professionals. Some languages do not have an easy way, for example, to differentiate the constructs of ‘‘thinking’’ and ‘‘feeling.’’ The clue to the occurrence of this problem is when the clinician asks how the refugee or asylum seeker felt after a particular experience and the client’s

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178 HANDBOOK OF MULTICULTURAL ASSESSMENT answer begins with ‘‘I think . . .’’ The word torture is another example of a word that cannot be translated in many languages with a single word that captures the overall construct of torture. In many countries, torture is translated as ‘‘beatings.’’ Thus, merely asking if the refugee or asylum seeker has ever been tortured may not elicit a response that covers the range of abuses that constitute torture. Cultures vary considerably in the size of their vocabulary for describing emotional states. As Spielberger, Moscoso, and Brunner (2005) comment, ‘‘Languages differ enormously in the size of their affective lexicon, and may also differ substantially in the number of words that designate either the presence or absence of an emotional state or its level of intensity’’ (p. 354). Rwanda’s language, Kinyarwanda, is limited in the number and subtlety of words for describing emotional states and states of mind compared to English. Note the translation of the following English phrases into Kinyarwanda (with the Kinyarwanda translation in parentheses): ‘‘I am relaxed’’ (‘‘I am calm’’), ‘‘I am tense’’ (‘‘I am not calm’’), ‘‘I am jittery’’ (‘‘I am not calm’’), and ‘‘I am worried’’ (‘‘I am not calm’’). You can imagine the look on a Rwandan refugee’s face if a clinician continued to ask him questions that when translated were all asking whether he was calm! It is critical to pay close attention to potential differences in language, as many of a clinician’s conclusions are based on the verbal responses of the refugee or asylum seeker. Open communication with the interpreter, if one is used, is essential in order to ascertain when there are words that cannot be translated clearly into the client’s language (see Chapter Eleven, this volume). The interpreter might not be aware of how important the choice of words is for a psychological evaluation. Even when great care is taken, working through an interpreter can go awry. One clinician reported working with an interpreter during the evaluation of an Eritrean torture survivor who spoke Tigrinha. The client had requested this particular interpreter, as she had met him before and felt safe discussing her trauma with him in the room. The interpreter reported several times during the evaluation that the survivor was not clear in her use of language and that it was hard to understand her. Because of the interpreter’s remarks and the client’s responses as translated by the interpreter, the clinician ended up concluding that the client had limited language skills and perhaps limited intelligence. After the report was completed, the clinician learned that the interpreter had not actually been communicating with the client in her own language, Tigrinha, but rather in Amharic, the language of her workplace for the past two years, of which she had acquired a few words. When ‘‘Yes’’ Does Not Mean ‘‘Yes.’’ In many cultures, it is not considered polite to say no to another person. In Japan, for example, a negative response

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might consist of the word yes uttered in a particular tone of voice. Clinicians must become as familiar as possible with the customs of their clients’ cultures to be sure they are getting accurate information. An elderly Vietnamese refugee, for example, smiled politely and answered yes when I asked her whether she would go to the emergency room for treatment of symptoms that resembled stroke. After several weeks of yes answers, the interpreter informed me privately that the woman had no intention of going to seek treatment, particularly not in a hospital, because during the war in Vietnam, people were said to have been poisoned or killed while in the hospital. However, her culture had dictated that she could not say no in response to an authority figure. Lack of Conceptual Equivalents. There are sometimes no equivalent concepts in the refugee’s or asylum seeker’s culture for Western concepts that might be inquired about in a psychological evaluation. Bolton and Tang (2002) point out that concepts like ‘‘health’’ and ‘‘mental health’’ are complex terms whose meaning varies widely among cultures. They found that it was not possible to ask the Rwandans and Ugandans in their study about mental health problems that they might be experiencing because in their subjects’ cultures, witchcraft or spirits are often thought to be the cause of what Americans consider to be mental health problems. A question about ‘‘mental health’’ thus would not elicit any information about symptoms that were instead attributed in that culture to witchcraft or spirits. Concepts such as ‘‘trauma’’ or ‘‘depression’’ might not be familiar to some refugees or asylum seekers. Onyet et al. (2004) reported that in their study of Rwandan and Somali communities in a Ugandan refugee camp, they had difficulty finding any key informants who had clear ideas about mental health constructs such as posttraumatic stress disorder or depression. Their key informants described mental disorders in behavioral terms, such as, ‘‘She runs away at night and screams’’ and ‘‘He does not sleep’’ (p. 96). It would therefore not be effective to ask these clients items from trauma symptom inventories that use wording from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000), such as ‘‘intrusive recollections of the trauma.’’ In interviewing refugees and asylum seekers, the language used must be understandable to them and relate to constructs understandable in their culture. There may also be some mental health constructs that exist in the refugee’s or asylum seeker’s culture but are not familiar to Western mental health professionals. Westermeyer (1987) describes these culture-bound syndromes as ‘‘essentially folk categories for certain conditions or behaviors’’ that often involve combinations of ‘‘universally-occurring psychiatric symptoms’’ such as fear, anxiety, amnesia, withdrawal, clouding of consciousness, suicidal ideation, and somatic symptoms (p. 472). Hinton, Um, and Ba (2001),

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180 HANDBOOK OF MULTICULTURAL ASSESSMENT for example, describe a culture-specific fainting syndrome among Cambodians called ‘‘wind overload’’ that has some similarity to the Western construct of panic attack.

CHOOSING PSYCHOLOGICAL INSTRUMENTS FOR THE ASSESSMENT OF REFUGEES AND ASYLUM SEEKERS A major challenge to the clinician performing a cross-cultural evaluation of refugees or asylum seekers lies in choosing psychological instruments that are appropriate for use with this diverse population. The use of psychological instruments developed in one culture for the assessment of people from other cultures and language groups is a subject of considerable controversy. As Padilla (2001) has pointed out, test development as been dominated thus far by Eurocentric approaches. Many test developers and practitioners have adhered to a universalist ideology, assuming that human beings are basically very similar and that differences among cultures are minimal. This etic point of view assumes that psychopathological disorders, symptoms, and instruments to measure them apply across cultures and that it is appropriate to apply tests developed for Western populations with other world populations. However, there is significant disagreement with the universalist approach among researchers and clinicians. Many researchers and clinicians argue that applying instruments, procedures, and norms that are developed by and for Americans, who represent only 5 percent of the world’s population, to people from other parts of the world is a mistake that can have serious consequences, such as misdiagnoses, overpathologizing of symptoms, mistaken conclusions, inappropriate recommendations, and missing or ignoring information that is critical for accurate understanding of the person being assessed (Aklin and Turner, 2006; Sue, 1999). In contrast to the etic approach, the emic approach stresses the importance of attending to cultural differences and culture-specific phenomena. Proponents of this more relativistic ideology argue that cultures are not directly comparable because of cultural differences in context, behavior, and indigenous concepts of distress (Bhui, Mohamud, Warfa, Craig, and Stansfeld, 2003; Fernando, 2004). The clinician who uses Western tests with non-Western populations may also make the mistake of assuming what Aklin and Turner (2006) call ‘‘too much homogeneity of symptom expression’’ (p. 51). Refugees and asylum seekers from Cameroon, Cambodia, or Chechnya, for example, may not express psychological distress in the same fashion as Americans do. Western tests may not elicit information about indigenous, culturally constructed disorders that are different from the disorders classified in the DSM-IV-TR yet are important in the culture of the person being assessed

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(Bhui et al., 2003). Fernando (2004), in her work with traumatized Sri Lankans, described the need for ‘‘cultural-specific instruments that are culturally relevant’’ and could be used to evaluate issues important to the collectivistic society of Sri Lankans and of somatic symptoms that indicate depression and anxiety (p. 110). Simply translating tests and using the same scoring algorithms may result in scores that are identical numerically but have ‘‘a psychologically different meaning’’ in the refugee’s or asylum seeker’s culture (Geisinger, 1994, p. 310). In addition, interpretation of the results of Western tests may lead to conclusions that are not valid for refugees or asylum seekers from Burma, or Sudan, or the Ukraine, who may well have very different demographics, cultural values, and perceptions (Camras et al., 2006; Fernando, 2004).

Guidelines Psychologists are required by the Ethical Principles and Code of Conduct (American Psychological Association, 2002) to use ‘‘assessment techniques, interviews, tests, or instruments in a manner and for purposes that are appropriate in light of the research on or evidence of the usefulness and proper application of the techniques’’ (9.02a) and to use assessment instruments ‘‘whose validity and reliability has been established for use with members of the population tested’’ (9.02b). What is a clinician to do in the face of the enormous challenges to the selection of appropriate instruments for use with refugees and asylum seekers, particularly when he or she might work with people from twenty to thirty different countries? The truth is that there are no easy answers to this question and no perfect solutions. Perhaps the best solution is for the clinician to learn about the standards for adapting tests for use with different cultures and to consider each instrument carefully in the light of these standards. Stating succinctly that simply adapting a measure for use in a second setting ‘‘is not professionally acceptable,’’ Geisinger (1994, p. 308) reports that several of the standards in the Standards for Educational and Psychological Testing (American Educational Research Association, American Psychological Association, and National Council on Measurement in Education, 1985) are applicable to cross-cultural assessment. Standard 4.3 refers to the need for norms developed for the population from which the client comes. Standard 6.2 requires that a test be revalidated if the user makes a substantial change in test format, mode of administration, instructions, or language, or else the user must have a rationale saying that additional validation is not necessary or possible. Standard 13.4 requires that when a test is translated, its reliability and validity for use in with the client’s culture should be established. Standard 13.6 states that evidence of test comparability should be reported when a test has been translated into a second language.

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182 HANDBOOK OF MULTICULTURAL ASSESSMENT Another useful source of information is the recently published International Test Commission’s Guidelines for Test Adaptation, described in detail by Hambleton, Merenda, and Spielberger (2005). Although these twenty-two guidelines refer specifically to the formal adaptation of tests for use in other cultures, the questions they address are critical for the clinician to consider in determining whether an evaluation instrument might be appropriate for use with a particular refugee or asylum seeker population. These two sets of guidelines, along with the work of a number of cross-cultural researchers, suggest that a test that has been developed in one culture and the test resulting from its adaptation for use in another culture should be equivalent in a number of ways (Flaherty et al., 1988; Hambleton, 2005; Marsella, 2001; van de Vijver and Poortinga, 2005): (1) construct, or conceptual, equivalence, (2) normative equivalence, (3) content equivalence, (4) semantic, or linguistic equivalence, and (5) technical and scale equivalence. Few tests meet all of these equivalences for use with the many different refugee and asylum seeker groups in the United States or meet cross-cultural research standards (Hollifield et al., 2002). However, these categories provide useful ways for clinicians working with refugees and asylum seekers to think about the appropriateness of each instrument for use with a client.

Construct Equivalence Construct equivalence refers to whether the construct being assessed by a particular instrument has the same meaning in the refugee’s or asylum seeker’s culture and whether the construct is operationalized in the same way (Flaherty et al., 1988; Hambleton, 2005; Marsella, 2001). If the refugee’s or asylum seeker’s culture differs systematically from the American cultural group in the underlying constructs assessed by an instrument, cross-cultural comparisons cannot be made with accuracy (Geisinger, 1994; Peng, Nisbett, and Wong, 1997; van de Vijver and Poortinga, 2005). Hambleton (2005) gives the example of the construct of intelligence, which is defined differently in different cultures. In the United States, for example, making responses quickly is considered one indication of ‘‘intelligence.’’ However, in Eastern cultures, ‘‘intelligence’’ is often associated with ‘‘thoughtfulness, reflection, and saying the right thing’’ (Hambleton, 2005, p. 26). Bolton (2001b) discovered that Rwandan culture has constructs to describe a person’s reaction to trauma that differ somewhat from the DSM-IV constructs of PTSD and depression. Using ethnographic methods to investigate how Rwandans perceived the mental health effects of the 1994 genocide, he found that two culture-specific constructs emerged: guhahamuka (a ‘‘mental trauma’’ syndrome, which includes PTSD symptoms mixed with some depressive and local symptoms, such as ‘‘feeling like you are dead,’’ ‘‘losing your mind,’’ and

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‘‘lack of love’’) and agahinda gakabije (a grief syndrome that includes other depressive and local symptoms; Bolton, 2001a).

Normative Equivalence Normative equivalence requires that the instrument being used has been normed on the population to which the refugee or asylum seeker client belongs (Marsella, 2001). This is a critical issue for clinicians working with refugees and asylum seekers. Instruments that are normed on American majority groups ‘‘cannot be indiscriminately used with people who differ from the normative population’’ (Padilla, 2001, p. 5). The normative sample of the Western instrument has different demographics, sets of experiences, educational level, and cultural values, which make the generalization of Western norms to the refugee population inappropriate (Fernando, 2004; Sue and Chang, 2003). Geisinger (1994) states that even if the test were revised for a new target population, ‘‘it would rarely, if ever, be appropriate to use the norms from the original instrument . . . with the revised and adapted instrument’’ (p. 307). Thus, an intelligence test that has been normed on an American population cannot be adapted for use with, say, Bosnians without obtaining normative data on the new population without serious questions about the validity of the results. Unfortunately for clinicians working with refugees and asylum seekers, few instruments have been normed on populations as varied as Somali, Rwandan, Cameroonian, Togolese, Sudanese, Laotian, Bosnian, Khmer, Indonesian, Russian, Uzbek, Chinese, Colombian, and Albanian, among others.

Content Equivalence Content equivalence refers to whether each test item describes a phenomenon relevant to the culture of the refugee or asylum seeker being assessed (Sue and Chang, 2003; Weiss and Berger, 2006) and whether test items represent a sample of the universe of possible items related to the concept being investigated (Flaherty et al., 1988). If, for example, a clinician is assessing a Togolese asylum seeker for symptoms of depression on an instrument developed to assess depression in Americans, will the test items assess the ways that depression is manifested in his culture, if indeed that culture has a similar construct for depression? If items are not applicable to his culture or have content that is not deemed important in his culture, his responses to those items will not be meaningful. As an example of an item with little relevance in some non-Western cultures, Geisinger (1994) cites a personality inventory item that asks whether an adolescent would rather go to the movies or go to a dance. Bolton and Tang (2002) found that Western function analysis instruments had too many questions that were culture bound to be useful with Ugandans and Rwandans, such as questions about the ability to climb stairs or go shopping.

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Semantic, or Linguistic, Equivalence Semantic equivalence refers to whether the items in an instrument have the same meaning across cultures, even after translation (Marsella, 2005). It can be difficult to achieve semantic equivalence with some items (Flaherty et al., 1988). An example is the word for torture, which in many languages is translated simply as ‘‘beatings,’’ thus limiting the construct of torture to one out of many brutal techniques. If the refugee or asylum seeker was not beaten but was instead subjected to other forms of torture, such as being dunked in a barrel of urine, blood, and feces or hung from a tree by his wrists, he may respond in the negative, and the clinician may incorrectly conclude that the person was not tortured. Some words or terms may not exist in the refugee’s language, such as ice hockey (Hambleton, 2005) or the word planet in Kinyarwanda. The language used in the test instructions, items, and scoring rubrics should be appropriate for the refugee’s or asylum seeker’s cultural and language group (ITC Guideline D.2, cited in Hambleton, 2005). The wording of some instructions may not make sense when translated into the client’s language. For example, instructions that ask, ‘‘How much have you been bothered by this symptom in the last week’’ can be hard to convey because of difficulty translating ‘‘bothered by’’ or ‘‘troubled by’’ in some languages. The test’s vocabulary should also be comparable in level of difficulty, readability, sentence structure, grammar use, writing style, and punctuation (Hambleton, 2005) and should consist of words that have similar familiarity, frequency of use in the language, and difficulty level (Geisinger, 1994). Although frequency of word use can be determined by frequency counts of words, such counts often do not exist in the target language (Hambleton, 2005). Test developers and translators face a formidable task in meeting these recommendations. Weiss and Berger (2006) describe the difficulty of translating an instrument into Spanish in a way that maintains similarity in meaning as well as ‘‘maintaining wording subtleties and cultural relevance of questionnaire items’’ (p. 192). They describe the challenges inherent in translating the Post-Traumatic Growth Inventory because of the heterogeneity of the population of Spanish speakers. Regional variations in Spanish, different cultural referents, and variations in colloquialisms and slang can affect the utility of the instrument with different Spanish-speaking groups (Weiss and Berger, 2006). Even if the same idiom occurs in the refugee’s language as in English, it may have different significance or prevalence in that language (Bhui et al., 2003). Sometimes the word choices of a refugee or asylum seeker do not carry full descriptive power when translated into English, such as the Ethiopian torture survivor who told me she was beaten with ‘‘sticks.’’ If the clinician had not

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queried what she meant by ‘‘sticks,’’ he would not have realized that she was beaten with the equivalent of a shortened baseball bat. The description of this form of torture as ‘‘beaten with sticks’’ in the asylum evaluation would not have conveyed the power of this form of torture. Ji et al. (2004) point out that a single word in English may be conveyed by several words with varying connotations in the client’s language: for example, there are several Chinese words for pride, a couple of which have negative connotations (Ji et al., 2004). Similarly, when I asked one refugee if he enjoyed going to parties, the interpreter asked me to define exactly what type of party I meant, as there were several different words in his language describing different types of parties. Grammatical structures vary across cultures. Some languages do not use subject pronouns (I, he, and she, for example). This may become evident in an evaluation when either the refugee or the interpreter interchanges she and he in a sentence and the clinician cannot figure out to whom he is referring. Compound nouns, such as babysitter or weekend do not exist in some languages, including Spanish (Weiss and Berger, 2006). The degree of client comfort with complex sentence structure may vary according to the literacy level of the refugee or asylum seeker being assessed. Westermeyer (1987) points out that illiterate people may have difficulty understanding statements that contain a conditional clause followed by a question, such as, ‘‘If you found a letter, what would you do with it?’’ He reported that there may be a tendency for the person to focus on the ‘‘if’’ statement rather than going to the problem posed by the question (Westermeyer, 1987).

Technical Equivalence Technical equivalence refers to whether the method of assessment used in an instrument (for example, the use of pencil-and-paper tests or interviews) yields comparable data in each culture (Flaherty et al., 1988). The stimulus materials, questions, rating scales, and tasks in the assessment instrument should have equivalent meaning and familiarity in the culture of the refugee or asylum seeker being evaluated or test validity will be affected (Hambleton, 2005). There are many stimulus materials in Western tests that are culture bound. A Dari-speaking clinician reported trying to give the Picture Completion subtest of the Wechsler Adult Intelligence Scale (WAIS) to an Afghan refugee. She reported that the woman, who came from a landlocked country, had never seen a rowboat and had no way of knowing that an oarlock was missing. As a substitute item, the clinician drew the client a picture of a samovar that was missing one of the five steam vents. The client immediately identified that the tiny hole was missing. Even supposedly culture-free tests can contain stimulus materials that are biased against people from other cultures. When I showed a Korean client an

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186 HANDBOOK OF MULTICULTURAL ASSESSMENT item in the language-free Comprehensive Test of Nonverbal Intelligence that required the client to pick a match for a stimulus picture of a rabbit and a kangaroo (animals that hopped), she pointed to the picture of a beaver for her answer. When I later returned to that item to examine the client’s thought processes, she identified the beaver as a squirrel, which she knew hopped from trees to the ground. She had never seen a beaver before and was only vaguely familiar with squirrels from the short time she had spent in the United States. Thus, she had correctly ascertained that she needed to choose an animal that hopped but did not have the familiarity with the choices necessary to get the item correct. Other characteristics of Western psychological instruments can significantly affect the refugee’s or asylum seeker’s responses. The repetitious nature of many Western questionnaires, the rewording of the same questions, and the probing for answers may remind people who suffered torture of their interrogations and perhaps elicit a trauma response. The age and gender of the examiner can also affect test results. One African chieftain was concerned about my interviewing him about his traumatic experiences because, the interpreter reported, I was ‘‘too young.’’ (This gentleman ultimately decided to participate in the evaluation, however, because he was amazed at my ability to write speedily with my left hand, which he had never seen done before.) The gender of the evaluator can be an important factor for refugee women or asylum seekers of certain religious groups, who will not respond openly when interviewed in a private setting by a male examiner because such an interview would not be considered appropriate in many cultures.

Rating Scales Scale equivalence is a component of technical equivalence and refers to the ‘‘cultural comparability of the scales’’ used in the assessment instrument (Marsella, 2001, p. 281). Test formats commonly used in Western tests but unfamiliar to people from other cultures include speeded tests, multiple-choice formats, true-false formats, the use of manipulatives, and linear and graduated rating scales. Differential familiarity with different item formats can be a source of invalidity of test results (Geisinger, 1994; Hambleton, 2005).

Speeded Tests Many refugees and asylum seekers have had no exposure to speeded tests or to the idea that performing tasks at great speed is a valued activity. Thus, their scores on such tests may not fairly represent the abilities being tested. Tests relying on speed and familiarity with the alphabet, such as the Trail Making Test, may be unfairly biased against the refugee or asylum seeker. Even if the client’s language uses the same alphabet, he may not have overlearned it

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as Americans do with the ‘‘ABCD’’ song and thus can not perform the task speedily. Multiple-Choice Format. Greenfield (1997) cites an example of cultural differences in response to multiple-choice formats in her research with Zinacantecan Mayans. In a task designed to assess skills in continuing striped patterns, the researchers drew several repetitions of a striped pattern on one sheet of paper and then offered subjects three alternative striped patterns on separate pieces of paper, of which one was the correct continuation of the stimulus pattern. They found that the Zinacantecan participants could not comprehend the multiple-choice format. Instead, they tried to use all three alternatives to construct something. The idea of eliminating, rather than using, a pattern given to them by the researcher was foreign to them. Greenfield explained, ‘‘The notion that something had no function other than to test understanding seemed to violate their implicit conventions of the nature of communication’’ (p. 1120). True-False Format. True-false test formats can pose similar dilemmas for people unfamiliar with such tests. In attempting to administer a true-false questionnaire to a refugee from an African country, I read each item aloud and noticed that the client was looking at me, perplexed, and giving answers that conflicted with information he had related during the interview. I inserted a spontaneous practice item, ‘‘I am a man,’’ and to my surprise, he answered in the negative. Further discussion revealed that because he was completely unfamiliar with true-false tests, he had thought that he was supposed to answer each item as it applied to me rather than to himself.

Use of Manipulatives The use of manipulatives to form designs is another type of test that may be unfamiliar to the refugee or asylum seeker client. Early in my career, I asked refugees and asylum seekers to perform selected nonverbal subtests of the WAIS, such as the Block Design subtest. Many clients appeared to be quite puzzled by the request that they put the blocks together so that their tops matched a particular picture. Several examinees told me that they had never done such an exercise and had no idea where to start. Finally a Somali interpreter informed me that Somalis did not have blocks to play with during their childhood and that the client was completely unfamiliar with using objects to perform such a task. Furthermore, she added, in the region of Somalia where my client lived, even the architecture lacked square shapes: the homes and village buildings were all circular. I was asking my client to do something that was not consistent with her cultural experiences.

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188 HANDBOOK OF MULTICULTURAL ASSESSMENT Linear and Graduated Rating Scale Formats. Linear and graduated rating scales such as Likert scales can be particularly problematic for use with refugee and asylum seeker clients. The concept of quantifying one’s emotions or experiences with a number between one and five seems to be perplexing and alien to refugees and asylum seekers from many cultures. Bolton and Tang (2002) coped with this problem in their development of a function analysis instrument to be used with Rwandans and Ugandans by designing a card to illustrate the construct of a five-point choice scale. The card showed a person lifting a rock with varying degrees of facility: the picture for the lowest number on the Likert scale showed a person holding a small rock up with ease, while the one for the highest score showed a person crawling on the ground with a huge boulder on his back (Bolton and Tang, 2002). I have found it useful to use a drawing of a series of circles that are larger in size as the numbers on the Likert scale increase. Visual aids are particularly important for clients who are illiterate or have limited literacy.

Measurement Unit Equivalence Another issue related to the use of Likert scales with a cross-cultural population is whether the translated scale has measurement unit equivalence, that is, whether the measurements are the same at different interval levels (van de Vijver and Poortinga, 2005). Measurement unit equivalence can be difficult to obtain, as languages vary in the weights associated with different words. Translating instrument scales such as Likert scales can be an unexpectedly problematic procedure. If the words used for Likert responses are not calibrated equivalently, the refugee’s or asylum seeker’s scores may not be accurate. What appear to be simple terms for gradations of experiences may not be easily translatable into languages such as French, Amharic, or Uzbek. For example, the terms ‘‘not at all,’’ ‘‘a little,’’ ‘‘quite a bit,’’ and ‘‘extremely’’ on a Likert scale are difficult to capture with French words that have equivalent gradations of meaning. An additional complication is that the terms chosen for this scale by French speakers from France were not the same as the words used by French-speaking asylum seekers from the Democratic Republic of the Congo. Weiss and Berger (2006) note similar difficulty in determining if the words ‘‘muy poco cambio’’ and ‘‘bien poco cambio’’ carried ‘‘the exact nuance of the original ‘very small degree of change’’’ (p. 193).

Response Tendencies Response tendencies (for example, for social approval, trait desirability, and tendency to acquiesce) may vary across cultures and thus must be considered in evaluating a refugee or asylum seeker. Peng, Nisbett, and Wong (1997) cite

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Chen, Lee, and Stevenson’s research (1995) suggesting that East Asian students have a ‘‘moderacy bias that precludes them from moving their responses very far from the middle of the scale’’ (Peng et al., p. 335).

Careful Choice of Instruments It can be difficult to find psychological instruments that meet the multiple criteria described above, which represent current standards for the adaptation of instruments to be used across cultures. This does not mean that psychological evaluations cannot be accomplished with refugees and asylum seekers, however. The clinician must recognize that administering the traditional battery of tests taught in graduate school may well not be ethical or valid in these cases. The clinician must look carefully at a range of instruments, evaluating their usability according to the cultural considerations listed above (see Hollifield et al.’s 2002 review and evaluation of a number of tests that have been used with refugees, including the Beck Depression Inventory, the Harvard Trauma Questionnaire, and the Hopkins Symptom Checklist-25). Clinicians who are evaluating refugees and asylum seekers must be scrupulously attentive to cultural issues and the potential drawbacks for the use of particular instruments and then work energetically to ensure that other aspects of the evaluation provide sufficient information to compensate for these drawbacks. In the light of these challenges, the clinical interview has increased importance.

CONCLUSION The cross-cultural evaluation of refugees and asylum seekers challenges clinicians to be attentive at all points to cultural differences that might obscure their ability to understand their clients’ mental health. During the clinical interview, every piece of information, whether it is body language, eye contact, choice of words, expression of emotions, description of symptoms, use of language, or thinking processes, is clothed in the refugee or asylum seeker’s cultural context and can be fully understood only by attention to that context. If the clinician responds with assumptions and conclusions generated only through his or her own cultural filters, critical information will be lost and injustice done to the refugee or asylum seeker. An extensive clinical interview in the evaluation of refugees and asylum seekers bears far greater importance than in other evaluations because of the difficult task of finding instruments that have appropriate norms, construct validity, and equivalent content, language, and scales. Evaluation instruments must be used with great care, after careful consideration of potential pitfalls.

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190 HANDBOOK OF MULTICULTURAL ASSESSMENT In spite of the many challenges in performing an ethical and culturally sensitive evaluation of these clients, it is an inspiring experience that has the capacity to enrich the lives of both the refugee or asylum seeker and the clinician. In order to develop the necessary sensitivity to cultural differences and knowledge of potential problems involved with the use of psychological instruments with this population, clinicians can read extensively, seek training, discuss cultural issues with interpreters, request consultation with another clinician skilled in cross-cultural work, and participate in a cross-cultural consultation peer group with other clinicians doing similar work. And above all, they must take more cross-cultural cases, listening attentively to the refugee or asylum seeker’s point of view, perception of symptoms and functioning, and view of his or her own reality. Clinicians must be prepared to make mistakes and be willing to forgive themselves for them. Sister Dianna Ortiz describes the clinician’s role as someone who ‘‘walks with the survivor’’ on his or her path toward healing (Sister Dianna Ortiz, personal communication, June 26, 1998). Clinicians will find themselves enriched in unexpected ways by this extraordinary opportunity to walk with the refugee or asylum seeker who has faced unthinkable, unspeakable trauma and yet is surviving to live another day.

Notes 1. Nearly 60 percent of these refugees were from Somalia, Laos, Cuba, and Russia. 2. For the year 2005, over 60 percent of people granted asylum came from China, Colombia, Haiti, Venezuela, Ethiopia, Albania, Cameroon, Russia, and Indonesia. 3. The name and details in this account have been disguised. 4. For a powerful personal account of torture, see Sister Dianna Ortiz’s The Blindfold’s Eyes: My Journey from Torture to Truth (2002). 5. The name and details in this account have been disguised. 6. Teachers participating in training I provided on the cross-cultural evaluation of refugee children from an African country said that the children were ‘‘real problem kids.’’ They said that the children were aggressive in class, talked in loud voices, would not listen, and could not sit still. These teachers were shocked to hear the range of traumatic experiences endured over several years by these children, including witnessing amputations, losing loved ones, and having their lives threatened by machete-wielding child soldiers as young as eight years old. 7. For information on performing psychological evaluations for asylum cases, see Freed (2005); Jacobs, Evans, and Patsalides (2001a, 2001b); Peel and Iacopino (2002); Physicians for Human Rights (2001); United Nations (1999). 8. For information on performing asylum evaluations, see Barrett (2005), Jacobs et al. (2001a, 2001b), Physicians for Human Rights (2001), and United Nations (1999).

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References Aklin, W. M., & Turner, S. M. (2006). Toward understanding ethnic and cultural factors in the interviewing process. Psychotherapy: Research, Practice, Training, 43(1), 50–64. American Educational Research Association, American Psychological Association, and National Council on Measurement in Education. (1985). Standards for educational and psychological testing. Washington, DC: American Psychological Association. American Psychiatric Association. (2000). Diagnostic and statistical manual for mental disorders (4th ed., text revision). Washington, DC: Author. American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. Retrieved October 5, 2006, from http://www2.apa.org/ethics/ code2002.doc. Amnesty International. (2000). Torture worldwide: An affront to human dignity. New York: Author. Barrett, K. H. (2005). Guidelines and suggestions for conducting successful cross-cultural evaluations for the courts. In K. H. Barrett & W. H. George (Eds.), Race, culture, psychology, and law (pp. 107–123). Thousand Oaks, CA: Sage. Basoglu, M. (Ed.). (1992). Torture and its consequences: Current treatment approaches. Cambridge: Cambridge University Press. Basoglu, M., Jaranson, J. M., Mollica, R., & Kastrup, M. (2001). Torture and mental health: A research overview. In E. Gerrity, T. M. Keane, & F. Tuma (Eds.), The mental health consequences of torture (pp. 35–62). New York: Kluwer Academic/Plenum Publishers. Batalova, J. (2006, August 1). Spotlight on legal immigration to the United States. Migration Policy Institute. Retrieved August 27, 2006, from http://www.migrationinformation.org/USfocus/print.cfm?ID = 414. Bhui, K., Mohamud, S., Warfa, N., Craig, T. J., & Stansfeld, S. A. (2003). Cultural adaptation of mental health measures: Improving the quality of clinical practice and research. British Journal of Psychiatry, 183, 184–186. Bolton, P. (2001a). Cross-cultural validity and reliability testing of a standard psychiatric assessment instrument without a gold standard. Journal of Nervous and Mental Disease, 189 (4), 238–242. Bolton, P. (2001b). Local perceptions of the mental health effects of the Rwandan genocide. Journal of Nervous and Mental Disease, 189 (4), 243–248. Bolton, P., & Tang, A. (2002). An alternative approach to cross-cultural function assessment. Social Psychiatry and Psychiatric Epidemiology, 37, 537–543. Camras, L. A., Chen, Y., Bakeman, R., Norris, K., & Cain, T. R. (2006). Culture, ethnicity, and children’s facial expressions: A study of European American, Mainland Chinese, Chinese American, and adopted Chinese girls. Emotion, 6 (1), 103–114. Cole, M., Gay, J., Glick, J., & Sharp, D.W. (1971). The cultural context of learning and thinking. New York: Basic Books.

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192 HANDBOOK OF MULTICULTURAL ASSESSMENT Fernando, G. A. (2004). Working with survivors of war in non-Western cultures: The role of the clinical psychologist. Intervention: International Journal of Mental Health, Psychosocial Work and Counselling in Areas of Armed Conflict, 2 (2), 108–117. Flaherty, J. A., Gaviria, F. M., Pathak, D., Mitchell, T., Wintrob, R., Richman, J. A., et al. (1988). Developing instruments for cross-cultural psychiatric research. Journal for Nervous and Mental Disease, 176 (5), 257–263. Fowers, B. J., & Davidov, B. J. (2006). The virtue of multiculturalism: Personal transformation, character, and openness to the other. American Psychologist, 61 (6), 581–594. Freed, D. (2005). Assessment of asylum seekers. In K. H. Barrett & W. H. George (Eds.), Race, culture, psychology, and law (pp. 177–193). Thousand Oaks, CA: Sage. Geisinger, K. F. (1994). Cross-cultural normative assessment: Translation and adaptation issues influencing the normative interpretation of assessment instruments. Psychological Assessment, 6 (4), 304–312. Gerrity, E., Keane, T. M., & Tuma, F. (2001). Introduction. In E. Gerrity, T. M. Keane, & F. Tuma (Eds.), The mental health consequences of torture (pp. 3–12). New York: Kluwer Academic/Plenum Publishers. Greenfield, P. M. (1997). You can’t take it with you: Why ability assessments don’t cross cultures. American Psychologist, 52 (10), 1115–1124. Hall, G.C.N. (2005). Introduction to the special section on multicultural and community psychology: Clinical psychology in context. Journal of Consulting and Clinical Psychology, 73 (5), 787–789. Hambleton, R. K. (2005). Issues, designs, and technical guidelines for adapting tests into multiple languages and cultures. In R. K. Hambleton, P. F. Merenda, & C. D. Spielberger (Eds.), Adapting educational and psychological tests for cross-cultural assessment (pp. 3–38). Mahwah, NJ: Erlbaum. Hambleton, R. K., Merenda, P. F., & Spielberger, C. D. (Eds.). (2005). Adapting educational and psychological tests for cross-cultural assessment. Mahwah, NJ: Erlbaum. Hinton, D., Um, K., & Ba, P. (2001). Kyolgoeu (‘‘wind overload’’). Part 1: A cultural syndrome of orthostatic panic among Khmer refugees. Transcultural Psychiatry, 38 (4), 403–432. Hollifield, M., Warner, T. D., Lian, N., Krakow, B., Jenkins, J. H., Kesler, J., et al. (2002). Measuring trauma and health status in refugees: A critical review. JAMA, 288 (5), 611–621. International Test Commission. (2001). International Test Commission guidelines for test adaptation. London: Author. Jacobs, U., Evans, F. B., & Patsalides, B. (2001a). Principles of documenting psychological evidence of torture (part I). Torture 2001, 11 (3), 85–89. Jacobs, U., Evans, F. B., & Patsalides, B. (2001b). Principles of documenting psychological evidence of torture (part II). Torture 2001, 11 (4), 100–102. Jaranson, J. M., & Popkin, M. K. (Eds.). (1998). Caring for victims of torture. New York: American Psychiatric Association.

CROSS-CULTURAL EVALUATION OF REFUGEES AND ASYLUM SEEKERS Jefferys, K. (2005). Refugees and Asylees. U.S. Department of Homeland Security Office of Immigration Statistics Annual Flow Report. Retrieved August 27, 2006, from http://uscis.gov/graphics/shared/statistics/publications/Refugee Asylee?5.pdf. Ji, L. J., Zhang, Z., & Nisbett, R. E. (2004). Is it culture or is it language? Examination of language effects in cross-cultural research on categorization. Journal of Personality and Social Psychology, 87 (1), 57–65. Keller, A. (2003). From persecution to prison: The health consequences of detention for asylum seekers. Boston: Physicians for Human Rights. Maass, A., Karasawa, M., Politi, F., & Suga, S. (2006). Do verbs and adjectives play different roles in different cultures? A cross-linguistic analysis of person representation. Journal of Personality and Social Psychology, 90 (5), 734–750. Marsella, A. J. (2001). Measurement issues. In E. Gerrity, T. M. Keane, & F. Tuma (Eds.), The mental health consequences of torture (pp. 277–290). New York: Kluwer Academics/Plenum Publishers. Masuda, T., & Nisbett, R. E. (2001). Attending holistically versus analytically: Comparing the context sensitivity of Japanese and Americans. Journal of Personality and Social Psychology, 81 (5), 922–934. Nisbett, R. E., Peng, K., Choi, I., & Norenzayan, A. (2001). Culture and systems of thought: Holistic versus analytic cognition. Psychological Review, 108, 291–310. Onyet, L. P., Neuner, F., Schauer, E., Ertl, V., Odenwald, M., Schauer, M., et al. (2004). The Nakivale Camp Mental Health Project: Building local competency for psychological assistance to traumatized refugees. Intervention 2004, 2 (2), 90–107. Ortiz, D. (2001). The survivors’ perspective: Voices from the center. In E. Gerrity, T. M. Keane, & F. Tuma (Eds.), The mental health consequences of torture (pp. 13–34). New York: Kluwer Academic/Plenum Publishers. Ortiz, D., with Davis, P. (2002). The blindfold’s eyes: My journey from torture to truth. Maryknoll, NY: Orbis Books. Padilla, A. M. (2001). Issues in culturally appropriate assessment. In L. A. Suzuki, J. G. Ponterotto, & P. J. Meller (Eds.), Handbook of multicultural assessment (2nd ed., pp. 5–27). San Francisco: Jossey-Bass. Peel, M., & Iacopino, V. (Eds.). (2002). The medical documentation of torture. London: Greenwich Medical Media Limited. Peng, K., Nisbett, R. E., & Wong, N.Y.C. (1997). Validity problems comparing values across cultures and possible solutions. Psychological Methods, 2 (4), 329–344. Physicians for Human Rights. (2001). Examining asylum seekers: A health professional’s guide to medical and psychological evaluations of torture. Boston: Author. Spielberger, C. D., Moscoso, M. S., & Brunner, T. M. (2005). Cross-cultural assessment of emotional states and personality traits. In R. K. Hambleton, P. F. Merenda, & C. D. Spielberger (Eds.), Adapting educational and psychological tests for cross-cultural assessment (pp. 343–367). Mahwah, NJ: Erlbaum.

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194 HANDBOOK OF MULTICULTURAL ASSESSMENT Straker, G. (1994). Integrating African and Western healing practices in South Africa. American Journal of Psychotherapy, 48 (3), 455–467. Sue, S. (1999). Science, ethnicity, and bias: Where have we gone wrong? American Psychologist, 54 (12), 1070–1077. Sue, S., & Chang, J. (2003). The state of psychological assessment in Asia. Psychological Assessment, 15 (3), 306–310. United Nations. (1999). Istanbul Protocol: Manual on the effective investigation and documentation of torture and other cruel, inhuman or degrading treatment or punishment. New York: Author. Available online at http://www.unhchr.ch/pdf/8istprot.pdf. U.S. Department of Health and Human Services. Office of Refugee Resettlement. (2006). Office of Refugee Resettlement Services for Survivors of Torture Program: Program description. Retrieved October 5, 2006, from http://www.acf.hhs.gov/programs/orr/ programs/torturep.htm. U.S. Department of Homeland Security, U.S. Citizenship and Immigration Service, Refugee, Asylum, and Parole System and U.S. Department of Justice, Executive Office for Immigration Review. (2005). Table 16: Individuals granted asylum affirmatively or defensively: Fiscal Years 1990–2005. Retrieved August 27, 2006, from http://www.dhs.gov/ximgtn/statistics/publications/YrBk05RA.shtm. Van de Vijver, F.J.R., & Poortinga, Y. H. (2005). Conceptual and methodological issues in adapting tests. In R. K. Hambleton, P. F. Merenda, & C. D. Spielberger (Eds.), Adapting educational and psychological tests for cross-cultural assessment (pp. 39–63). Mahwah, NJ: Erlbaum. Van der Veer, G. (1998). Counselling and therapy with refugees and victims of trauma (2nd ed.). Hoboken, NJ: Wiley. Weiss, T., & Berger, R. (2006). Reliability and validity of a Spanish version of the Posttraumatic Growth Inventory. Research on Social Work Practice, 16 (2), 191–199. Westermeyer, J. (1987). Cultural factors in clinical assessment. Journal of Consulting and Clinical Psychology, 55 (4), 471–478.

CHAPTER TEN

Cultural Adaptation and Translation of Assessment Instruments for Diverse Populations The Use of the Harvard Trauma Questionnaire in Rwanda Mary Fabri

Acknowledging the equality of these different realities is a matter of human justice. . . . Learning to understand and respect these alternate [cultural] realities is a first step toward a better world. –David Freidel

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uman migration has occurred since the first days of human existence. Movement seeking to improve living conditions is a natural phenomenon. In the twenty-first century, there is an ever growing awareness of an international community. Information technology, global trade, travel opportunities, governmental agreements, and conflicts all contribute to modern migration patterns. This chapter examines the impact of human migration in response to war, civil conflict, and torture on the provision of psychological services to diverse populations. A discussion of the modifications and adjustments required to provide mental health service and care to the displaced, the traumatized, and the ethnically diverse is presented, with a focus on work done in Rwanda since the 1994 genocide. Particular attention will be given to the adaptation and translation of the Harvard Trauma Questionnaire and its use in measuring trauma events and symptoms.

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WHO ARE THE DIVERSE POPULATIONS? Foreign-born populations living in the United States increased from 7.9 percent in 1990 to 12.1 percent in 2005 (Migration Policy Institute, 2006). Many reasons contribute to migration. Often there is a push-pull interaction. Individuals living in poverty and without gainful employment opportunities desire to move to more developed countries, where they perceive a higher standard of living supported by better wages and greater labor demand. At other times, conditions of civil strife and war result in persecution for a particular race, religion, nationality, membership in a social group, or political opinion resulting in a threat to one’s life, and leaving is the only option for survival. Environmental conditions following a natural disaster also result in reasons for departure from one’s home and homeland (Global Commission on International Migration, 2005). Rarely do individuals or families leave their homelands without a push from unbearable conditions and a pull toward improving their lives, perhaps even saving their lives and their families. The 2005 Annual Refugee and Asylee Report (Jeffreys, 2006) published by the U.S. Department of Homeland Security’s Office of Immigration Statistics cited more than fifty-seven thousand persons admitted to the United States as refugees, with the largest numbers from Somalia, Laos, and Cuba arriving between 2003 and 2005. Refugee arrivals over the past ten years have annually ranged from more than eighty-five thousand in 1996 to a dip in 2002 to fewer than twenty-seven thousand to the 2005 admittance of more than fifty-three thousand. They arrived from more than sixty countries from the continents of Africa, Asia, Europe, North America, and South America. In addition, more than twenty-five thousand individuals were granted political asylum in 2005, with the leading countries being China, Colombia, and Haiti. Political asylum grants increased from 8,472 in 1990 to the 25,257 asylees in 2005 from more than a hundred countries. There is truly an internationally diverse representation of refugees and asylees living in the United States.

TORTURE, WAR, AND CIVIL CONFLICT In addition to the more than 100 countries where asylees granted political asylum have fled well-founded fear of harm, the Amnesty International report Torture Worldwide (2000) has documented the practice of torture in 150 countries. In addition to torture, the impact of war and civil conflict on migration trends is well documented in reports by the U.S. State Department, the United Nations, Human Rights Watch, and other human rights monitoring

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agencies (Human Rights Watch, 2006; United Nations, 2006b; U.S. Department of State, 2007). News reports have highlighted the conditions of war in Afghanistan, Bosnia-Herzegovina, Burma, Colombia, East Timor, Iraq, Israel, Kosovo, Lebanon, Liberia, Palestine, Rwanda, and Sudan. Pain, fear, and confusion are visible on the faces of women and children, families, elderly, and the wounded as we view them in the news. The impact of war and other civil conflicts on civilian populations is well documented as a public health concern (Carballo and Nerukar, 2001; Levy and Sidel, 1997; Magar, 1990; Pearn, 2003; Toole, Galson, and Brady, 1993). Internal displacement—being forced to leave one’s home as the result of war, ethnic cleansing, or natural disaster without crossing a border—creates another huge health problem. The Internal Displacement Monitoring Centre (2006), based in Norway and funded by the United Nations, reports that internally displaced persons outnumber refugees two to one. As of December 2005, an estimated 23.7 million people within fifteen countries are living within their country of origin, not crossing borders, to escape harm. Africa alone has 12.1 million internally displaced persons within 20 countries on the continent. Noteworthy examples include Sudan with 5.4 million, Uganda with 2 million, and the Democratic Republic of Congo with 1.7 million internally displaced. Internal displacement, often the result of a campaign by the national government, results in conditions that are vulnerable to hunger, disease, and violence. International humanitarian aid is often inadequate and may add to the chaos and political strife. The return of internally displaced to their homes is often complicated by the location of the original home and control over the area, status of peace, and the lack of monitoring involvement by the international community. The development of culturally appropriate models of mental health care for traumatized populations is a public health issue. In December 2004, a mental health action plan was proposed at an International Congress of Ministers of Health for Mental Health and Post-Conflict Recovery. Named Project 1 Billion, which represents the 1 billion people worldwide subjected to mass violence, it cites goals of creating culturally effective and sustainable mental health systems, determining and disseminating best practices, promoting standards and evidenced-based practices for mental health supported by research, and encouraging an international dialogue within a network (International Congress of Ministers of Health for Mental Health and Post Conflict Recovery, 2004). Mental health strategies cannot be developed outside the sociocultural context of the target country or region (de Jong, Komproe, Van Ommeren, El Masri, Araya, and Khaled et al., 2002). The long-term psychological consequences of war in a global society are profound and provide a challenge to mental health professionals and health care systems.

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ASSISTING DIVERSE POPULATIONS Terms such as multicultural, cross-cultural, and transcultural have emerged in the psychological literature and encourage the recognition and use of culture to understand the traditions, behaviors, and practices of people from other cultures. The American Psychological Association’s Task Force on the Delivery of Services to Ethnic Minority Populations presented guidelines for provision of psychological services to ethnic, linguistic, and culturally diverse populations in 1990; these were most recently updated in 2003 (American Psychological Association, 2003). In 2001, the U.S. Department of Health and Human Services developed standards of cultural competency for mental health services. Yet many foreign-born people do not have a concept of a mental health care and come from countries without a comparable mental health system. The World Health Organization (2001) and the World Federation for Mental Health (2001) have documented the shortages of mental health care workers and the lack of access to services in a large part of the world. The shortage of care is compounded by the lack of understanding and stigma associated with mental illness. Mental health providers in the United States have a double challenge before them: providing culturally competent care to diverse populations who may not readily access care because of unfamiliarity and stigma associated with mental health care systems.

THE CHALLENGES Psychological assessments are conducted for different reasons and may serve different purposes. For example, a clinician will use assessment to assist in obtaining a diagnosis and treatment plan that may include referrals for other services. A service program may require assessments as part of a standard of care, quality improvement, and administrative needs driven by funding requirements, monitoring agencies, and reimbursement requirements. Researchers may include standardized assessments as part of their research protocol, with the data contributing to a scientific study. Adapting psychological assessments to be culturally sensitive and appropriate is essential for obtaining valid and reliable clinical, administrative, and scientific information. There are many considerations involved in the adaptation of assessment procedures that are addressed in other chapters of this book. Language differences may require the use of an interpreter. Culture may also require consideration of the age and sex of the clinician. Length of sessions is influenced by the use of an interpreter and other cultural adjustments. The perception of the assessment process by individuals from a non-Western culture can be a factor.

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A clear and comparable understanding of the assessment procedures and their purpose needs to be established for all participants in the process. This chapter addresses the challenge of assessing the mental health of individuals living in a postconflict setting but having remained in their homeland. Considerations overlap with those working in other cross-cultural situations, but each has unique characteristics. The use of Western-developed instruments based on Western-developed criteria for diagnosis of mental illness and distress for services within a Western health care system raises many questions of adaptability for non-Western populations. Determining the cross-cultural appropriateness of diagnostic categories of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000), the adaptation and translation of culturally sensitive tools, and the use of trained bilingual staff from the culture are necessary components to successfully assessing diverse populations.

MODELS OF ASSESSING DIVERSE POPULATIONS Health and aid systems are challenged to provide ethnic, linguistic, and culturally appropriate services to foreign-born diverse populations. Title VI of the Civil Rights Act of 1964 provided the foundation for President Clinton’s signing Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency, in 2000. Programs serving refugees and political asylees provide models for assisting non-English-speaking and culturally diverse populations.

Bilingual-Bicultural Model in Refugee Mental Health The Office of Refugee Resettlement reports that more than 1.6 million refuges have been resettled in the United States since 1983 (Office of Refugee Resettlement, 2006). The primary goal of refugee resettlement is to provide assistance to help refugees achieve economic self-sufficiency and social adjustment. The influx of Southeast Asians from 1975 to 1985 brought attention to the special health and mental health needs of individuals who have survived war, torture, and other traumas at home (Boehnlein, 1987; Lanphier, 1983). Concerns about Southeast Asian refugee mental health and an appropriate model for delivery of care resulted in the development of refugee-specific psychiatry clinics. The bicultural model of psychiatric treatment of refugees used a multidisciplinary and bicultural-bilingual team approach with an emphasis on understanding the mental health problems within the context of the patient’s trauma history, culture, social, and political background (Allden, 1998; Kinzie, Tran, Breckenridge, and Bloom, 1980). The models employed by both the Boston Indochinese Psychiatric Clinic and the Portland Intercultural

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200 HANDBOOK OF MULTICULTURAL ASSESSMENT Psychiatric Program used bicultural-bilingual workers trained to interpret in psychiatric sessions and in therapy sessions with traumatized refugees for the Western-trained professional staff. The learning exchange that emerged allowed the professional staff to learn about ethnic, linguistic, and cultural interpretations of psychological concepts and provided professional development opportunities for the bicultural-bilingual staff. The refugee patients benefited from having someone present from both their homeland and their new host country to assist them with their problems. The bicultural-bilingual worker model is not without its own set of challenges. Identifying appropriate and capable workers requires community outreach, training, and supervision. The outcome, however, is the provision of much-needed services to assist refugees suffering from mental distress and disorders who may not otherwise access services.

Torture Rehabilitation Programs The bicultural-bilingual model has been refined over the years and is employed in different health settings. Torture treatment centers looked to the refugee mental health model and borrowed the concept of conducting mental health services with the assistance of an interpreter as a viable treatment modality. The National Consortium of Torture Treatment Centers has thirty members in twenty states. Torture treatment centers have a diverse client base with more than sixty languages from more than fifty countries represented in their client population. Similar to refugee mental health issues, torture survivors have been forced to flee their homeland, may have physical or psychological wounds secondary to severe trauma, and have daunting social needs. The use of interpreters in providing services has become commonplace in the field of refugee mental health and torture treatment services. There is great diversity within the client populations served by each torture treatment center, different from refugee resettlement agencies, which receive specific refugees in groups. It is not unusual for a center to serve in one year individuals from forty countries. This situation often finds torture survivors without a resettled community and living in cultural isolation. Finding interpreters from the same country or region presents a variety of problems. Is an interpreter available for in-person interpretation? Is a telephonic interpretation service available and an appropriate option? Is the interpreter perceived as trustworthy by the torture survivor, who may be suspicious of anyone from his or her homeland? Is it possible to find a person who speaks the survivor’s language who may not be a native from their country but perhaps someone who lived and worked there, such as a returned Peace Corps volunteer? Or is the language spoken by other Americans, perhaps students of language at a university?

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The model of bilingual-bicultural worker may not be the most viable option when working with torture survivors, and other choices need to be considered. A model of working in collaboration with an interpreter, however, allows clinicians to provide services to a non-English-speaking survivor of torture. The concept of creating a therapeutic triad or partnership emerges from this model and is not reliant on bilingual-bicultural workers from an ethnic community. The overlayer of trauma secondary to torture in combination with the multiple linguistic, cultural, ethnic, social and political aspects is an ongoing challenge for the centers. Approaches to assessment and treatment have required adjustments and modifications to be successful in working with such diverse and severely traumatized individuals (Fabri, 2001).

INTERNATIONAL POSTCONFLICT RESPONSE TO MENTAL HEALTH The World Health Organization (2003) provided a framework for response in postconflict areas. The recommendations include an assessment of local resources and personnel to assist in the development of a local response to the mental health needs of the affected population. The response should include a culturally appropriate assessment tool, training for local personnel, and ongoing support and supervision of local workers. Mental health projects need to be community specific and evaluated for effectiveness. The use of local health providers, traditional healers, and relief workers can provide the most culturally competent and effective intervention model (Mollica, Lopes Cardozo, et al., 2004). Psychologists, psychiatrists, medical anthropologists, and international public health workers generally agree that concepts of emotional well-being exist within and across cultures (Bolton, 2001b; James and Prilleltensky, 2002; Kleinman, 1980; Westermeyer, 1985; Lewis-Fernandez and Kleinman, 1995; Marsella, Friedman, Gerrity, and Scurfield, 1996; Mollica et al., 1993). Understanding local perceptions of mental health is essential to assess culture-bound and cross-cultural concepts of symptoms and symptom expression.

Cross-Cultural Translation and Adaptation Medical anthropology, a cross-cultural perspective of health, illness, and healing, and ethnographic research methodology, an interactive exploration of local and community funds of knowledge, have made major contributions to the development of cross-cultural instruments. In addition, the World Health Organization (WHO) has identified mental health in general and the mental health of refugees in particular as priorities for global health initiatives. Most

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202 HANDBOOK OF MULTICULTURAL ASSESSMENT theories, standardized instruments, and interventions are developed in Western countries. The development of global mental health strategies requires the translation and adaptation of assessment instruments in collaboration with community leaders, health workers, and traditional healers to develop psychosocial measurements (World Health Organization, 2006a). Standards for cross-cultural translation emphasize the importance of cultural and conceptual rather than linguistic equivalence. This requires translators who are not only fluent in the language but also in the local and cultural meaning of words (World Health Organization 2006b; Medical Outcomes Trust, 1997). The steps required for cross-cultural translation include identifying a number of translators who will be familiar with the terminology in both English and the target language. A forward translation with an emphasis on the conceptual and contextual equivalence for each term is completed by one translator. Language should be kept simple and with the commonly used words, with an avoidance of any terms or words that would be offensive to any groups based on age, gender, religious beliefs and social status. Once the document is completed, it is reviewed by a panel of local experts who have the language capability to examine both the original-language version and the target-language version. Any discrepancies or questionable translations need to be resolved among the expert panel. Once a draft is agreed on, a back translation is conducted by an independent translator who has had no previous exposure to the document being translated. Again, the emphasis of the back translation is the conceptual and cultural equivalence. Any discrepancies in the back translation need to be reviewed by the expert panel. Forward translations, discussions, and back translations for any problematic items need to be repeated as many times as needed to have a satisfactory version. It is essential to pretest the translated tool on a representative population before its use. The instrument should be administered to a corresponding sample, and the respondents should be provided with a debriefing that allows their input about the wording of items. Experienced or well-trained interviewers should conduct the pretests. A final version of the translated instrument is the result of these steps, with each version tracked with a serial number. Modifications may need to be made when experts for a panel review are limited. For example, local equivalents to professional experts are used on the review panel. Local equivalents may include community leaders, elders, traditional healers, midwives, heads of local associations, or other individuals identified by the community as trustworthy and knowledgeable. This is a time-consuming but necessary process. Exhibit 10.1 highlights the steps required in cross-cultural translation.

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Exhibit 10.1. Steps Required in Cross-Cultural Translation and Adaptation 1. Identify translators fluent in English and target language. 2. The translator conducts a forward translation from English into the target language with a focus on conceptual and contextual equivalence for each term. 3. A proficient bilingual panel of local experts reviews the translated document. 4. Once an expert review panel accepts the translation, it is back-translated from the target language into English by an independent translator who has no familiarity with the document. Conceptual and cultural equivalence is emphasized. 5. The back translation is reviewed by the expert panel. Discrepancies are resolved among the local experts. 6. Forward translation, expert panel review, back translation, and discrepancy resolution are repeated until a satisfactory translation is agreed on. 7. The translated tool is pretested on a corresponding sample who provides input about the wording of items in a debriefing session. 8. The panel of experts conducts the final review of the modified tool.

An Example in Rwanda The 1994 genocide in Rwanda created a situation of massive trauma among the country’s entire population. Approximately 1 million human lives were lost, the state and economy collapsed, the country’s infrastructure was destroyed, and 4.5 million people became refugees. Rwanda became the recipient of an international emergency response. The work of Paul Bolton, an international public health researcher, is worth noting (Bolton, 2001a, 2001b; Bolton, Neugebauer, and Ndogoni, 2002; Bolton and Tang, 2002). In Rwanda, Bolton asked to what extent the Rwandans’ perceptions were similar to the Western standards of mental illness as described in the DSM-IV. This question needed to be answered before proceeding with the use of any existing assessment tools. Five Rwandans identified to be translators and interviewers for the project had training and experience working in the psychosocial program of World Vision, a Christian relief and development organization. Two rural communities near the capital city of Rwanda were identified for the study. The Rwandan staff identified local community leaders to work with, and the process began by asking the local leaders to describe the main problems resulting from the 1994 genocide. The data were then organized into composite lists of

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204 HANDBOOK OF MULTICULTURAL ASSESSMENT categories, including mental and emotional problems. The most commonly named problems were consistent with many of the DSM-IV symptoms of posttraumatic stress disorder (PTSD) and depression. With the reality of funding restrictions, the project decided to focus on the symptom list consistent with depression and in one of the two communities initially identified. Community key informants were identified by the local leaders as individuals who were experiencing these problems. Key informants were interviewed by the Rwandan staff by asking for their input when a hypothetical person was described suffering from the symptoms earlier identified and DSM-IV descriptors. Informants were asked to name and describe all the problems these symptoms may cause for the hypothetical person. A second interview the following day was conducted to provide the key informants an opportunity to expand their input if there had been any afterthoughts. The information collected from these interviews was noted on cards, and pile sorts were created. This included an inventory of the listed local symptoms and the DSM-IV descriptors named by the local informants. What emerged was a local understanding of depression-like sequelae. The term guhahamuka was found to be a term that emerged after the genocide and consists of problems from the genocide. A few of the identified symptoms of guhahamuka included sleeping, hopelessness, anger, failure to eat, and attempting suicide. In all, thirty-six symptoms were listed and contained descriptors consistent with the criteria of depression and PTSD. Another term identified that preexisted the genocide was agahinda, which has indicators of being associated with grief. Symptoms described as agahinda included isolation, lack of self-care, not working, feeling shattered, and sadness. Sixteen symptoms fell under agahinda and were most consistent with the criteria for depression. This example of ethnographic research preceding an effort to conduct assessments illustrates the importance of understanding local perceptions of emotional well-being. It also supports the feasibility of adapting and translating appropriate standardized instruments. Exhibit 10.2 presents an ethnographic mini-assessment of local perceptions.

Cross-Cultural Assessment Instruments Finding assessment instruments that are reliable and valid across cultures requires careful consideration. The Hopkins Symptom Checklist (Parloff, Kelman, and Frank, 1954) was demonstrated to be a useful tool in a shorter twenty-five-item version by Rickels (Hesbacher, Rickels, Morris, Newman, and Rosenfeld, 1980; Winokur, Winokur, Rickels, and Cox, 1984), who also worked on the original version. The Hopkins Symptom Checklist-25 (HSCL-25) measures symptoms of anxiety (ten items) and depression (fifteen items). The total score is correlated with emotional distress, and the depression score is correlated with major depression as defined by the DSM-IV. In 1987,

ASSESSMENT INSTRUMENTS FOR DIVERSE POPULATIONS

Exhibit 10.2. Ethnographic Mini-Assessment of Local Perceptions 1. Select bilingual local staff for translations and interviews. 2. Local informants list and describe the main problems after violence, conflict, or natural disaster. 3. Local informants identify community members who are experiencing the identified problems as key informants. 4. Composite lists are made of the identified problems, including the mental and emotional problems. 5. Lists of the mental and emotional problems are cross-checked with target DSM-IV categories. 6. Key informants are approached as consultants, and hypothetical persons are described with specific mental health symptoms from the list that cross-check with DSM-IV target diagnosis. These informants are asked to name and describe all problems the hypothetical person may experience as a result of the symptoms. 7. A second interview is conducted the next day with key informants for any additional information. 8. Local symptoms, including the cross-checked DSM-IV local symptoms, are recorded on separate cards. 9. A convenient community sample is asked to sort cards based on ‘‘what goes together.’’ 10. Community consultants determine appropriateness of target DSM-IV criteria and diagnosis for the community sampled. Source: Bolton (2001b).

Mollica, Wyshak, de Marneffe, Khuon, and Lavelle reported the development and validation of Cambodian, Laotian, and Vietnamese versions of the Hopkins Symptom Checklist-25. The translation and adaptation of a standardized assessment instrument was a new development. The Harvard Trauma Questionnaire was developed by Mollica and his colleagues over a four-year period at the Indochinese Psychiatry Clinic. The instrument was a self-report scale documenting trauma events and symptoms of posttraumatic stress disorder. Linguistic equivalence was established in Khmer, Lao, and Vietnamese following translation guidelines of English into the three Indochinese languages by bilingual mental health professionals. These versions were then blind back-translated by other Indochinese health professionals who had not participated in the initial translation from English. The initial English version and the back-translated English version were compared to assess the

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206 HANDBOOK OF MULTICULTURAL ASSESSMENT similarity of the content. Final adjustments in the Indochinese translations were made based on discrepancies. The translated version was piloted for one year at the clinic. A final revised copy was then used in a study to establish validity and reliability (Mollica et al., 1992). This rigorous process established a standard for cross-cultural adaptation and translation.

A RWANDAN STUDY A project in Rwanda illustrates the intricacies of the adaptation and translation of an assessment instrument. In 2004 the National Institutes of Health awarded supplemental funding for a Rwandan HIV study to the Montefiore Hospital study site of the Women’s Inter-Agency HIV Study (WIHS), a multiyear national cohort study of women with HIV and at-risk women. The project in Rwanda, named RWISA (Rwandan Women’s Inter-Association Study and Assessment), is a prospective observational cohort study assessing the effectiveness and toxicity of antiretroviral therapy in HIV-infected Rwandan women. The context of the 1994 genocide in Rwanda, however, could not be ignored when designing this study (Cohen, d’Adesky, and Anastos, 2005). The primary investigators for RWISA are Kathryn Anastos (WIHS in New York) and Mardge Cohen (WIHS in Chicago), physicians affiliated with the U.S.-based nongovernmental organization Women’s Equity in Access to Care and Treatment (WE-ACTx) who began working in Rwanda in 2004, the tenth-anniversary year of the genocide. WE-ACTx and the WIHS physicians spent several months planning the study. The design and implementation of RWISA was conducted in collaboration with Rwandan government officials and representatives of local nongovernmental organizations (NGOs). A sample of HIV-positive women from Rwandan women’s associations was surveyed regarding their interest in participating in such a study and was asked, ‘‘How will such research benefit you or other Rwandan women?’’ For many, the answer was they would participate to give something back to Rwanda, to show they have something positive to offer the world. A community advisory board was established for oversight of the recruitment, and the study was reviewed by the Rwandan National Ethics Committee (Cohen et al., 2005). I was asked to assist in the implementation of a trauma component of the study. The preparation for traveling to Rwanda in 2004 to assist with RWISA involved a review of the literature and consultation with experts.

Rwanda: Background Information Rwanda, located in eastern Central Africa, is landlocked and surrounded by the Democratic Republic of the Congo to the west, Uganda to the north, Tanzania to the east, and Burundi to the south. Known as the land of a thousand

ASSESSMENT INSTRUMENTS FOR DIVERSE POPULATIONS

hills, it is mostly green, grassy uplands and hills. Rwanda is a poor country, with 90 percent of the population engaged in subsistence farming. The official language is Kinyarwanda. With a postcolonial history fraught with conflict, 1959 was a turning point in Rwandan history, with the first recorded violence between the Hutus and Tutsis, with thousands killed and many Tutsis fleeing to neighboring countries as refugees. In 1963 and 1973, there were additional massacres of Tutsis and more fleeing into neighboring countries. In 1994, the majority government of the Hutu ethnic group planned genocide to exterminate the Tutsi people and any moderate Hutu who rejected their killing plan. This was in response to the advance of the Rwandan Patriotic Front, an army of Tutsi and moderate Hutu exiled since 1959 when they or their parents fled Rwanda. As a result, approximately 1 million human lives were lost. The state and economy collapsed, infrastructure was destroyed, and 4.5 million people became refugees (Des Forges, 1999). In addition, rape was used as a weapon of war, and subsequently there have been high rates of HIV infection among Rwandan women who were raped during the 1994 genocide. This has been referenced as the ‘‘slow genocide’’ by the Rwandan Women’s Network, a national NGO (United Nations, 2006a). With the context of a history of genocide beyond the scope of the 1994 genocide and the HIV crisis in Rwanda, the idea of measuring trauma can seem overwhelming. The value of having guidelines and a series of logical steps gives focus to the task at hand. It is also important to review published work about the lessons already learned.

Review of Trauma Studies Target populations of traumatized refugees living in the United States and civilians living in a postconflict country emerged as the most informative studies. Measures for trauma, depression, and posttraumatic stress were the most commonly studied. Instruments used included the PTSD Checklist-Civilian Version (Pham, Weinstein, and Longman, 2004); the Composite International Diagnostic Interview (de Jong et al., 2001), the Stanford Acute Stress Reaction Questionnaire (Bleich, Gelkopf, and Solomon, 2003), the Harvard Trauma Questionnaire (Cardozo, Bilukha, et al., 2004; Cardozo, Talley, et al., 2004; Cardozo, Vergara, Agani, and Gotway, 2000; Mollica et al., 1992, 2001, 1998, 1999; Sabin, Cardozo, Nackerud, Kaiser, and Varese, 2003; Scholte et al., 2004; Smith Fawzi et al., 1997), and the Hopkins Symptom Checklist (Bolton, 2001a; Bolton et al., 2003; Verdeli et al., 2003). Many of the studies that used the Harvard Trauma Questionnaire for a PTSD measure also used the Hopkins Symptom Checklist-25 for a depression measure. In addition to journal articles, a completed manuscript of Measuring Trauma, Measuring Torture, written by Richard Mollica and his colleagues at the Harvard Program in Refugee Trauma, became available in September 2004 (Mollica, McDonald, Massagli, and Silove, 2004).

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208 HANDBOOK OF MULTICULTURAL ASSESSMENT Review of the literature pointed to the use of the Harvard Trauma Questionnaire (HTQ) (Mollica et al., 1992) which has been widely used and modified since its original version. The modifications have improved the instrument without changing its basic constructs and have been efficacious in clinical and research settings. The benefits of the HTQ include its successful linguistic translation and cultural adaptation with different traumatized groups. It can be administered by well-trained interviewers in areas where professional health workers are scarce. Multiple studies have demonstrated its psychometric properties as valid and reliable (Mollica, McDonald et al., 2004).

Rwandan Women’s Inter-Association Study and Assessment The members of the U.S. team were two physicians as primary investigators of the HIV research and me, a clinical psychologist, as the primary trauma investigator. The in-country team includes Rwandan physicians, nurses, and trauma counselors. The decision to use the HTQ was based on several factors, including its use as a cross-cultural assessment tool that has been effectively adapted, translated, and used in multiple different cultures, languages, and settings. In addition, the most current version of the questionnaire has five sections: trauma events, personal description of the most traumatic event, head injury, trauma symptoms, and torture history. The diversity of the sections allows the documentation of traumatic events, inquiry of head injury for differential diagnoses, and the collection of trauma symptoms, which can be diagnostically significant with the determination of a population-specific cutoff point and application of a PTSD diagnostic algorithm. The narrative portion allows the participant to describe the most distressing events at the time of the trauma and currently. This provides the opportunity to tell the interviewer an event that the subject may not otherwise disclose and also provides information about events or consequences subsequent to the original trauma. The HTQ provides a breadth and depth of information. With the decision made to use the HTQ as the research instrument to document trauma events and symptoms, competent translators for English and Kinyarwanda and a panel of experts for review of the translated version for conceptual and cultural equivalence were selected.

Translation Process Forum Activistes des Contre la Torture/Forum for Activists against Torture (FACT)-Rwanda is a Rwandan NGO working with victims of torture and other forms of violence. It is staffed by Rwandan physicians, trauma counselors, and psychosocial workers. FACT agreed to take on the task of the initial forward translation of the HTQ and to participate on the panel-of-experts review. Kinyarwanda is the official language of Rwanda. French and English

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are spoken depending on one’s educational level and family history of exile. For example, repatriated Rwandans from Uganda speak English and Kinyarwanda. Rwandans repatriated from the Democratic Republic of the Congo speak French and Kinyarwanda. Individuals educated in Rwanda who attend secondary school select either English or French as a second language. The English version of the HTQ required translation into Kinyarwanda and was provided by two teams made up of three staff each (a total of six staff) from FACT-Rwanda. Once the translation was completed, the director of FACT, a physician, joined me in conducting focus groups with senior trauma counselors from six Rwandan women’s associations. Trauma counselor is a profession created after the 1994 genocide to provide psychological support to survivors of the genocide. International agencies provided curriculum and training to women, most of whom had been nurses and teachers prior to the genocide (United Nations, 1996). The Association of Rwandan Trauma Counselors grew out of this initiative and now provides training and certification of trauma counselors. Women’s associations have been a part of Rwandan civil society since the 1970s. They have been predominantly grassroots NGOs and cooperatives attending to health, nutritional, and economic needs of women (USAID/ Rwanda, 2001). Although profoundly impacted by the genocide, the women’s associations rebounded quickly and are a strong social force in Rwanda. Associations function at local, regional, and national levels and provide a range of services, including emergency financial assistance, trauma counseling, legal assistance, vocational training, and income-generation projects. Many women’s associations employ trauma counselors who function as outreach workers, case managers, and counselors. Senior trauma counselors from local women’s associations and the staff at FACT-Rwanda were a natural panel of experts. The focus groups were conducted in Kinyarwanda, with the director of FACT taking a leadership role. The U.S.-based investigators, with the assistance of an interpreter, participated with representatives from six women’s association. The Kinyarwanda translation was reviewed item by item with the women’s input on the linguistic, conceptual, and contextual translation. The focus group review took place over three sessions, with comments and recommended changes noted. Once this process was completed, the document was given to a professional translator to incorporate the changes and provide a blind back translation from Kinyarwanda into English, a translation provided without having reviewed the original questionnaire. Once the blind back translation was completed and reviewed, a trauma counselor from FACT- Rwanda conducted a pretest with ten women survivors of torture, including a debriefing session to gather their comments about the wording of the items. A report was written with the noted experience of the

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210 HANDBOOK OF MULTICULTURAL ASSESSMENT interviewer and the comments of the participants. Changes to the document were again provided by the professional translator. Once the changes were completed in Kinyarwanda, focus groups were convened again with members from the original group and a few new participants, all senior trauma counselors. Once again the items were reviewed one by one, with additional comments noted. Examples from this process follow. Linguistic Changes. The word brainwashing, HTQ item 16, in the trauma events sections was an unfamiliar term. Discussion took place among the focus group members in trying to understand what brainwashing meant and then to create a descriptive equivalence. Brainwashing became others using their words and behaviors to change the way you think. Item 6 in the HTQ trauma symptoms section inquires about startle reactions. This required an explanation of what startle means and required an acting out of the jump or startle that may occur when someone is reactive to sounds, sights, or other stimuli that are unexpected or remind someone of a traumatic experience. The item was then written in Kinyarwanda to descriptively explain the term startle. Feeling on guard, item 9 of the trauma symptoms, resulted in discussion about what it means for a person to be ‘‘on guard.’’ In order to translate this into Kinyarwanda, discussion clarified the questions raised: Did it mean being employed as a guard (for example, a security guard), or did it mean carrying a weapon? The importance of linguistic equivalence to conceptual equivalence of psychological concepts was clearly demonstrated in this discussion. The discussion with local experts was essential to determine how emotional guardedness translates into Kinyarwanda, a language that does not have the term and where the use of the word guard suggests physical protection. The ability to describe adequately the meaning of words and entertain different ways of communicating meaning within the parameters of a language and a culture is essential to the integrity of the instrument. It is also interesting and challenging for Western-trained health providers. The final Kinyarwanda translation for on guard was feeling insecure. Rwandan local experts stated, ‘‘If you are feeling insecure, you must be watching.’’ Contextual Changes. Item 7 of the HTQ inquires if the individual suffered beatings to the body. The Kinyarwanda version asks if there were beatings to the body, including use of an obuhire, a clublike weapon used during the genocide. HTQ item 10 in the trauma events section lists knifing or axing. Review of implements used during the 1994 genocide resulted in item 10 listing use of machetes, spears, or any type of knife as the trauma event.

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Item 24 in the HTQ torture history asks about the administration of nontherapeutic medications. For the Rwandan version, this item was changed to being injected with dangerous medical drugs or even with AIDS-infected syringes. These examples illustrate how the use of medical anthropologic and ethnographic techniques to tap into the fund of knowledge of local experts informs the development of a culturally sensitive assessment instrument. Table 10.1 presents selected items from the trauma symptom section of the HTQ with references to the original version and the back translation.

The Use of the Harvard Trauma Questionnaire in a New Culture Countries affected by war, civil conflict, and natural disasters often have the populations in most need of care. Death, disability, destruction, disease, and traumatic experiences reach levels beyond description. Political, social, and family structures are struck. Forced external and internal migrations deprive refugees of basic needs for subsistence. The major mental health needs of traumatized populations are those arising from war, disaster, and displacement.

Table 10.1. Comparison of Original and Back Translation of the Harvard Trauma Questionnaire: Selected Items from the Trauma Symptom Section Item Number

Original English

Back Translation from Kinyarwandar

4

Feeling detached or withdrawn from people

Feeling like I am alone even amongst others

5

Unable to feel emotions

Feeling like a dead-man walking (moving corpse)

6

Feeling jumpy, easily startled

Not feeling calm and getting scared at nothing

18

Having difficulty dealing with new situations

Having problems with handling the new times you are in

21

Troubled by physical problem(s)

Having problems with your body

25

Feeling as if you are split into two people and one of you is watching what the other is doing

There are times when you feel like you are watching yourself, or you feel like you are acting a movie instead of looking after your life

32

Feeling that others are hostile to you

Feeling that others are your enemies

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212 HANDBOOK OF MULTICULTURAL ASSESSMENT The World Health Report 2006—Working Together for Health (World Health Organization, 2006c) cites a health care worker shortage in sub-Saharan Africa and Southeast Asia, where the greatest needs exist. Developing countries are often the recipients of international aid. Documentation of needs, development of programs, and program evaluations are inherent in aid funding. Translated and adapted instruments for use in a study require working within the realities of the health care system of the identified country. Standards set in an industrialized country will be different from those set in a developing country. The identification and training of local interviewers is an important component of implementing the use of an adapted and translated assessment instrument. Learning the health care system and its workforce is important. A shortage of medical doctors exists in many countries. Nurses are often used to provide health care, with one physician overseeing a team of nurses. Traditional healers are also important in many developing countries, in particular, in rural areas, where there may be no doctor or nurse. Determining the most appropriate and accessible health care worker to assist in conducting an assessment can be a challenge. My experience in Rwanda provides an example of the process. As we were identifying a local team to assist with the translation and adaptation, we were also arranging meetings with in-country governmental and nongovernmental health organizations. These meetings included the psychologist in charge of the mental health section within the Rwandan Ministry of Health, the Association of Rwandan Trauma Counselors, and women’s associations with psychosocial programs. The Kigali Health Institute, the primary training program for health care workers, including mental health nursing, provided direction in understanding the health care system. In early 2004, the National University of Rwanda in Butare had yet to graduate its first class of psychologists. With a better understanding of the mental health system in Rwanda, WE–ACTx employed local trauma counselors as interviewers for the trauma assessment component of the RWISA. The trauma counselors had completed secondary education with vocational tracks in nursing or teaching. The supervising trauma counselor had received certification from the Association of Rwandan Trauma Counselors. The director of FACT Rwanda and I conducted an eight-hour training. The translated and adapted instrument was reviewed item by item, and input on questions was considered in the wording. The role of the instrument as an assessment of trauma events and symptoms and its role in the larger research study were explained. The next training session was four hours and focused on the administration of the HTQ. Staff were assigned roles as either interviewer or participant and directed to conduct the interviews. Once the role play was completed, the group met to talk about the process as interviewers and as

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participants. The staff’s comments resulted in additional minor changes in the translation. The next step involved women referred from participating associations who would be willing to have the assessment conducted as a pilot sample. The HTQ-Rwandan version was given to eight women, with each staff trauma counselor conducting two assessments. I observed each interview to assess the emotional responses of the participants and the tone, demeanor, and response of each trauma counselor. Debriefing sessions were provided for the participants by their counselor from their association. The supervising trauma counselor and I then met with the trauma counselors. Our guidelines for the trauma interview with the HTQ-Rwandan version were voluntary participation, and at any point, a participant could decline to continue or choose not to answer a particular question. The instrument takes forty-five minutes to one hour to administer. Participants are allowed one debriefing session with the interviewer but were referred back to their association for counseling. Follow-up visits occur every six months, with the trauma symptom inventory section from the HTQ being readministered as part of a larger clinic visit that includes medical follow-up for health problems. RWISA works closely with the women’s associations to ensure follow-up visits by the enrolled participants. The U.S.-based team visits the project three to four times annually and provides the Rwandan staff additional training and review of protocol. Problems are addressed as a team. Communication between visits takes place through electronic communication.

Providing Care and Support for the In-Country Team Projects responding to the needs of postconflict populations employ local staff who are also survivors of trauma. Many bicultural workers share that being able to assist others and appreciate that others are also suffering helps them recover (E. Boskailo, personal communication, Oct. 1996; H. Byabagamba, personal communication, May 2005). The impact of personal trauma and the impact of working with trauma survivors, however, may leave staff vulnerable to secondary traumatization and compassion fatigue (Figley, 1995). Strategies for self-care and treatment of emotional symptoms presenting in local staff need to be included in postconflict projects. (Holtz, Salama, Lopes Cardozo, and Gotway, 2002; Mollica, Lopes Cardoza, et al., 2004). The Rwandan RWISA staff are provided with a four-week mandatory vacation, weekly supervision with the project-supervising trauma counselor, self-care workshops with visiting U.S. professionals, and debriefing sessions with the U.S.-based team. These and other self-care strategies are essential to the well-being and longevity of the staff and the project.

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CONCLUSION Culture is fluid and dynamic, as are the political, social, and economic situations of countries, regions, and the world. Cross-cultural work includes an exchange of knowledge, an ethnographic study that encompasses the examination of commonalities and differences, and the modifications and adjustments required to accomplish a collaborative effort of assisting people suffering from emotional distress and disorders. The challenges presented to Western-trained mental health professionals require creativity, flexibility, and a spirit of adventure. We need to ask ourselves whether the constructs, theories, criteria, symptoms, and interventions developed in Western-cultures translate into helpful resources elsewhere. Or do they result in an imposition and a form of neocolonialism? The efforts of health professionals from the fields of public health, psychology, psychiatry, and medicine to develop valid and reliable instruments for assessing the mental health needs of diverse populations have been described in this chapter. It is a sampling from the work being done in postconflict areas, refugee camps, and host countries of refugees and political asylees. The dedication, persistence, and tenacity of Western-trained health professionals and their local country counterparts to develop culturally appropriate mental health assessments and interventions are important contributions to the growing body of knowledge of cross-cultural health care. The twentieth century has been identified as the ‘‘century of refugees,’’ with major multinational wars, many civil wars, and the current war on terror creating millions of refugees and internally displaced persons. The international humanitarian response efforts that include mental health provisions are essential to the healing and reconciliation of the postconflict country. The time-consuming processes of creating culturally appropriate tools are worth the effort, frustrations, and misunderstandings that may occur. The larger end goals of assisting those who are suffering and contributing to a growing body of knowledge on cross-cultural mental health make all the challenges worth the efforts. The assessment tools developed across cultures improve the understanding of our similarities and differences, promote mental well-being, and advocate for health within the context of human rights.

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ASSESSMENT INSTRUMENTS FOR DIVERSE POPULATIONS American Psychological Association. (1990). Guidelines for providers of psychological services to ethnic, linguistic, and culturally diverse populations. Washington, DC: American Psychological Association. American Psychological Association. (2003). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist 58(5), 377–402. Amnesty International. (2000). Torture worldwide: An affront to human dignity. New York: Amnesty International. Bleich, A. B., Gelkopf, M., & Solomon, Z. (2003). Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel. JAMA, 290(5), 612–620. Boehnlein, J. K. (1987). A review of mental health services for refugees between 1975 and 1985 and a proposal for future services. Hospital Community Psychiatry, 38(7), 764–768. Bolton, P. (2001a). Cross-cultural validity and reliability of a standard psychiatric assessment instrument without a gold standard. Journal of Nervous and Mental Disease, 189(4), 238–242. Bolton, P. (2001b). Local perceptions of the mental health effects of the Rwandan genocide. Journal of Nervous and Mental Disease, 189(4), 243–248. Bolton, P., Bass, J., Neugebauer, R., Verdeli, H., Clougherty, R. F., Wickramaratne, P., et al. (2003). Group interpersonal psychotherapy for depression in rural Uganda. JAMA, 289(23), 3117–3124. Bolton, P., Neugebauer, R., & Ndogoni, L. (2001b). Prevalence of depression in rural Rwanda based on symptom and functional criteria. Journal of Nervous and Mental Disease, 190(9), 631–637. Bolton, P., & Tang, A. (2002). An alternative approach to cross-cultural function assessment. Social Psychiatry Psychiatric Epidemiology, 37(1), 537–543. Carballo, M., & Nerukar, A. (2001). Migration, refugees, and health risks, Emerging Infectious Diseases, 7(3 Suppl.), 556–560. Cardozo, B. L., Bilukha, O. O., Gotway Crawford, C. A., Shaikh, I., Wolfe, M. I., Gerber, M. L., et al. (2004). Mental health, social functioning, and disability in postwar Afghanistan. JAMA, 292(5), 575–584. Cardozo, B. L., Talley, L., Burton, A., & Crawford, C. (2004). Karenni refugees living in Thai-Burmese border camps: Traumatic experiences, mental health outcomes, and social functioning. Social Science and Medicine, 58(12), 2637–2644. Cardozo, B. L., Vergara, A., Agani, F., & Gotway, C. A. (2000). Mental health, social functioning, and attitudes of Kosovo Albanians following the war in Kosovo. JAMA, 284(5), 569–577. Cohen, M. H., d’Adesky, A. C., & Anastos, K. (2005). Women in Rwanda: Another world is possible. JAMA, 294(5), 613–615.

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216 HANDBOOK OF MULTICULTURAL ASSESSMENT de Jong, J.T.V.M., Komproe, I. H., Van Ommeren, M., El Masri, M., Araya, M., Khaled, N., et al. (2001). Lifetime events and posttraumatic stress in four postconflict settings. JAMA, 286(5), 555–562. Des Forges, A. (1999). Leave none to tell the story: Genocide in Rwanda. New York: Human Rights Watch. Fabri, M. (2001). Reconstructing safety: Adjustments to the therapeutic frame in the treatment of survivors of political torture. Professional Psychology: Research and Practice, 32(5), 452–457. Figley, C. R. (Ed.). (1995). Compassion fatigue: Secondary traumatic stress disorders in those who treat the traumatized. London: Routledge. Global Commission on International Migration. (2005). Migration in an interconnected world: New directions for action. Retrieved July 28, 2006, from http://www.gcim.org/ attachements/gcim-complete-report-2005.pdf. Hesbacher, P. T., Rickels, K., Morris, R. J., Newman, H., & Rosenfeld, H. (1980). Psychiatric illness in family practice. Journal of Clinical Psychiatry, 41(1), 6–10. Holtz, T. H., Salama, P., Lopes Cardozo, B., & Gotway, C. A. (2002). Mental health status of human rights workers, Kosovo, June 2000. Journal of Traumatic Stress 15(5), 389–395. Human Rights Watch. (2006). Reports on refugees, internally displaced persons and asylum seekers. Retrieved February 10, 2007, from http://hrw.org/doc/?t=refugees pub. Internal Displacement Monitoring Centre. (2006). Internal displacement: Global overview of trends and developments in 2005. Geneva: Internal Displacement Monitoring Center. International Congress of Ministers of Health for Mental Health and Post-Conflict Recovery. (2004). Project 1 billion: Mental health action plan. Retrieved July 28, 2006, from www.hno.harvard.edu/press/pressdoc/supplements/mentalhealth.pdf. James, S., & Prilleltensky, I. (2002). Cultural diversity and mental health: Toward integrative practice. Clinical Psychology Review, 22(8), 1133–1154. Jeffreys, K. (2006). Refugees and asylees: 2005. Retrieved February 10, 2007, from Dhttp://www.dhs.gov/xlibrary/assets/statistics/publications/Refugee Asylee 5.pdf. Kinzie, J. D., Tran, K. A., Breckenridge, A., & Bloom, J. D. (1980). An Indochinese refugee psychiatric clinic: Culturally accepted treatment approaches. American Journal of Psychiatry, 137(1), 1429–1432. Kleinman, A. (1980). Patients and healers in the context of culture: An exploration of the borderlands between anthropology, medicine, and psychiatry. Berkeley: University of California Press. Lanphier, C. M. (1983). Refugee resettlement: Models in action. International Migration Review, 17(1), 4–33.

ASSESSMENT INSTRUMENTS FOR DIVERSE POPULATIONS Levy, B. S., & Sidel, V. W. (Eds.). (1997). War and public health. New York: Oxford University Press. Lewis-Fernandez, R., & Kleinman, A. (1995). Cultural psychiatry: Theoretical, clinical, and research issues. Psychiatric Clinics of North America, 18(3), 433–448. Magar, V. (1990). Health care needs of Central American refugees. Nursing Outlook, 38(5), 239–242. Marsella, A. J., Friedman, M. J., Gerrity, E. T., & Scurfield, R. M. (Eds.). (1996). Ethnocultural aspects of posttraumatic stress disorder. Washington, DC: American Psychological Association. Medical Outcomes Trust. (1997). Trust introduces new translation criteria. Retrieved July 28, 2006, from http://www.outcomes-trust.org/bulletin/0797blltn.htm. Migration Policy Institute. (2006). Global data center. Retrieved July 28, 2006, from http://www.migrationinformation.org/GlobalData/countrydata/data.cfm. Mollica, R. F., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S., & Lavelle, J. (1992). The Harvard Trauma Questionnaire: Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. Journal of Nervous and Mental Disease, 180(2), 111–116. Mollica, R. F., Donelan, K., Tor, S., Lavelle, J., Elias, C., Frankel, M., et al. (1993). The effect of trauma and confinement on functional health and mental health status of Cambodians living in Thailand-Cambodian border camps. JAMA, 270(5), 581–586. Mollica, R. F., Lopes Cardozo, B., Osofsky, H. F., Raphael, B., Ager, A., & Salama, P. (2004). Mental health in complex emergencies. Lancet, 354(9450), 2058–2067. Mollica, R. F., McDonald, L. S., Massagli, M. P., & Silove, D. M. (2004). Measuring trauma, measuring torture. Cambridge, MA: Harvard Program in Refugee Trauma. Mollica, R. F., McInnes, K., Pham, T., Smith Fawzi, M. C., Murphy, E., & Lin, L. (1998). The dose-effect relationships between torture and psychiatric symptoms in Vietnamese ex-political detainees and a comparison group. Journal of Nervous and Mental Disease, 186(9), 543–553. Mollica, R. F., McInnes, K., Sarajlic, N., Lavelle, J., Sarajilic, I., & Massagli, M. P. (1999). Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. JAMA, 281(5), 433–439. Mollica, R. F., Sarajlic, N., Chernoff, M., Lavelle, J., Sarajlic Vukovic, I., & Massagli, M. P. (2001). Longitudinal study of psychiatric symptoms, disability, mortality, and emigration among Bosnian refugees. JAMA, 286(5), 546–554. Mollica, R. F., Wyshak, G., de Marneffe, D., Khuon, F., & Lavelle, J. (1987). Indochinese versions of the Hopkins Symptom Checklist-25: A screening instrument for the psychiatric care of refugees. American Journal of Psychiatry, 144(4), 497–500. Office of Refugee Resettlement. (2006). Office of Refugee Resettlement annual report to Congress— 2004. Retrieved on July 28, 2006, from http://www.acf.hhs.gov/ programs/orr/policy/04arc2.htm# Ref532872905.

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218 HANDBOOK OF MULTICULTURAL ASSESSMENT Parloff, M., Kelman, H.C., & Frank, J. D. (1954). Comfort, effectiveness, and selfawareness as criteria for improvement in psychotherapy. American Journal of Psychiatry, 3(5), 343–351. Pearn, J. (2003). Children and war. Journal of Paediatric Child Health, 39(3), 166–172. Pham, P. N., Weinstein, H. M., & Longman, T. (2004). Trauma and PTSD symptoms in Rwanda. JAMA, 292(5), 602–612. Sabin, M., Cardozo, B. L., Nackerud, L., Kaiser, R., & Varese, L. (2003). Factors associated with poor mental health among Guatemalan refugees living in Mexico twenty years after civil conflict. JAMA, 290(5), 635–642. Scholte, W. F., Olff, M., Ventevogel, P., de Vries, G., Jansveld, E., Cardozo, B. L., et al. (2004). Mental health symptoms following war and repression in Eastern Afghanistan. JAMA, 292(5), 585–593. Smith Fawzi, M. C., Murphy, E., Pham, T., Lin, L., Poole, C., & Mollica, R. F. (1997). The validity of screening for post-traumatic stress disorder and major depression among Vietnamese former political prisoners. Acta Psychiatrica Scandinvica, 95(2), 87–93. Toole, M. J., Galson, S., & Brady, W. (1993). Are war and public health compatible? Lancet, 341(8854), 1193–1196. United Nations. (1996). United Nations situation report for Rwanda. Kigali: Office of the Resident Coordinator of the United Nations System’s Operational Activities for Development in Rwanda. United Nations. Integrated Regional Information Networks. (2006a). Rwanda: Twelve years on. Retrieved July 28, 2006, from http://allafrica.com/stories/200607070949 .html. United Nations. Office of the High Commissioner for Refugees. (2006b). The state of the world’s refugees: Human displacement in the new millennium. Oxford: Oxford University Press. USAID/Rwanda. (2001). Civil society in Rwanda: Assessment and options. Burlington, VT: ARD. U.S. Department of Health and Human Services. Office of Minority Health. (2001). National standards for culturally and linguistically appropriate services in health care. Retrieved February 10, 2007, from http://www.omhrc.gov/assets/pdf/checked/ finalreport.pdf. U.S. Department of State, Under Secretary for Democracy and Global Affairs. Bureau of Population, Migration, and Refugees. Retrieved February 10, 2007, from http://www. state.gove/g/prm/. Verdeli, H., Clougherty, K., Bolton, P., Speelman, L., Ndogoni, L., Bass, J., et al. (2003). Adapting group interpersonal psychotherapy for a developing country: Experience in rural Uganda. World Psychiatry, 2(2), 114–120. Westermeyer, J. (1985). Psychiatric diagnosis across cultural boundaries. American Journal of Psychiatry, 142(7), 798–805.

ASSESSMENT INSTRUMENTS FOR DIVERSE POPULATIONS Winokur, A., Winokur, D. F., Rickels, K., & Cox, D. S. (1984). Symptoms of emotional distress in a family planning service: Stability over a four-week period. British Journal of Psychiatry, 144, 395–399. World Federation for Mental Health. (2001). Newsletter, First Quarter 2001. Retrieved July 28, 2006, from http://www.wfmh.com/nl011.htm. World Health Organization. (2001). World health report: 2001: Mental health: New understanding, new hope. Geneva: World Health Organization. World Health Organization. (2003). Mental health in emergencies: Mental and social aspects of health of populations exposed to extreme stressors. Geneva: World Health Organization. World Health Organization. (2006a). Mental health of refugees, internally displaced persons and other populations affected by conflict. Retrieved July 28, 2006, from http://www.who.int/hac/techguidance/pht/mental health refugees/en/. World Health Organization. (2006b). Process of translation and adaptation of instruments. Retrieved July 28, 2006, from http://www.who.int/substance abuse/ research tools/translation/en/. World Health Organization. (2006c). The world health report 2006: Working together for health. Geneva: World Health Organization.

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CHAPTER ELEVEN

Delivering Quality Mental Health Services to Immigrants and Refugees Through an Interpreter Maria Prendes-Lintel Francisca Peterson

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his chapter is based on research on the use of interpreters and our seven years of experience as founders of the For Immigrants and Refugees Surviving Torture (FIRST Project). Located in Lincoln, Nebraska, FIRST Project helps individuals and families overcome adversity and counteract the pain, inhumanity, and degradation of the torture and trauma experienced at the hands of a government. In addition to direct services to survivors, FIRST Project offers training to other professionals and volunteers. This chapter focuses on one of the services provided: interpreter training. In the past ten years, Nebraska has enjoyed a growing diversity in its population. In Nebraska, the percentage of persons five years old and over who spoke a language other than English at home rose from 55,954 to 135,796, indicating a 41 percent growth in ten years (U.S. Census Bureau, 1990, 2000, 2003). Nationally, the percentage of persons five years and over who spoke a language other than English at home rose from 31.8 million to 47.0 million people, indicating a growth of 47 percent in the 1990s (U.S. Census Bureau, 2000). Traditionally Lincoln has been a city with low unemployment and a low cost of living. It was identified in the 1990s by the U.S. Office of Refugee Resettlement as a community for newly arriving refugees because of the availability of job opportunities and the affordable resources. Lincoln is identified as one of the major cities for resettlement in the United States. Refugees and immigrants from Croatia, Iraq, Vietnam, Mexico, Guatemala, El Salvador, Russia, Serbia,

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Bosnia, Hungary, Ethiopia, Sudan, Afghanistan, Liberia, Somalia, and Sierra Leone have relocated to Lincoln. While welcoming the new Americans, many communities are not prepared to address the number of changes that population shifts present. Health care is one area affected directly by this shift, including mental and behavioral health. Language limitations are one of the contributing barriers of access to care. The increased number of migrant and refugee programs addressing mental health issues from adjustment to war and torture forces the use of interpreters and translators because not enough mental health professionals are bilingual or knowledgeable in the myriad of languages and cultures represented. This chapter provides information regarding interpreter services, language competency, cultural brokerage, problems in using untrained interpreter in treatment, and the interpreter training program at FIRST Project.

FIRST PROJECT The FIRST Project interpreter program was developed to address a number of critical issues identified in the literature. Topics included refugee trauma, acculturation, adjustment, and the use of interpreters in treatment (Marcos, 1979; Acosta and Cristo, 1981; Baker, 1981; Kinzey, 1986; Lin, 1986; Ben-Porath, 1987; Butcher, Egli, Shiota, and Ben-Porath, 1988; Egli, 1987; Garcia-Peltoniemi, 1987; Westermeyer, 1987a, 1987b, Benhamida, 1988). The unique experiences of individuals, the meaning of their torture, and experiences of multiple losses, acculturation, and adjustment, as well as culture, race, ethnicity, religion, gender, and abilities, all had to be addressed within the context of language. Our staff of professionals, whose cultural backgrounds mirrored the communities we served, included former refugees and immigrants. Using interpreters allowed us to acknowledge the importance of listening and bearing witness to the individual whose voice had been silenced in torture. Finally, we wanted to understand the meaning and context of the client’s pain, needs, and coping. Knowing our needs and limitations, we budgeted for the use of interpreters and their training. We knew that clients could relate factual information with minimal English, but we also understood that emotionally laden information is best communicated in one’s native language (Marcos, 1979; Acosta and Cristo, 1981; Egli, 1987; Westermeyer, 1987a; Hays, 2001). In addition, as Hays (2001) states, interpretation is a demanding job and should be paid. Paying interpreters gave us the opportunity to communicate as accurately as possible with the client, and the consistency of using the same interpreter fostered trust building. We also paid interpreters for coming to training because we wanted

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222 HANDBOOK OF MULTICULTURAL ASSESSMENT to ensure that our team was competent and professional in its delivery of services. Finally, interpreters were paid if cancellation of a session occurred within less than twenty-four hours, a recognition of their valued service.

INTERPRETER SERVICES An interpreter is a person who translates orally, and a translator is a person who produces an interpretation from one language to another in a written format. Although many of the skills require overlap, the interpreter’s skills lie in a live oral performance, while the translator must produce accurate written products (Fradd and Wilen, 1990). Both have to be knowledgeable of cultural nuances. However, interpreter services are not always accessed appropriately, as clinicians do not know when to use an interpreter, how to work with an interpreter, or how to find trained interpreters. Clients who seem to speak English because of their high conversational proficiency in English are often seen without an interpreter. An example of such a case is our experience with Isidro, who worked with a local therapist for two years without an interpreter. When Isidro was referred to our program, it became apparent that an interpreter was needed in order to deliver adequate services. This situation posed both clinical and ethical concerns. In general, an interpreter should be called in whenever the client requests it. Milectic et al. (2006) suggest that English proficiency is divided into comprehension and expression in both oral and written forms. They present a three-category scale of proficiency. In category one, the client is unable to have an everyday conversation beyond simple greetings. In category two, the client is able to have everyday conversations but is unable to discuss clinical issues or emotional content. In category three, the client is able to communicate well and readily discusses clinical information. Only when a client falls into category three is an interpreter not needed. An important point that Milectic et al. make is that in acute illness, a client may shift from category three to two or one. The U.S. Department of Health and Human Services’ Office of Minority Health (2001b) published its policy guidance for the provision of culturally and linguistically appropriate services in 2000. One of the reasons for the development of the standards was to correct disparities in mental health treatment, which were documented in the first surgeon general’s report, Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services, 1999), as well as a later supplement, Surgeon General’s Report on Mental Health: Culture, Race, and Ethnicity (U.S. Department of Health and Human Services, 2001a). These reports documented a number of pervasive disparities in mental health care and identified language as a barrier in accessing services. Even when services are accessed, language remains a barrier, because clients

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are unable to fully explain symptoms, ask questions, or actively participate in treatment. Moreover, due to language barriers, the clinician is unable to obtain complete and accurate information. Among examples of identified cultural disparity in the reports are the issues of misdiagnosis due to differences in the way symptoms are expressed in different cultures. Health care delivery organizations receiving federal funding such as Medicare or Medicaid are mandated to use the culturally and linguistically appropriate services standards. These standards require organizations and agencies to provide, at no cost to the client, services that meet the cultural and linguistic needs of the client. Standards 1 through 3 address culturally competent care. Standards 4 through 7 address language access services, and standards 8 through 14 address organizational support for cultural competence. However, these standards are not enforced, and currently there is much discussion between providers and Medicare and Medicaid as to who should pay for these services. One of the problems cited is the low rate that Medicare and Medicaid pays providers, which is insufficient to cover the cost of interpreter services.

LANGUAGE COMPETENCY Bancroft (2005) reports that over three hundred languages are spoken in the United States. Only therapists fluent in the target language are qualified to conduct therapy within the client’s language (Westermeyer, 1987a; Hays, 2001). Cummins (1981) suggests that it takes two to seven years to acquire the cognitive-academic language proficiency required to communicate effectively. Clinicians in the field recommend that therapists not try to speak the client’s language without proficiency for several reasons. One is the clear possibility of miscommunication, leading to misdiagnosis or the wrong treatment. The other is the awkward position of the client who does not want to insult the therapist by requesting an interpreter (Westermeyer, 1987a; Butcher et al., 1988; Hays, 2001). Learning basic colloquialisms does not mean one is qualified to conduct therapy in the target language. Languages are dynamic; they change over time and are affected by the local culture. For example, Vietnamese French is not the same as African French; Middle Eastern Arabic is not the same as African Arabic; and Spanish, spoken in twenty-two countries, is not exactly the same in any of them. Languages are laden with cultural nuances, tones, and implications that can significantly change the meaning of a statement. Language also has a religious, sociopolitical, and socioeconomic context that varies from setting to setting, significantly changing meaning (Butcher et al., 1988; Westermeyer, 1987a). In the FIRST Project these problems were particularly evident when the agency faced an interpreter shortage. In one case, a Vietnamese interpreter

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224 HANDBOOK OF MULTICULTURAL ASSESSMENT who spoke French tried to interpret for a French-speaking African client. The session had to be stopped as frustration set in when it was obvious the interpreter had to keep clarifying information received from the client.

CULTURAL BROKERAGE Language competency represents only half of the story. Cultural brokerage competency is the other half. Knowing a culture and its nuances well enough to place a client’s remarks in a cultural context or to ascertain if the client’s ideas and behaviors are consistent with the culture is another part of the interpreter’s role (Acosta and Cristo, 1981; Westermeyer, 1987b). For example, Myhriam, a Middle Eastern client, began hitting herself in session when addressing feelings of guilt. The interpreter was able to provide information identifying this behavior as a common cultural practice often confused as originating from religious practice. Understanding the context of this behavior allowed the therapist to clarify its meaning for the client and approach issues of guilt and forgiveness rather than focus on this behavior as pathological. It should be noted that cultural information derived from an interpreter, although useful, represents a subjective opinion that may or may not apply to the client. In consulting an interpreter for cultural information, it is also important to identify whether she or he is from the same culture and speaks the same language (for example, the same dialect). It is recommended that clinicians turn to the professional literature for further cultural information. However, here again, whether the information applies to the client should not be assumed without checking directly with him or her. The issues of role boundaries can be particularly confusing in cultural brokerage. In attempts to address the cultural context of the information, the clinician may relinquish her or his role as a therapist to the interpreter, forgetting that the interpreter should provide only information and opinions in regard to communication and culture, not on the therapeutic process (Milectic et al., 2006). An example of cultural brokerage gone wrong is the clinician whose reliance on the interpreter’s cultural insights results in the interpreter’s dominating and guiding treatment by telling the therapist what to do. The therapist reframes the dominance by stating that he appreciates the interpreter’s cultural insights. For example, Mirko, a client, stated, ‘‘I don’t need to be here. Just ask Michael [the interpreter] how I feel,’’ in an example of confused role boundary. Role boundaries are especially evident in the length of verbalizations the interpreter makes in session. It has been our experience that when the interpreter is the main voice in a session, the boundaries are being crossed and the interpreter is in control.

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THE UNTRAINED INTERPRETER IN TREATMENT Although it may seem like a daunting task to train and work through interpreters, the consequences when interpreters are not used are far more serious. Butcher et al. (1988) presents a case resulting in suicide because the depth of the problem was not revealed in therapy. In this situation, that a family member was interpreting was also a factor in the patient’s distress. Using untrained family, friends, and service staff may prove disastrous even during an initial intake due to the inability of the interpreter to provide accurate translations (Marcos, 1979). Family members present a host of difficulties when interpreting (Marcos, 1979; Westermeyer, 1987a, 1987b). They may have a stake in the problem, may be afraid to minimize or magnify pathology, or may have a personal agenda (Prendes-Lintel, 2001). When domestic violence is an issue of treatment, it is especially important to make sure that the interpreter is not the abuser. We have seen this situation in our work with torture survivors. Using children to interpret makes it difficult for the adults to discuss personal information openly. In addition, it may contribute to disrupting the parent-child hierarchy in which the parent becomes dependent on the child for guidance, problem identification, and resolution (Prendes-Lintel, 2001). Untrained interpreters may inadvertently alter statements and can also change the meaning of an individual’s communication. For example, inaccurate translations of symptoms could mask the psychotic process of a hallucinating patient (Price, 1975). In addition, untrained interpreters who disclose information shared during a counseling session to the client’s community can be the cause of further trauma, turning what should be a healing session into a traumatic experience.

INTERPRETING IN THE MENTAL HEALTH SETTING Although there are similarities among medical, court, and behavioral health interpretation, the use of interpreters in the mental health setting with torture survivors requires specialized conditioning and training. Jaranson (cited in Friedman and Jaranson, 1994), describes the inability of untrained interpreters to maintain professional distance. Jaranson related the story of an interpreter who stopped a client from sharing a trauma story to explain how much worse the interpreter’s personal trauma had been. Haenel (1997) tells of an interpreter who identified so closely with the individual client that the interpreter began to suffer the same symptoms. Both vicarious trauma and retraumatization are risks that therapists can experience in the treatment of trauma (Herman, 1997). Although little is known about the ways interpreters are affected by the stories they hear, it is important to consider that these risks are present given that interpreters are often drawn from the same refugee population (Miller, Martell,

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226 HANDBOOK OF MULTICULTURAL ASSESSMENT Pazdirek, Caruth, and Lopez, 2005), and the story of the trauma can bring back memories of the interpreter’s own experience (Butcher et al., 1988). In addition, Butcher et al. (1988) warns of ethical considerations when a therapist exposes untrained interpreters to potentially emotionally damaging materials. Debriefing on a regular and an as-needed basis is important for therapists working in torture treatment (Herman, 1997) and work with interpreters (Haenel, 1997). In our program, debriefing occurs regularly and is always available following a session. Lynch (1998) and Hays (2001) recommend pre- and postsessions between therapist and interpreter to learn about the interpreter’s background, establish rapport, and address goals of treatment. We use pre- and postsession meetings during the intake process and the initial sessions with the clinician. As the case progresses, these sessions become more streamlined and less frequent. At FIRST Project, clients are asked to pick an interpreter from our list of trained interpreters. Because of the longevity of the interpreters in our program, clients have on occasion made statements of feeling comfortable with our interpreters. This is very similar to a client’s comfort level when referred to a particular therapist whose reputation he or she trusts. We are sensitive to gender issues and provide same-sex therapists when requested. If a client is referred whose language we do not have available, we search for a suitable interpreter and pursue our regular plan of interviewing and training the candidate prior to engaging this person in assessment and treatment. As a result, some clients have been placed temporarily on a waiting list because we believe that proceeding without appropriate training would provide that client with less-than-competent service. Interpreters are part of the team. Female and male interpreters who do not want to work with members of the opposite sex are respected. And although the interpreter stays with the client throughout treatment, sometimes situations call for a change—for example, when an unexpected issue comes up in treatment, such as abortion and it is against the interpreter’s beliefs. It is ideal to identify such issues prior to the start of treatment; however, these issues may arise as different topics are addressed. This is admittedly difficult; however, in such a situation, changing the interpreter is critical if treatment is to continue. When possible, this change is handled in session when the interpreter is present and seeks to help the client understand that he or she has not caused the problem; rather, this is the interpreter’s choice. The effect the interpreter’s presence may have on the client and therapy is also well documented. Three situations may prevent clients from sharing information: emotional inhibition, fear of information leaking into the community, and difficulty acknowledging and addressing emotional-laden topics in front of the interpreter who is a community member (Turner, McFarlane, and van der Kolk, 1996). Complex interpersonal dynamics are created when using an

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interpreter (Butcher et al., 1988; Haenel, 1997; Westermeyer, 1987a). A therapeutic interaction exists not only among therapist, interpreter, and client but also among the three distinct dyads of client—interpreter, interpreter-clinician, and client-clinician (Butcher et al., 1988; Haenel, 1997). Transference and countertransference can run rampant between these three dyads (Dalenberg, 2000).

THE TRAINING OF INTERPRETERS Training interpreters to work in a highly charged situation with emotional material of war trauma and loss requiring long-term treatment demands that the training address the uniqueness of interpreting in a psychotherapy context (Miller et al., 2005). Our experience mirrors that of Miller et al. in that the longer the interpreter works in the field with appropriate training and opportunities for regular debriefing, the less strong his or her reactions are. As interpreters acclimate to this work, they seem to find a variety of strategies to cope with occasional distress. Leila, one of our interpreters, stated that ongoing training and our willingness to be available for support (whether she accessed it or not) was particularly helpful. In our program, we found that the longer the interpreter was with us, the less often he or she attended debriefing even when paid for this time. Anecdotally, some of the coping strategies the interpreters reported using were relaxation and observing client-interpreter boundaries and other techniques discussed in training and in sessions with clients. In one such example, Mohammad, an Arabic interpreter, reported successfully using grounding techniques that were being taught to a client when he felt he was being triggered by the client’s story. In a second example, Olga, a Russian interpreter, reported the training regarding boundaries helped her not feel guilty when a client asked her to interpret outside the center and she refused. Miller et al. (2005) noted that interpreters made use of support systems from both the agency and in their personal life, training, opportunities to debrief after session, and focusing on the importance of their work as preferred coping strategies. During one of our sessions, our interpreter, Laura, began to cry as the client spoke of being forced to watch her mother’s torture. In a debriefing session, the therapist and Laura were able to discuss the trigger of Laura’s own mother whose torture she did not watch but whom she heard had died under similar circumstances.

SELECTING INTERPRETERS: THE APPLICATION PROCESS In our interview with the interpreter applicant, we begin by addressing the nature of our work in trauma and its possible impact on others, as well as on previous trauma. This leads to an inquiry of the applicant’s background

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228 HANDBOOK OF MULTICULTURAL ASSESSMENT inclusive of trauma, this person’s healing, and how this type of work may affect him or her. On one occasion during this part of the interview, two applicants decided they would not be able to tolerate listening to the trauma story of the clients since they had had similar experiences in their background. In addition, we address personal politics and how they may interfere in treatment. We are interested in interpreters who can respect religious and political differences. The interpreter will be exposed to individuals from various religions and opposing political groups as they interact with the center. Examples of such groups are refugees from the Balkans or from Sudan, where religion and political oppositions have been the basis of war and genocide. Previous interpreting experiences and experience in ethical issues, confidentiality, and empowerment practices are also explored during the interview. In one case, an applicant made it clear that it would be hard for him not to share information with others. ‘‘People want to know,’’ he said. According to this applicant, it would be rude for him not to share information when asked; for the clinic, such sharing would have devastating effects. Obviously this was not a good candidate despite his excellent English. We address applicants’ knowledge of the culture in the interview. We have found that interpreters who grew up in the United States or are not native speakers are not always helpful when it comes to their culture of origin or ancestry. This becomes a problem since their ability to provide cultural brokerage services is limited. Applicants’ ability to accept and understand the nature of our work and their need for training is evaluated and is evident in the interpreter’s appreciation and commitment of fidelity to their role. Finally, we evaluate the quality of our interactions with each applicant, including interpersonal skills. Miller et al. (2005) suggest additional characteristics of psychological-mindedness and empathy that should be present in qualified interpreters.

General Interpreter Characteristics Examples of specific characteristics used by our team in evaluating the applicant’s readiness are addressed below. Pre- and posttesting in mental health training plus performance in session round off the general characteristics necessary for successful interpreting. • Tested Language Proficiency English Language (TOEFL) is one of the best-known standardized tests for language proficiency. However, any language-proficiency standardized test that is accepted by a college program is appropriate. In the case of the TOEFL, our local university uses a cutoff score of 500 as adequate for admission. If the applicant has previous testing scores available for review, we do not require a retake of this test. The passing of

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this test is simply a beginning standard to make a decision about adding this candidate to the training pool. If the interpreter is a U.S. college graduate, no English proficiency testing is required. • Training in basics of interpreting includes understanding of the basic role of interpreting, such as the do’s and don’ts, types of interpreting such as consecutive and simultaneous, ethics, and role boundaries. • Mental health interpreting training. Topics and descriptions of the curriculum are presented in Appendix 11A. In our program, interpreters are expected to go through mental health interpreter training even if they have previous work experience in the mental health field. • We ask about personal traumas and coping with traumatic experiences. If the interpreter has previously experienced trauma, we would expect that he or she has worked toward healing. An interpreter who is experiencing trauma symptoms would be at high risk for further traumatization in working with our population of torture survivors. As a result, this is an area that has to be carefully discussed. What helps us to address this issue is to identify the potential for triggering of trauma in therapy. • Supportive resources available are an important factor in coping. Although we provide support for our interpreters, our concern here is an interpreter who might not have additional supportive resources: personal, social, religious, or financial. Questions addressing ways they cope with difficulties and resources accessed are helpful in this discussion. • Self-awareness is an important characteristic for the interpreter. Interpreter awareness of issues affecting self and sensitivity in how they affect others is important in maintaining the role of interpreter in therapy. In one case, we had to dismiss an interpreter after training because he repeatedly addressed personal issues with the client and at times with the therapist. This would occur after the session had started, and the interpreter seemed oblivious to the inappropriateness of his interruption and insensitive to the client’s need that was being presented. • Flexibility is needed as the interpreter is part of a team. • Trustworthiness is another important characteristic as the interpreter is counted on for the continuity of treatment. • Professionalism in general demeanor and behavior—for example, the unobtrusive way the applicant carries out the role and his or her regard for clients—is important. • Full bilingualism results in no ambiguous areas of communication. • Cultural familiarity is paramount in correctly conveying the client’s cultural context.

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230 HANDBOOK OF MULTICULTURAL ASSESSMENT • Awareness of limitations allows the interpreter to step down in situations where she or he may not perform adequately for personal reasons. This protects the well-being of the client.

Full-Language Bilingualism We evaluate English proficiency as determined by the TOEFL or other standardized college entrance language-proficiency exams. However, full bilingualism as determined by back translation was not used, because there was no way for us to evaluate this. We tried to address this shortcoming by hiring only interpreters who have at least a high school education in their native language. Most of our interpreters are professionals such as physicians, nurses, teachers, businesspeople, and judges. This ensures they are proficient in oral language as well as reading and writing in their native language. In addition, we address this limitation by having all of our materials translated by a professional translating agency that used back translation in their work. Using these materials ensured a certain degree of consistency and served as part of the training for the interpreter. Knowing the correct terminology in both languages is important.

CODE OF ETHICS IN TRAINING INTERPRETERS Starting with the interview, issues pertaining to the code of ethics are discussed, and the interpreter signs the code of ethics before seeing clients. It is important for interpreters to abide consistently by the code of ethics they have signed as they go across settings from physicians, to clinicians, the court, the school, and social services, among others. Practitioners may be unaware of potential ethical issues. For example, for expediency, they may interrogate the interpreter regarding the client’s experience in other settings. Problems arise in that not only is the provider asking the interpreter to break confidentiality but is also obtaining information from the interpreter, not the client. The ethics code is also broken when an interpreter provides false translations or offers consultation outside his or her competency boundaries (Dean and Pollard 2005). Confidentiality is the hallmark of not only clinicians but interpreters as well. It is important to emphasize to both the client and the interpreter that the guidelines for clinicians extend to interpreters. Aside from specific training on issues of confidentiality, we advise our interpreters on potential liability issues in violating confidentiality. Currently liability lies with the therapist if there is interpreter violation. However, it is anticipated that as the interpreter profession develops into licensure, the legal responsibility may shift. This training is considered a beginning point. Continued training is necessary as it is in any other profession. Interpreters are tested before and after training on material that covers the breadth of the training. The base score shows

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where the interpreter is starting from regarding basic interpreting and mental health knowledge. In addition, the test allows us to adjust the training to the particular group. The posttest is used to evaluate usefulness of training. Videotapes are used to demonstrate good and bad interpretation. Interpreters receive a binder of terminology in mental health. Role-play, PowerPoint presentations, newspaper articles, cases from the literature, and discussion are used to illustrate examples and promote learning. Due to confidentiality and the small refugee community, no local cases should be used in any of the trainings. Appendix 11A highlights the specific domains, definitions, and materials covered in interpreter training.

INTERPRETERS AND ASSESSMENT The most critical part of any assessment is obtaining the client history. Understanding the journey of the individual from his or her perspective is the accurate way to know the depth of the wounding, what it means, and its effects. Knowing individuals’ social, cultural, political, spiritual, and environmental influences that shaped their life before and after their refugee, immigrant, or torture experience helps us to better understand the needs of the clients, their strengths, and their coping resources. The journey, which begins at home before war, must be followed through the trauma or torture experience leading to the exodus from home and to resettlement. In resettlement, the pressures and strengths bearing on clients affect their ability to function, and issues of acculturation are also part of the assessment. Through this history, we identify the possibility of traumatic brain injury from beatings or bombings and obtain a clearer picture of specific emotional injuries. None of this can be assumed or understood without the client’s providing the information through a well-trained interpreter. The clinical interview assesses the client’s level of cognitive ability, appearance, emotional mood and speech, thought patterns, insight, and judgment at the time of evaluation. It includes the clinician’s observations about the client’s attitude and cooperativeness in answering questions. The purpose of the clinical interview is to assess the presence and extent of a person’s mental impairment. The clinical interview is heavily reliant on language and is culturally laden. An example of the importance of understanding the client’s perspective versus making assumptions is highlighted in the case of a client who had had horrific experiences of torture, including the witnessing of family members killed. This client later hid from soldiers by pretending to be dead and lying among dead bodies. The well-meaning clinician kept addressing the losses he thought were at the core of the client’s pain. The client was finally able to verbalize that although he could accept the losses of his family members

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232 HANDBOOK OF MULTICULTURAL ASSESSMENT in war, he could not accept the feelings about hiding among corpses, a cultural taboo (Center for Victims of Torture, 1999). In this case, neither the clinician nor the interpreter was versed in the cultural impact of the client’s experience. In such cases, a feedback loop is critical to clarify meaning and intent. In our clinic, we gather multiple sources of information, such as medical and familial, when necessary. We extensively train interpreters in the importance of accurately gathering this information within the client’s cultural context. Specifically, we train interpreters to transmit the information so the clinician can access the richness of the information as the client expresses it. This is critical for clinical assessment. For example, Irfam was a client whose language disorder was identified and whose impaired functioning affected his ability to become an American citizen. This would not have been detected were it not for the accurate interpretation. Another clinical example is Zainab, who complained of seeing jinis (spirits in Muslim legend that can take human or animal form and can influence people) in her apartment. Without having knowledge of jinis within Islam, it would have been very easy to assume hallucinations. Another piece of assessment is the use of tests. There are not many tests available that can readily be used to assess this population. However, when these instruments are used, guidelines are important. Since we are already breaking standardization by using an interpreter, we do not want to change the nature of the test. This could happen, for example, if a well-meaning interpreter were to assist the client by giving verbal or nonverbal cues on a test. The interpreter’s role in the assessment is to: • Understand the purpose of the assessment session • Be familiar with the assessment process and understand his or her role in it • Understand and, if appropriate, discuss aspects of the assessment and tests • Discusses administration format • Discuss key concepts • Discuss cultural or linguistic concerns • Follow the established plan • Refrain from on-the-spot translation Translated versions of tests may be used, such as the Harvard Trauma Questionnaire (see Chapter Nine) and quality-of-life instruments (see Chapter Fourteen) such as those translated by the World Health Organization. These are available in numerous languages. Other assessment-gathering materials such as checklists have been translated by a professional translation agency that uses back translation. In these cases, results are interpreted with caution

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and limitations are identified with respect to use of an interpreter and the discrepancies between client characteristics and the populations on which the test was normed.

CLINICIANS WORKING WITH INTERPRETERS So far we have been highlighting the importance of using a trained interpreter in order to deliver quality services to clients. The Center for Victims of Torture (1999), Physician Toolkit and Curriculum (2004), and Rhodes, Ochoa, and Ortiz (2005), as well as our own experience, indicate the importance of allocating time when working with an interpreter. In addition to the time spent during the session, preparation time prior to the session and debriefing time after it are essential. During our own group debriefings with the interpreters, one of the main complaints was the lack of meetings with community clinicians before and after sessions. Interpreters complained they came to the case with no information and were left with many doubts and questions as to the efficacy of their performance and any changes or adjustments that needed to happen for follow-up appointments. The interpreters also expressed frustration with their lack of information from the community clinician as to what their role would be, the mode of interpretation (for example, simultaneous and consecutive; see Appendix 11A), and how to clarify miscommunication and address cultural issues. Lee (1997) suggests that optimal delivery of services through an interpreter requires coordination between the interpreter and the clinician, which can best be accomplished by following a four-stage format. In stage one, the language and culture of the client and the interpreter are assessed to achieve a successful match. Factors such as dialects, gender, age, ethnic group, religion, socioeconomic status, and awareness of the client’s community are specifically noted. In stage two, the preinterview between interpreter and clinician provides an opportunity to build rapport. Included are the objectives of the session (for example, assessment versus therapy), the interpreter’s awareness of the client’s group and community, whether the interpreter has a relationship with the client, and the clinician’s expectations regarding mode of interpretation. Stage three is the actual interview in which the clinician and the interpreter play out what was discussed in preinterview. They keep a record of observations for further discussion during the review session in stage four. The review session allows the clinician and the interpreter to address the questions and observations derived from the actual interview session. The focus is on what worked, what did not work, changes needed, and planning for future sessions. Our experience suggests that the postsession should not occur until after the client leaves. The interpreter, the clinician, and the client should walk together

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234 HANDBOOK OF MULTICULTURAL ASSESSMENT to the waiting room. After the client leaves, the postsession can be initiated if necessary. This prevents the client from seeing the review session as an opportunity for the clinician and the interpreter to discuss the case behind the client’s back. Care should be taken to discuss only issues that are pertinent to enhance the dynamics of the triad and not discuss personal issues.

ETHICAL STANDARDS REGARDING INTERPRETERS The American Psychological Association in its Ethics Code of 2002 made additions to address the use of interpreters. Standard 2.05 says that ‘‘psychologists should take reasonable steps to avoid interpreters who have multiple relationships with clients and that the interpreter should be competent.’’ Standard 9.03 requires psychologists who use an interpreter to ‘‘obtain informed consent from the client to use that interpreter, ensure the confidentiality of test results and include the limitations of the data when giving recommendations, reports, evaluations or forensic testimony.’’ The core guidelines for providers working through interpreters are as follows: • Do not use untrained interpreters. • Insist on high-level bilingual-bicultural individuals with interpreter training in the behavioral health setting. • Be observant, and do not disengage during client-interpreter interaction. Valuable information can be gathered through nonverbal cues to address later with the client. • Watch your nonverbal cues for cultural appropriateness. • Remember that your primary contact should be with the client, not the interpreter. • Balance the client interaction with cultural appropriateness (such as eye contact, space, and touching). • Do not allow excessive unsupervised contact between client and interpreter, which may affect the interpreter-client boundary. • Watch carefully for triadic relationship issues. • Do not relinquish your role as provider during the cultural brokerage exchange. • The interpreter has inherently the most power given he or she is the only one who knows all sides. • When speaking, use short and simple sentences, and avoid idioms and jargon.

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• Avoid complex sentences and the use of might, would, and may, which the client could interpret as recommendations. • Do not think out loud (for example, by backing up or rephrasing) or speak more loudly than usual. • Do not carry on any side conversations with the interpreter. • During the session, take the leading role by explaining to the client the role of the interpreter during the session and the mode of interpretation. • Use the same interpreter through the process. • Keep in mind self-care and debriefing issues for the interpreter. • Look at the client, not the interpreter, when communicating with the client. • Use the feedback loop. Cross Cultural Communication Systems (2003) has developed the following acronym, CIFE, to use in presession for interpreters: Confidentiality: This applies to both provider and interpreter. I: The interpreter speaks for the client and clinician in the first person. Flow/question balance: Although questions break the flow of the session, it is important not to sacrifice flow for accuracy. Everything you say will be interpreted. Working with interpreters can be a positive experience. In fact, sometimes it gives clinicians extra time to reflect on what is going on in the session. However, problems can arise when interpreters cross boundaries (Miller et al. 2005), as when they attempt to control a session by directing the therapist. The interpreter and therapist must reach a level of collaboration to be effective. Miller et al. (2005) give an example of an interpreter’s attempting to direct a therapist by suggesting the client is not emotionally ready for a specific line of inquiry. A second example has to do with a therapist who is trying to use grounding techniques with a dissociating client. In this case, the therapist was asking questions related to the ‘‘now’’ to ground the client, such as what color the client’s skirt was. The interpreter, who was unfamiliar with grounding techniques, told the client the therapist wanted her to ask what color her skirt was and she did not know why because this seemed to be a ‘‘really stupid’’ request. A second area of potential concern is the perception that the interpreter is selectively interpreting (Miller et al., 2005), for example, an interpreter who not did not want to deal with what the therapist was bringing up so he left it out. A final example is one we experienced as we worked with doctoral students inexperienced in working with interpreters. This is the feeling of self-consciousness at being observed by another person. With an experienced

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236 HANDBOOK OF MULTICULTURAL ASSESSMENT therapist, this feeling soon fades, whereas with an inexperienced therapist, there is the danger of relinquishing the role of the therapist to the interpreter. Therapists have also been the target of interpreter fraud in our community. In one situation, a couple of interpreters developed a relationship with a particular clinician and became familiar with the human service system for the purpose of taking advantage of both. The interpreters recruited clients who were not requesting treatment but wanted an immigration waiver or to obtain benefits without going to work. The interpreter referred clients to the therapist they were familiar with (unknown to the therapist). The recruited client was coached by the interpreter on how to present to the therapist to obtain a disability waiver for immigration in order to obtain citizenship. The interpreter charged a fee to the client for this service. In the case of disability, the interpreter recruited and coached the client, promising disability and associated benefits in exchange for obtaining the client’s first disability check, usually amounting to a few thousand dollars. A third strategy of interpreter fraud is when interpreters take turns going to different therapists’ offices and assuming the roles of interpreter and client and then switching. In such cases, the interpreters were being paid for playing fictitious clients. Interpreter fraud or inappropriateness is not limited to interpreters but also to agencies claiming to do training for which they obtain funding. In this case, a person who provides the training is monolingual and inexperienced in mental health but has the responsibility of evaluating bilingual scenarios and giving promotion to hiring status for mental health interpreting. This occurs in the absence of proficiency in the target language, mental health, or experience in the mental health field. Evaluation of quality of interpretation in mental health requires proficiency in the language the interpreter is assessing, interpreting and mental health. There are many issues to address regarding the use of interpreters in treatment that are beyond the scope of this chapter. We have highlighted only those that have been particularly pertinent to our work.

TRENDS IN INTERPRETING Licensure of interpreters inclusive of language, cultural standards, and continuing education requirements will be an important trend as interpreters gain wider use. In addition, as interpreters gain professional status, there is likely to be an increase in litigation surrounding their use and responsibilities in treatment. Interpreting standards are further developed in the fields of medicine and law and need to be further developed in mental health as well. Studies are needed to address the interpreter’s perspective regarding mental health interpreting and usefulness of their training. Studies are also needed regarding clients’ perspectives on the use of language interpreters and cultural brokers in their treatment.

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The development of interpreter training and licensure is likely to lead to greater specialization of services. This may be particularly true as the value of interpreters in treatment is realized. Issues regarding payment of interpreters will need to be resolved. Whether this is paid through insurance or by the clinician, it will require more funding. However, it is anticipated that this will be offset by the improvement in the delivery of appropriate, and consequently preventive, services. Technology is springing up in outlying communities to meet the needs of limited-English-proficiency clients. The use of such technology in counseling with interpreter and client and its efficacy may be the only way such needs can be met and should be further explored. An example of this is the use of telehealth in counseling, where the therapist and interpreter may be in one city and the client in another. While the number of bilingual or multilingual and bicultural or multicultural professionals is growing, it is important to recognize that a client may prefer to go to a professional who is unlike himself or herself and needs to have that choice. These trends will enable some degree of quality assurance with respect to interpreters and can potentially expand the availability of services to clients from diverse communities. Given the growth of languages and cultures represented in the United States, the demand for interpreters will surely increase in the near future.

FIRST PROJECT INTERPRETER CURRICULUM Areas of General Interpreter Training

Description

Consecutive and simultaneous interpreting

Modes of interpretation Consecutive: The interpreter waits for the client or therapist to stop speaking before interpreting. Simultaneous: The interpreter speaks concurrently with the client or therapist

Role of the interpreter

Expectations of performance in the role of interpreter Cultural broker makes therapist aware of cultural customs and nuances that may affect treatment or explains behavior Conduit conveys exactly what is said Advocate intervenes on behalf of the client in certain situations Clarifier explains equivalencies across languages

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Areas of General Interpreter Training

Description

General issues of interpreting in behavioral health settings

Brief introduction to behavioral health interpreter competencies: Personal characteristics: Concentration, observation, flexibility, self-knowledge. Brief introduction to skills to be developed: Short-term-memory strategies, CIFE skills (Confidentiality, appropriate use of first person, flow versus clarification, everything you say will be interpreted), register skills, specialized vocabulary

Basic barriers to interpretation in the behavioral health settings

Brief discussion about barriers (fatigue, terminology, emotional factors, burn-out, vicarious traumatization, health, speaker issues) and filters (culture, belief/religion, biases, learning styles, gender, age, socioeconomic status)

Code of ethics (general)

Code of ethics is reviewed in detail

Legal issues in interpreting and liability

Brief discussion of the impact of interpretation on the client’s well-being. Liabilities and legal responsibilities on ‘‘do no harm’’

Areas of Mental Health Interpreting

Description

Applying mental health skills in the behavioral health setting

Differences/similarities between interpretation in the behavioral health setting and court, medical, community

Interpretation in the behavioral health setting challenges

Unequal training of provider, client, interpreter; lack of translatable words, types of cases and clientele

Ethics in the behavioral health setting

Case examples discussed on the basis of the code of ethics; code of ethics issues permeate all sessions

Mental health and mental illness concepts and history

Brief history of mental illness and mental health concepts in Western countries. Bridge the information to the cultures of the interpreters.

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Areas of Mental Health Interpreting

Description

Mental health terminology

Begin providing behavioral health glossary and terminology, and expand every training session; interpreters encouraged to develop their own glossary as well

Mental health providers

Detailed information on who are the providers, their training and their practice (psychologist, psychiatrists, others)

Mental health settings

Settings where behavioral health is practiced in general and specific agencies and their services to Lincoln; services in acute care, emergency rooms, crisis services, inpatient and outpatient clinics

Areas of Mental Health Assessment

Description

Dynamics in the behavioral health setting

Information about the triadic relationship in the behavioral health setting. Multiple relationships (transference and countertransference) and the importance of boundaries and debriefing.

The therapy process

Different types of therapy (behavioral, insight, group versus individual therapies, biological treatments including medication), their background and current use. Role of the interpreter in each therapy process. Bridge treatment to the cultures of the interpreters.

DSM—IV

The concept of normality across time and cultures. The DSM system brief history, its strengths and challenges. The 5 Axis, the Global Assessment of Functioning (GAF), the decision tree. The International Classification of Diseases (ICD) system. Bridging the systems to the cultures of the interpreters. In-depth discussion of cultural syndromes and impact on diagnosis. Case studies from client presentation to completed diagnosis.

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Areas of Mental Health Assessment

Description

Mental status exam

Explanation of the content, importance of accuracy. Impact of culture and language on outcomes. Bridging the systems to the cultures of the interpreters.

Assessment and evaluation

Role of the interpreter in different types of evaluation both formal and dynamic. Different ways and techniques used to assess the different areas. Types of tests, checklists, and so on. Importance of accuracy. Bridging the content to the cultures of the interpreters.

Areas of Mental Health Interpretation

Description

Difficult situations

Homicide, suicide, duty to inform, difficult or unusual individuals (speech or dysfluency issues, hallucinations, delusions, and others)

Protocol for working with providers

Tools for interpreters to facilitate their role with untrained providers. Opportunities to develop a personalized protocol to use with providers (definition of the interpreter role, modes of interpretation, rules for cultural parenthesis and clarification, interpreter boundaries, and others)

Self-care

Background on burn-out, vicarious traumatization, retraumatization. Checklists to inform, assess, address issues in all areas. Importance of debriefing.

Resources

Clinician reviewed Web pages to address different areas, glossaries, visits to local agencies and hospitals, discussions with mental health professionals, brochures and other informative material from agencies and the Internet, interpreter-developed folder with useful contacts, personalized glossaries, and others. Resources are presented and researched throughout the sessions.

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References Acosta, F., & Cristo, M. (1981). Development of Bilingual Interpreters Program: An alternative model for Spanish Speaking services. Professional Psychology, 12, 474–482. Baker, N. (1981). Social work through an interpreter. Social Work, 26, 391–397. Bancroft, M. (2005, March). The interpreter’s world tour: An environmental scan of standards of practice for interpreters. Prepared for the National Council on Interpreting in Healthcare. Retrieved January 29, 2007, from www.hablamosjuntos.org/resources/ pdf/The Interpreter’s World Tour.pdf. Benhamida, L. (1988). Interpreter training: A review and discussion of existing interpreter training programs. Washington, DC: National Institute of Mental Health. Ben-Porath, Y. (1987). Issues in psychosocial adjustment of refugees. Bethesda, MD: National Institute of Mental Health. Butcher, J., Egli, E., Shiota, N., & Ben-Porath, Y. (1988). Psychological Interventions with refugees: A report prepared for the Refugee Assistance Program-Mental Health: Technical Assistance Center. Minneapolis: University of Minnesota. Center for Victims of Torture. (1999). General principles in working with interpreters in mental health service delivery. Handout, new staff orientation, Kovler Center, Chicago. Cross Cultural Communication Systems. (2003). Ethics and medical interpretation: The value of a pre-session. Retrieved January 18, 2007, from http://www.cccsorg.com. Cummins, J. (1981). Age on arrival and immigrant second language learning in Canada: A reassessment. Applied Linguistics, 2, 132–149. Dalenberg, C. (2000). Countertransference and the treatment of trauma. Washington, DC: American Psychological Association. Dean, R., & Pollard, R., Jr. (2005). Consumers and service effectiveness in interpreting work: A practice profession perspective. In M. Marschardk, R. Peterson, & E. A. Winston (Eds.), Sign language interpreting and interpreting education: Directions for research and practice (pp. 259–282). New York: Oxford University Press. Egli, E. A. (1987). The role of bilingual workers without professional mental health training in mental health services for refugees. Bethesda, MD: National Institute of Mental Health. Fradd, S. H., & Wilen, D. K. (1990, Summer). Using interpreters and translators to meet the needs of handicapped language minority students and their families. Retrieved January 4, 2007, from http://www.ncela.gwu.edu/pubs/pigs/pig4.htm. Friedman, M., & Jaranson, J. (1994). The applicability of the post traumatic stress disorder concept on refugees. In A. Marsella, T. Bornemann, S. Eblad, & J. Orley (Eds.), Admist peril and pain: The mental health and well-being of the world’s refugees (pp. 207–218). Washington, DC: American Psychological Association. Garcia-Peltoniemi, R. (1987). Psychopathology in refugees. Bethesda, MD: National Institute of Mental Health.

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242 HANDBOOK OF MULTICULTURAL ASSESSMENT Haenel, F. (1997). Aspects and problems associated with the use of interpreters in psychotherapy of victims of torture. Torture, 7 (3), 68–71. Hays, P. (2001). Addressing cultural complexities in practice. Washington, DC: American Psychological Association. Herman, J. (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. New York: Basic Books. Kinzey, J. (1986). The establishment of outpatient mental health services for Southeast Asian refugees. In C. Williams & J. Westermeyer (Eds.), Refugee mental health in resettlement countries (pp. 217–231). Washington, DC: Hemisphere Lee, E. (1997). Cross-cultural communication: Therapeutic use of interpreters. In E. Lee E (Ed.), Working with Asian Americans: A guide for clinicians (pp. 477–489). New York: Guilford Press. Lin, K. (1986). Psychopathology and social disruption in refugees. In C. Williams & J. Westermeyer (Eds.), Refugee mental health in resettlement countries (pp. 61–73). Washington, DC: Hemisphere. Lynch, E. (1998). Developing cross-cultural competence. In E. Lynch & M. Hanson (Eds.), Developing cross-cultural competence: A guide for working with children and their families (2nd ed., pp. 47–91). Baltimore, MD: Paul H. Brookes Publishing. Marcos, L. (1979). Effects of interpreters on the evaluation of psychopathology in non-English speaking patients. American Journal of Psychiatry, 136, 171–174. Milectic, T., Piu, M., Minas, H., Stankovska, M., Stolk, Y., & Kimidis, S. (2006). Guidelines for working with interpreters in mental health settings. Victorian Transcultural Psychiatry Unit, Victoria Australia. Retrieved January 15, 2007, from www.vtpu.org.au/docs/interpreter/VTPU GuidelinesBooklet.pdf. Miller, K., Martell, Z., Pazdirek, L., Caruth, M., & Lopez, D. (2005). The role of interpreters in psychotherapy with refugees: An exploratory study. American Journal of Orthopsychiatry 75(1), 27–39. Physician Toolkit and Curriculum. (2004, March). Prepared by University of Massachusetts Medical School Office of Community Programs. U.S. Department of Health and Human Services-Office of Minority Health. Prendes-Lintel, M. (2001). Important issues in counseling recent refugees. In J. Ponterotto, M. Casas, L. Suzuki, & C. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 729–752). Thousand Oaks, CA: Sage. Price, J. (1975). Foreign language interpreting in psychiatric practice. Australian and New Zealand Journal of Psychiatry, 9, 263–267. Rhodes, R., Ochoa, S., & Ortiz, S. (2005). Assessing culturally and linguistically diverse students. New York: Guilford Press. Turner, S., McFarlane, A., & van der Kolk, B. (1996). The therapeutic environment and new explorations. In B. Van der Kolk, A. McFarlane, & L. Weisaeth (Eds.), The treatment of traumatic stress: The effects of overwhelming experiences on mind, body and society. (pp. 537–559). New York: Guilford Press

DELIVERING QUALITY MENTAL HEALTH SERVICES THROUGH AN INTERPRETER U.S. Census Bureau. (1990). Census of population and housing summary tape file 3 (sample data), matrices P13, P31. Retrieved February 16, 2006, from http://www.census.gov/prod/2003pubs/c2kbr-29.pdf. U.S. Census Bureau. (2000). Summary file 3, matrix P19. Retrieved February 16, 2006, from http://www.census.gov/prod/2003pubs/c2kbr-29.pdf. U.S. Census Bureau. (2003). Language use and English ability: 2000. Washington, DC: U.S. Government Printing Office. Retrieved January 26, 2007, from www.census.gov/ Press-Release/www/releases/archives/census 2000/001406.html. U.S. Department of Health and Human Services. (1999). Mental health: A report of the surgeon general— Executive summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institute of Health, National Institute of Mental Health. U.S. Department of Health and Human Services. (2001a). Mental health: Culture, race, and ethnicity— A supplement to Mental Health: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health. U.S. Department of Health and Human Services. Office of Minority Health. (2001b). National standards for culturally and linguistically appropriate services in health are: Executive summary. Washington, DC: Retrieved January 29, 2007, http://www. omhrc.gov/assets/pdf/checked/executive.pdf. Westermeyer, J. (1987a). Clinical considerations in cross-cultural diagnosis. Hospital and Community Psychiatry, 38, 160–165. Westermeyer, J. (1987b). Cultural factors in clinical assessment. Journal of Consulting and Clinical Psychology, 55, 471–478.

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SECTION THREE

DAILY LIVING ASSESSMENT

T

he three chapters in this section focus on components of daily living: assessment of family systems, vocational issues, and quality of life. The chapter authors provide updated information regarding these topics, as well as reformulations of earlier work in previous editions. Chapter Twelve, by Daniel T. Sciarra and George M. Simon, looks at the assessment of family systems. It opens with a description of a therapy case involving a disputing couple, which the authors use to illustrate various topics throughout the chapter pertaining to therapeutic models. Issues of culture are interwoven in the discussion, with specific attention given to structural family therapy and blended nomothetic and idiographic assessment schemes. Chapter Thirteen, by Margo A. Jackson, Aisha M. B. Holder, and Morgan T. Ramage, discusses culturally appropriate vocational assessment in relation to individually focused instruments and procedures. In particular, the strengths and limitations of research regarding culturally competent vocational assessment are identified in relation to the vocational development of adolescents in low-income, culturally diverse, urban middle and high schools. Chapter Fourteen, by Shawn O. Utsey and Mark A. Bolden, provides information regarding the theoretical ambiguity in cross-cultural application of quality-of-life (QOL) concepts and technical considerations in assessing QOL across cultures. In addition, the authors review a number of QOL measures and their usage with diverse populations.

CHAPTER TWELVE

Assessment of Diverse Family Systems Daniel T. Sciarra George M. Simon

Elana stared plaintively for a moment at her husband, Curtis, and then turned toward the therapist: ‘‘We were a happy couple as long as we were both foreigners. Now that I am the only foreigner and he is on his home turf, everything has turned sour.’’ Curtis and Elana sought couple therapy after she had stumbled on the fact that he had been having an extramarital affair. This was the third time that Elana had caught Curtis in an affair. On all three occasions, Curtis had ended the affair immediately after Elana discovered it. Curtis, a native of New York City, had met Elana about six years prior to the crisis that brought them into therapy. They had met in Israel, where Curtis was on a week’s leave from his military assignment in Kuwait. Elana, an Ethiopian Jew, had migrated to Israel with her family when she was a young child. ‘‘We caught each other’s eye at a club,’’ Curtis laughingly explained to the therapist, ‘‘because we were the only black people in the place.’’ The couple had spent an intense week together and had remained in contact with each other when Curtis returned to his assignment. A few months later, he had been reassigned to a post in Virginia. He invited Elana to join him, and she accepted. The two got an apartment together and married within a couple of months. As they told their story to the therapist, both spouses agreed that the ensuing two years had been idyllic. This was the period when, in Elana’s words, they were both ‘‘foreigners.’’ Curtis had found rural Virginia, where they were living, almost as foreign as had Elana, and so, out of necessity, the spouses had developed an intense reliance on each other. Except for when Curtis was working, they became nearly inseparable. Happily, they found that they enjoyed each other’s company immensely.

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248 HANDBOOK OF MULTICULTURAL ASSESSMENT Then came the development that instigated the rapid unraveling of the couple’s tightly wound relationship. Curtis was transferred to a recruiting office not far from the New York City neighborhood where he had grown up and where most of his family and childhood friends still resided. They secured an apartment in Curtis’s old neighborhood, and Curtis began renewing his old social contacts. As Elana astutely observed, she was now the only ‘‘foreigner’’ in the marriage. Where Curtis had previously thrived on Elana’s dependence on him, he now began to experience her as ‘‘clingy’’ and ‘‘needy.’’ He began to put distance between himself and his wife, and she began to make ever more exaggerated expressions of dependence on him. Curtis had his first affair four months after he and Elana moved to New York. Over the course of the next two and a half years, he had become involved in two more. Each of the affairs had ended with the same dramatic scene in which Elana confronted Curtis with the evidence she had accumulated, and he, penitently admitting to his transgression, begged her not to end the marriage. The couple’s most recent rendition of this now all-too-familiar scene had been played out two weeks prior to their first meeting with the therapist. It was now the therapist’s task to decide how to intervene into this troubled marriage.

FAMILY ASSESSMENT: A RANGE OF OPTIONS The literature of the field of family therapy makes available to Curtis and Elana’s therapist a considerable array of assessment schemes and related therapeutic protocols that the therapist could use to make sense of and intervene into the couple’s functioning. So numerous, in fact, are such schemes and protocols that several efforts have been made to organize and categorize them. Minuchin, Lee, and Simon (2006), for example, have divided family therapy models into interventionist and restrained approaches. Interventionist models, as they are defined by these authors, prescribe a relatively high degree of activism on the part of the therapist, aimed at eliminating family dysfunction. Restrained models seek to protect client families from a therapist’s potentially disempowering meddling by severely restricting the domain of family functioning into which the therapist is allowed to intervene or by prescribing an exaggerated posture of tentativity for the therapist. In a related effort at categorization, Simon (2003) has attempted to organize family therapy models based on the models’ underlying stances on five fundamental philosophical issues: ‘‘the relationship between the individual and the group, the proper use of human freedom in relational/ethical decision making, the question of whether humans are capable of doing evil, the relationship between mind and body, and the question of whether primacy in the human domain belongs to being or becoming’’ (Simon, 2006, p. 334).

ASSESSMENT OF DIVERSE FAMILY SYSTEMS

Yet another way of categorizing family therapy models can be used to throw into relief the manner in which the models deal with the issues raised by a multicultural perspective. Fraenkel (1995) has proposed that models of family therapy can be categorized as being nomothetic or idiographic in their orientation. Nomothetic models use concepts of allegedly universal validity to reach normative judgments regarding the relative adaptiveness of a given family’s functioning. Idiographic models eschew universal descriptive schemes in favor of viewing each family as a unique entity. We find Fraenkel’s proposal helpful and use a modified version of it to provide an overview of the varying ways in which the major models of family therapy deal with the issue of multicultural assessment. Instead of a simple dichotomous characterization of the models as being either nomothetic or idiographic, we use a tripartite scheme, depicting models as nomothetic, idiographic, or a systematic blending of nomothetic and idiographic elements.

Idiographic Models Par´e (1995, 1996) provided perhaps the clearest and most concise statement of an idiographic perspective on family therapy when he proposed that family therapists think of each family as a distinct culture unto itself. Family therapy, Par´e (1996) asserts, can be thought of as an encounter between two cultures: the culture that is the client family and the culture that is the therapist. If each family is a culture unto itself, then any attempt to understand the family using concepts imported from the outside—equivalently, from a foreign culture—constitutes nothing less than an exercise in colonialism. Preexisting assessment schemes thus need to be assiduously avoided in clinical practice: When informed by the metaphor of a meeting of cultures, I am inclined in my clinical work to take heed of the practices that have been seen to lead to the devastation of indigenous cultures. The metaphor itself entails the hegemonic risks associated with the practice of therapy: the therapist as colonial power (Kearney, Byrne, and McCarthy, 1989), the therapeutic model as the dogma of a foreign culture, the therapy room as the mission school where religious conversion and cultural assimilation are the undergirding agendas [Par´e, 1996, p. 28].

The postmodern therapies developed by Harlene Anderson (1997, 2001; Anderson and Goolishian, 1988), Steve de Shazer (Berg and de Shazer, 1993; Miller and de Shazer, 1998, 2000), and Michael White (1991; White and Epston, 1990) exemplify Par´e’s idiographic aversion to preexisting assessment schemes. Key concepts of these idiographic models are presented in Table 12.1. Anderson’s collaborative language systems therapy is typical of these models, when it demands that its practitioner enter into each therapeutic encounter with a family with an attitude of ‘‘not knowing.’’ The language systems

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250 HANDBOOK OF MULTICULTURAL ASSESSMENT Table 12.1. Key Concepts of Representative Idiographic Models

Model

Literature References

Goal of Therapy

Signature Intervention

Collaborative language systems therapy

Anderson (1997, 2001); Anderson & Goolishian (1988)

Facilitate the ongoing elaboration of the constellation of meanings that the client family has developed to describe and explain the presenting problem

Questioning based on an attitude of ‘‘not knowing,’’ that is, an attitude that no meaning expressed by clients is simple, clear, and easily understandable

Solution-focused therapy

Berg & de Shazer (1993); Miller & de Shazer (1998, 2000)

Help the client family to identify and amplify exceptions to the presenting problem that are already occurring

Questioning and tasks designed to help clients identify and amplify exceptions to the presenting problem

Narrative therapy

White (1991); White & Epston (1990)

Liberate the client family from the subjugating influence that societal-level cultural discourses have on the family’s indigenous meaning making and wisdom

Externalization (the depiction of the family as beset by an anthropomorphized external enemy, bent on subjugating the family)

therapist does not use an assessment protocol to make sense of the client family’s situation; instead, the therapist listens carefully to the sense that family members themselves are already making of their own situation. A language systems therapist working with Elana and Curtis would note Elana’s use of the word foreigner and Curtis’s use of the word needy to make sense of their relational situation. These words would be significant for the therapist not because they have some relevance to an assessment scheme that the therapist brought into the therapy, but because the words are central to the language the clients themselves are using to assess their own situation.

ASSESSMENT OF DIVERSE FAMILY SYSTEMS

As conceived in the collaborative language systems approach to therapy, it is the therapist’s task simply to ask questions that invite family members to elaborate further the home-grown constellation of meanings that have evolved within the family to describe and explain the therapy’s presenting problem. In doing so, the therapist assiduously avoids leading the therapeutic conversation in any given direction, based on some preunderstanding of the clinical situation: The language systems therapist attempts to keep the [family’s] conversation fluid by adopting the attitude that no meaning expressed as part of the conversation is simple, clear, and easily understandable. . . . Participating in the [family’s] conversation in this way, the language systems therapist helps keep the conversation tending in the direction of the not-yet-said [Simon, 2003, p. 22].

The model assumes that given the inherent evanescence of meaning, a fluid conversation about the presenting problem, tending always toward the not-yet-said, will inevitably evolve to the point where the presenting problem is defined out of existence (in the language of the model, dissolved). While the collaborative language systems approach to therapy focuses on a client family’s idiosyncratic meaning-making around something that they have defined to be a problem, de Shazer’s (Berg and de Shazer, 1993; Miller and de Shazer, 1998, 2000) solution-focused therapy focuses on the family’s idiosyncratic solutions to the problem. As much as the collaborative language systems therapist does, the solution-focused therapist avoids imposing any kind of preunderstanding on the clinical situation. Thus, like a language systems therapist, a solution-focused therapist would refuse to use any kind of preexisting assessment scheme to inform a therapeutic encounter with Curtis and Elana, choosing instead to use what is indigenous to the couple. However, different from a language systems therapist, a solution-focused therapist would be relatively disinterested in how the couple is making sense of their situation. Instead, she or he would be interested in unearthing what Elana and Curtis are already doing from time to time, separately or collectively, to alleviate, at least a little bit, the state of affairs that they have presented as the problem to be addressed in therapy. That Curtis and Elana are already enacting such solutions is an article of faith for the solution-focused therapist. At the beginning of therapy, the therapist does not know what they are. True to the nonnormative ethos that characterizes all of the idiographic models of family therapy, the solution-focused therapist certainly has no preexisting notion of what these solutions should be. The therapist restricts himself or herself to the task of asking Curtis and Elana questions and giving them tasks designed to help them become aware of what they are already doing to contain and alleviate their presenting problem.

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252 HANDBOOK OF MULTICULTURAL ASSESSMENT Once the couple has identified their idiosyncratic solutions to their presenting problem, the therapist will encourage them to amplify these solutions. White’s narrative therapy values the indigenous meaning making and wisdom of families as much as do collaborative language systems therapy and solution-focused therapy. However, it is far less optimistic than the other two models that a simple therapeutic conversation, focused exclusively on the local culture of a client family, can succeed in bringing a client family’s indigenous wisdom to the fore. The narrative model is founded on the keen awareness that local conversations, within a family and within the therapy room, take place within the context of broader sociocultural discourses. The model views these broader discourses negatively, seeing them as inevitably working to subjugate and eradicate local meaning-making and wisdom: Narrative therapy sees group-level phenomena as being inevitably dehumanizing. For narrative therapy, that which is authentically human is always found at the level of the local and the particular. The further one moves from the level of the individual, the more one moves into the domain of the impersonal, the coercive, and the dehumanizing [Simon, 2003, p. 28].

It must be noted that narrative therapy’s negative valuation of societal-level cultural discourses is not restricted to the discourses of a given society’s dominant culture. Rather, all cultures, including those that might have minority status within a given society, are seen as ultimately dehumanizing and coercive. Narrative therapists Griffith and Griffith (1994) state this view plainly: ‘‘Authentic expression of personal experience is always fluid, idiosyncratic, and unpredictable. It does not know the bounds imposed by cultural practices. . . . It inevitably takes a stand against some type of cultural practice’’ (p. 58, emphasis added). Avoiding preexisting assessment schemes, the strategy used by the language systems therapist and the solution-focused therapist to avoid subjugating a client family’s local culture will not, in the view of the narrative therapist, succeed in purging the therapeutic conversation of the destructive influence of broader sociocultural discourses. The only way that the therapeutic conversation can achieve the liberation of a client family’s local knowledge, the goal of all the idiographic therapies, is for the conversation to focus explicitly on the pervasive, corrosive effects of societal-level cultural discourses. Noting how frequently Elana and Curtis use the word foreigner to make sense of their relational difficulties, a narrative therapy working with them would attempt to sensitize them—and to increase her or his own sensitivity as well—to the negative connotations imparted to this word by the various sociocultural discourses in which the therapist, Curtis, and Elana are immersed. The therapist would have used this strategy no matter what language the

ASSESSMENT OF DIVERSE FAMILY SYSTEMS

couple used to explain their problem. In the view of the narrative therapist, the problems that lead people to seek therapy are almost invariably the result of the impoverishing, subjugating influence that sociocultural discourses have on the language people use to make sense of their life together. In order to make their subjugation visible to Curtis and Elana, a narrative therapist would use the signature narrative technique of externalization. The therapist would anthropomorphize ‘‘foreignness,’’ depicting the couple as tyrannized by this external enemy bent on destroying their marriage. Using an elaborate protocol of therapeutic questions, the therapist would ask the couple to explore the destructive influence that foreignness has had on their relationship. Crucially, the therapist would ask Elana and Curtis to detail how they, separately and collectively, have succeeded in keeping foreignness from damaging their relationship even more than it has. The narrative therapist would anticipate that in response to this questioning, the couple would move from the mutual blaming in which they are currently engaged, a blaming that serves only to increase the power of foreignness, to a pooling of resources in a shared battle against the externalized enemy into which the therapeutic conversation would have transmuted foreignness. In their prizing of local knowledge and their wariness of becoming mechanisms of cultural domination, the idiographic models of family therapy are thoroughly in sync with the fundamental ethos of the multicultural movement in the mental health disciplines. In their zeal to privilege local conversations and local wisdom, these models have expunged from the therapeutic protocols that they prescribe the whole notion of therapist-driven assessment. So thoroughgoing is these models’ wariness of therapy becoming an exercise in cultural colonialism that topics constituting key components of other multicultural therapeutic approaches—topics such as ethnicity, immigration, acculturation, and racial identity—are in these models either completely ignored (unless raised by the clients themselves) or, in the case of narrative therapy, seen as part of the problem (therapist-driven, professional discourse) rather than part of the solution.

Nomothetic Models Where the idiographic models of family therapy bring client families’ own assessments of their life situations to the fore of the therapeutic encounter, the nomothetic models prescribe a therapy process constructed around therapists’ assessments of what is transpiring in families. These therapist-driven assessments use preexisting conceptual schemes that purport to provide descriptions of family processes that possess near-universal validity. Before we begin to summarize some of the models that we judge to be nomothetic in their orientation, we must insert a disclaimer. Our categorization of models as nomothetic is based solely on the published literature about these

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254 HANDBOOK OF MULTICULTURAL ASSESSMENT models. We recognize that therapy done can look very different from therapy written about. It is possible, even likely, that many practitioners of the models that we are about to mention include, in their implementation of the models, accommodations to the local and the particular that are lacking in formal, written renditions of the models. Such accommodations may or may not fit organically into the model that is being used. If there is an organic fit, then what is being practiced is not a nomothetic therapy but a therapy with a systematic blending of nomothetic and idiographic elements, about which we will have more to say later in this chapter. All of what are considered the classic models of family therapy are unabashedly nomothetic in their conceptualization of the therapeutic process. All identify some aspect of family functioning that is deemed to play a determinative role across cultures in the genesis or maintenance of therapy-relevant human problems. The models prescribe ways in which the therapist can assess this putatively crucial aspect of family functioning. The models then go on to detail interventive protocols designed to influence this area of functioning. Key concepts of the nomothetic models that we are about to summarize, both classic and contemporary, are provided in Table 12.2. Structural family therapy is typical of these classic, nomothetic approaches to family therapy. A structural family therapist working with Elana and Curtis would enter his or her first encounter with the couple assuming that their presenting problem is maintained by dysfunctional boundaries within the relational system of which they are members. Thus, early in the encounter, the therapist would assess the quality of the boundary between the spouses and between the spousal subsystem and other social systems with which it interacts (Minuchin, 1974). (We describe structural family therapy’s conceptualization of family functioning in greater detail later in this chapter.) A practitioner of strategic family therapy would also bring some well-defined assumptions into this first encounter with Curtis and Elana. The model that she or he practices is founded on the view that therapy-relevant human problems are maintained by incongruous hierarchies within family systems (Haley, 1987). These are hierarchies that are either the reverse of developmentally appropriate hierarchies (for example, a child exercising authority over a caregiver) or a hierarchy that exists where none is appropriate (for example, between a husband and a wife). A strategic therapist meeting with Elana and Curtis would focus assessment efforts on detecting the presence of incongruous hierarchies. In the process of doing so, she or he would almost certainly take note of the fact that most of the time, Curtis occupies a one-up position in relation to Elana and that this situation undergoes a temporary reversal and correction of sorts in the aftermath of Elana’s discovery of an affair. For a practitioner of Bowen family systems therapy, it is people’s lack of differentiation that gives rise to symptomatic expression. Lack of differentiation

ASSESSMENT OF DIVERSE FAMILY SYSTEMS

Table 12.2. Key Concepts of Representative Nomothetic Models

Model

Literature References

Goal of Therapy

Signature Intervention

Structural family therapy

Minuchin (1974); Minuchin & Fishman (1981)

Adaptively restructure family subsystem boundaries

Enactment (direct interaction between family members during the therapy session)

Strategic family therapy

Haley (1987)

Adaptively restructure incongruous hierarchies within the family

Assignment of between-session tasks, individually tailored for each client family so as to reduce resistance

Bowen family systems therapy

Bowen (1966); Kerr & Bowen (1988)

Increase family members’ level of differentiation

Coaching of adult family members to assume a more differentiated posture in their respective families of origin

Emotionally focused therapy

Johnson (2002, 2004)

Access and amplify family members’ expression of attachment-related emotions

Softening (eliciting the experience and expression of soft, attachment-related emotions)

reveals itself when strong emotions swamp a person’s cognitive functioning, with the result that the person behaves reactively rather than in a calm, deliberative manner (Bowen, 1966; Kerr and Bowen, 1988). A Bowenian therapist would see in Elana’s emotional displays of neediness and in Curtis’s reactive distancing from his wife evidence that they are both lacking in differentiation. Seeing family-of-origin processes as exercising determinative influence on people’s level of differentiation, the Bowenian therapist would mount an effort to assess what dysfunctionally triangular relational arrangements in Curtis’s and Elana’s respective families of origin had resulted in the lack of differentiation displayed in their dealings with each other. By and large, the classic models of family therapy do not prescribe the use of formal, structured assessment protocols to elicit the data that they

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256 HANDBOOK OF MULTICULTURAL ASSESSMENT consider central to the therapeutic enterprise. Practitioners of all three of the classic models rely heavily on their observation of and interaction with client families during the first therapy session in order to construct their assessment of the families. The structural family therapist makes extensive use of the signature technique of enactment for assessment purposes, eliciting direct interactions among family members in the consulting room, which allow the therapist to observe the quality of the boundaries between family subsystems, and between the family-as-a-whole and the outside world, represented in the therapeutic situation by the therapist himself or herself (Minuchin and Fishman, 1981). While perhaps making some use of enactment, the strategic therapist relies more on questioning to ferret out the incongruous hierarchies that will become the target of his or her signature intervention: the assignment of between-session tasks that are individually tailored for each client family so as to decrease the family’s inevitable resistance to change. The Bowenian therapist observes clients’ in-session behavior, both toward herself or himself and toward each other, to detect the presence of the emotional reactivity, which, according to the model, provides the best indicator of clients’ degree of differentiation. Uniquely among the classic family therapy models, Bowen family systems therapy prescribes the use of a structured assessment protocol, in addition to the therapist’s informal observation of family processes occurring in the therapeutic setting. In order to elicit and organize data about the family-of-origin processes that the Bowenian therapist considers so crucial in determining clients’ levels of differentiation, the therapist engages clients in the shared construction of genograms—diagrams that graphically display relational processes across at least three generations in the families of origin of the adult members of the client family. The Bowenian therapist uses these genograms to guide his or her signature intervention: the coaching of adult members of the client family to assume differentiated, nonreactive postures in relating to key members of their respective families of origin. Although all of the classic models of family therapy are nomothetic, so too are many of the models that have been developed more recently. Typical in this regard is emotionally focused therapy, an evidence-based treatment for couples presenting relational distress as a focus for treatment (Johnson, 2004). Grounding itself in attachment theory, emotionally focused therapy sees most couple dysfunction as resulting from the intersection of couple members’ maladaptive attachment styles, resulting in self-reinforcing sequences of destructive interaction. The emotionally focused therapist seeks to modify these sequences using his or her signature technique of softening: the empathic accessing and amplifying of ‘‘soft,’’ attachment-related emotions that are seen as underlying the ‘‘hard,’’ self-protective emotions that couple members experience and express as they engage in their usual dysfunctional relational dance.

ASSESSMENT OF DIVERSE FAMILY SYSTEMS

Accessing these softer emotions requires that the therapist assess the attachment styles of clients. Although paper-and-pencil instruments are available for such assessment, the emotionally focused therapist prefers to rely on direct observation of clients’ behavior toward each other and toward him or her in the immediacy of the therapeutic encounter in order to construct an assessment of clients’ attachment styles. Such observation of Elana and Curtis would likely lead the emotionally focused therapist to assess that Elana has an anxious attachment style, to which she gives expression in her pursuit of her husband, and that Curtis has an avoidant style, which primes his distancing from Elana. Emotionally focused therapy, like the classic nomothetic family therapy approaches that came before it, ‘‘assumes that we are all children of the same mother’’ (Johnson, 2002, p. 54). These models assume that in the most therapeutically relevant aspects of their functioning, all families are essentially the same. All the nomothetic models presume that a therapist skilled in assessing families should be able to do so effectively across a broad range of cultures.

SYSTEMATIC NOMOTHETIC-IDIOGRAPHIC BLENDS The idiographic models of family therapy are founded on the premise that all families are fundamentally different; the nomothetic models assume that all families are fundamentally the same. This difference in outlook reflects, and has its roots in, a millennia-old quandary within the Western philosophical tradition regarding how best to conceive the relationship between the one and the many (see Simon, 2003). Both the idiographic and the nomothetic models share the strategy of resolving this quandary by associating themselves exclusively with one pole of this polarity. However, another strategy for resolving the quandary is possible. One can take the position that both the idiographic and the nomothetic models reflect half, and only half, of the clinically useful truth: in the ways that matter to the family therapist, families are both all different and all the same. If one adopts this synthetic position, then what is needed to ground the therapeutic enterprise are models of treatment that systematically and coherently blend idiographic and nomothetic elements. One way of achieving this blend has been proposed by Monica McGoldrick and her colleagues (McGoldrick, Giordano, and Garcia-Preto, 2005). These authors do not call into question the assumption made by all nomothetic models of family therapy: that there is some aspect of family functioning that, across families and across cultures, is pivotally involved in the genesis or maintenance of therapy-relevant human difficulties. Accordingly, the authors accept the need for therapists to assess client families in that area of functioning deemed crucial

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258 HANDBOOK OF MULTICULTURAL ASSESSMENT by the model that they are practicing. However, the authors demur from the nomothetic assumption that what constitutes adaptive functioning in this area is the same across cultures. Different cultures provide differing renditions of ‘‘normal’’ family life. Thus, McGoldrick would maintain that assessing boundaries, or hierarchies, or differentiation, or attachment styles in the case of Elana and Curtis must take into account Elana’s Ethiopian Jewish cultural heritage and Curtis’s middle-class African American cultural heritage, which provide the standards against which judgments of functional and dysfunctional must be made. The work of Boyd-Franklin (2003) and of Falicov (1998) has amplified and extended McGoldrick’s approach to constructing a systematic blending of nomothetic and idiographic elements in therapeutic models. While laudable in their attempt to render family assessment sensitive to the particularities of culture, the efforts just referenced can be criticized for overly emphasizing the nomothetic in the systematic nomothetic-idiographic blending that they have tried to achieve. Although the efforts recognize between-culture differences in what constitutes normal family functioning, they gloss over within-culture differences, and so from an idiographic perspective, they still tend to privilege the universal over the local and particular. George Gushue (1993; Gushue and Sciarra, 1995) has proposed a scheme of family assessment that he sees as containing, using the language of this chapter, a more balanced blending of idiographic and nomothetic elements. Gushue accepts the description of between-culture differences in normal family functioning offered by scholars like those just referenced. However, calling on models of cultural-identity development (Atkinson, Morten, and Sue, 1998), Gushue notes that individuals from a minority culture assume a variety of positions toward their own culture and toward the dominant culture in which they are immersed. Cultural-identity development models hold that these positions assume predictable forms and that these forms evolve in predictable sequences. Thus, individuals, say within a given family, can be compared as to their relative levels of cultural-identity formation. By attending to the family dynamics resulting from the interplay of family members’ varying levels of cultural-identity formation, therapists can construct an assessment of a given client family that is more genuinely attentive to the local and particular than would be possible were the assessment based on the assumption that the family as a whole subscribes to the norms prescribed by the family’s ethnic culture. Practitioners of the postmodern, idiographic models that we described earlier in this chapter would likely judge that Gushue (1993) has been only partially successful in his attempt to increase the idiographic component in the nomothetic-idiographic blend that he has proposed. Of concern to these practitioners would be Gushue’s unquestioning reliance on developmental thinking in his model. A postmodern perspective would view developmental

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thinking as nothing more than an artifact of the dominant, Western, positivistic, professional cultural discourse. Ironically, in using the concept of cultural-identity development in his attempt to render family assessment more attuned to the local, Gushue can be viewed as having become an unwitting exponent of the imposition of a therapist-driven, ‘‘foreign’’ cultural discourse on minority families. His model can still be criticized for favoring the nomothetic in its nomothetic-idiographic blend.

STRUCTURAL FAMILY THERAPY: A NOMOTHETIC-IDIOGRAPHIC RENDITION We propose yet another scheme for systematically blending nomothetic and idiographic elements in the task of assessing families. This scheme has been constructed in much more explicit dialogue with the postmodern, idiographic models of family therapy summarized earlier in this chapter than were the nomothetic-idiographic blends just referenced. As a result, our scheme is constructed along significantly different lines from these other blends. The nomothetic elements in our blend come from structural family therapy (SFT). The idiographic elements are heavily indebted to the collaborative language systems model of family therapy.

Nomothetic Elements Along with most of the classic models of family therapy, SFT views the family as a system. Understanding the family as a system entails seeing its members as being so interconnected as to constitute, quite literally, a single, multibodied organism (Minuchin and Fishman, 1981). Behaviors enacted within the family are seen as being cocreated by all the members of the family. As a result of this unity of functioning, change in one area of the family is seen as inevitably causing compensation in another. Over time, every family develops patterns of interaction, along with stories that both justify and explain these patterns (Minuchin et al., 2006). SFT uses a structural frame to make sense of these patterns. Family structure is not something that SFT therapists can directly observe or discover. Therapists are simply privy to their observations of family members’ interactions, which SFT brings into the therapy room through its signature technique of enactment. Upon these observable data, SFT therapists impose a conceptual framework that allows them to organize the complex and often confounding world of family interaction and communication. The major components of this framework are the concepts of subsystems, boundaries, and circular causality (Minuchin, 1974).

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260 HANDBOOK OF MULTICULTURAL ASSESSMENT Subsystems. It occurs naturally in families that some members unite with others to perform a certain function or engage in some shared activity. Such functionally united segments of the family system are what SFT refers to as subsystems. As families develop and change over time, different subsystems come into play and exert more or less influence at various points in the family’s developmental trajectory. Two adults who join together for the explicit purpose of forming a family create a spousal subsystem. (While this term, canonized by long usage by SFT therapists, implies that the adults are married, and even heterosexual, such, of course, need not be, and frequently is not, the case.) Each adult brings into the relationship a set of values and expectations that must be reconciled if they are to live together with a degree of harmony. In order to achieve this harmony, a set of rules is established, some of which are explicitly negotiated (Jane goes food shopping on Saturday morning, while Dick does the laundry), while others remain implicit (when Dick is in an angry mood, Jane goes out with one of her friends). Precisely because its members usually carry differing relational expectations, harmony in the spousal subsystem is not easily achieved. Some degree of conflict between the partners is to be expected, and resolution of a given set of conflictual issues is likely to be followed in fairly short order by the emergence of another. As with all else, the spousal subsystem develops patterns for dealing with conflict. It may be dealt with through direct exchange, and so remain contained within the subsystem. Alternatively, and less functionally, one or both members of the spousal subsystem may seek allies outside the subsystem. In another potentially dysfunctional arrangement, the spousal subsystem may stabilize a pattern of detouring away from conflict by turning toward other things or people as a distraction. Children, if present in the family, frequently serve as the focus toward which spousal conflict is detoured. If children do enter the family, whether by birth, adoption, or fostering, a new set of functional demands, focused on child rearing, is brought to bear on the system, giving rise to a new subsystem, the parental subsystem. In a nuclear family, the parental subsystem is usually composed of the two adults who joined together originally to form the family. It may also include many different people: grandparents, aunts or uncles, an older child, a live-in nanny, or anyone else designated to guard, discipline, and nurture the younger and more vulnerable family members. In assessing families, SFT therapists pay careful attention to the parental subsystem. What is its constituency? Is anyone included who might not be appropriate (perhaps a younger, parentified child)? Is anyone excluded who might serve as a resource (perhaps one of the adults)? How is authority exercised by the subsystem? If there are two parents present, is authority in the hands of both, or of just one to the exclusion of the other? Do the members of

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the parental subsystem work together as a team in managing and disciplining the children, or is the authority of one member of the subsystem undermined by another member? When the constituency of the parental and spousal subsystems is identical, it can be expected that problems in the spousal subsystem might reduce the effectiveness of the parental subsystem. Specifically, mismanaged conflict in the spousal subsystem could undermine the effectiveness of the parental subsystem. As noted, the triangulation of children into spousal conflicts is quite common. For example, one parent might enter into a coalition with a son or daughter against the other parent. The SFT therapist would see such an intergenerational coalition as potentially problematic as a result of the disempowering of a parent and the inappropriate empowering of a child that it produces. In families with children, the third major subsystem of the family is the sibling subsystem. While children in a family (optimally) live most of their lives under the umbrella of care and management provided by the parental subsystem, they do—or should—have significant interactions among themselves that do not directly involve the adult caregivers. Siblings play together, go to school together, hold secrets together. The sibling subsystem is the laboratory in which children can develop the interpersonal skills required for relating to peers throughout the life span. However, it can serve as such a laboratory only if its integrity is guarded within the family system. One reason that intergenerational coalitions, detouring of spousal conflict toward children, and the parentification of young children are deemed dysfunctional by SFT therapists is the violation of the integrity of the sibling subsystem that all of these structural arrangements entail. Boundaries. The major component of family assessment in SFT is examination of the relationships among the different subsystems in a family. In making this examination, the SFT therapist relies on the concept of boundaries. Family subsystems are differentiated by boundaries, invisible barriers that demarcate and define the relationship among the different subsystems (Nichols and Schwartz, 2006). Moreover, the family system as a whole is differentiated by a boundary that creates both psychological and physical distance between the family and the extrafamilial world. For example, a family may have a rule that prohibits the sibling subsystem from having friends stay past 6:00 P.M. on weekdays, since the family eats dinner together and by themselves. This would contrast with a family that has no set time for dinner and cares little whether there are others in the home while family members are eating. In SFT, boundaries are assessed along a continuum from rigid to diffuse. A rigid boundary between subsystems produces a disengaged relationship between the members of the respective subsystems, while a diffuse boundary

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262 HANDBOOK OF MULTICULTURAL ASSESSMENT is productive of enmeshed relationships. For example, the SFT therapist would see the overinvolvement of one or both parents in the lives of their children as the result of a diffuse boundary between the parental and sibling subsystems. Other signs of diffuse boundaries in a family system might include a lack of privacy in the home, family members’ finishing one another’s sentences, and parents who are constantly in school or calling the school to check on their child’s welfare. Signs of a rigid boundary between the parental and sibling subsystems can include disregard for a child’s difficulty, unreturned telephone calls from school personnel, repeated inability to make meetings concerning the child, and a general inability to foster support when needed. SFT assumes that problematic families have subsystem boundaries that are too diffuse or too rigid. Children who are enmeshed with one or both parents receive wonderful care and support but at the expense of independence and autonomy (Nichols and Schwartz, 2006). Problems arise when such children are unable to negotiate the demands of the outside world. They might be afraid to go to school, and if they do go to school, they might not have the courage to meet the demands for socialization. Parent-child enmeshment also entails negative impacts for the spousal subsystem, allowing little time and opportunity for the spouses to be alone with each other. The likely result is a nonfulfilling spousal relationship. In contrast to families with diffuse boundaries, families with rigid boundaries have members who are independent of yet isolated from one another. On the positive side, children from disengaged families learn to be resourceful and not to shy away from tasks that require perseverance and mastery. On the negative side, such children will not have experienced the warmth, nurturance, and affection so prevalent in enmeshed families. Both disengagement and enmeshment can, and frequently do, coexist within the same family system. For example, one parent might be enmeshed with the sibling subsystem, while the other is disengaged. Father might be enmeshed with his daughter and disengaged from his son. Mother might be overinvolved in her job and underinvolved at home. Whatever the constellation, SFT relies on the concept of boundaries to assess the overall degree of enmeshment and disengagement among the various subsystems and their individual members. Circular Causality. The concept of circular causality is central to systems thinking and the assessment process in SFT. In opposition to a linear understanding of behavior (A causes B, which causes C), which searches for explanations in the past, circular causality views behavior within a system as being maintained in the present by repetitive, circular interactional loops. The linear understanding of A causing B causing C is thus replaced by the understanding of A causing B, which in turn causes A.

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A system regulates itself through circular causality. Consider the simple example of a thermostat used to heat and cool a room. The thermostat instigates heating if the room temperature drops below a set point, and it cuts off heating if the temperature rises above another set point. Through this feedback loop, the thermostat maintains the temperature in the room within a constant range. When applied to families, the concept of circular causality produces the view that a family member’s behavior is both caused by and causes the other members’ behavior. From the perspective of SFT, it is never a question of ‘‘who started it’’ or ‘‘who is to blame,’’ since all family members are assumed to be coresponsible for maintaining any and all patterned behaviors enacted within the family. A simple example of circular causality might be found in a spousal subsystem that is organized into the well-known pattern of distance-and-pursue. The pursuer pushes for closeness, while the distancer pulls back. The pursuer feels more of a need for connection and pursues harder. The distancer now feels even more need for space and distances even more. A more elaborate example involves a punitive father and his acting-out son. The son’s acting out causes the father to be punitive, which in turn elicits further acting out on the son’s part. Mother intervenes by coddling her son, since she cannot stand seeing him cry. Father feels undermined and punishes the son even more.

Idiographic Elements SFT has well-defined notions of how it is that family systems malfunction. The presence of excessively rigid or diffuse boundaries between subsystems, frequently linked to the mismanagement of conflict in the spousal subsystem, is deemed to constitute dysfunctionality within the family. Dysfunctional structural arrangements are assumed to be maintained in the here and now through multiply linked and nested interactional loops of circular causality. Family assessment in SFT boils down to a search for the presence of rigid or diffuse subsystem boundaries within the client family. Both clinical experience (see, for example, Minuchin, Nichols, and Lee, 2007) and outcome research (see, for example, Szapocznik and Williams, 2000) suggest that therapy based on this assessment scheme is effective with families within a broad range of cultural contexts. However, therapy, even when it is effective, can still be colonizing and impositional. And it must be admitted that, left unchecked, the nomothetic elements in SFT place the model at risk for fitting any family that crosses its path onto the Procrustean bed of its assessment scheme, running roughshod, in the process, over whatever is idiosyncratic to the family. To reduce this risk, we have incorporated some idiographic elements into the SFT assessment scheme. These elements are intended to provide checks and balances against the universalizing tendency inherent in SFT’s nomothetic

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264 HANDBOOK OF MULTICULTURAL ASSESSMENT outlook. As we will now describe, these elements increase SFT’s sensitivity to the local and particular by providing strict criteria regarding when it is and is not appropriate to assess a family and by prescribing how the results of assessment should be communicated to a family.

To Assess or Not to Assess Family dysfunctionality, in the view of SFT, is associated with excessive rigidity or diffuseness in a family’s subsystem boundaries. But what constitutes ‘‘excessive’’? Those who subscribe to the intellectual-clinical tradition instigated by Monica McGoldrick would answer that a family’s ethnicity is the crucial determinant of what constitutes normal and excessive in this matter of the permeability of subsystem boundaries. We have already observed that this approach to norming can be criticized for still privileging the universal-nomothetic over the local-idiographic, as a result of its lack of attentiveness to salient within-culture differences. Inspired by Harlene Anderson’s collaborative language systems model of therapy, which we mentioned earlier in this chapter, we propose that it is the client family itself that must set the standard against which the relative functionality of its subsystem boundaries should be judged. It is the family that should make the determination that its boundaries have become excessively rigid or diffuse. We consider that a family communicates such a determination when it defines into existence a problem that it judges merits therapeutic attention. Following the collaborative language systems model, we assume that problems do not have any kind of objective existence. Like everything else in the human world, a problem exists only when it is consensually defined into existence by members of a system. A behavior, feeling, or thought is a problem only if some members of the system in which the behavior, feeling, or thought occurs define it to be problematic. Thinking in this way, Anderson and Goolishian (1988) see a family’s defining into existence of a therapy-meriting ‘‘problem’’ as an ‘‘alarmed objection’’ by the family—the family’s way of signaling that it has determined that something is amiss within the system. If a family with a ‘‘problem’’ consults with an SFT therapist, that therapist will bring to the encounter several preformed ideas of where to look within the family for the malfunction whose existence the family is signaling by its definition of a problem. The therapist assumes that by defining a problem into existence, the family is signaling that its subsystem boundaries have become excessively rigid or diffuse according to the family’s own idiosyncratic standards. The therapist will thus apply SFT’s assessment scheme to ferret out the enmeshment or disengagement, whose presence the family itself has signaled by its generation of a problem.

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The nomothetic elements in the SFT assessment scheme tell therapists where to look within a family for dysfunction. However, in the perspective that we are presenting here, it is the family itself that signals whether a therapist should be looking for dysfunction in the first place. The SFT assessment scheme is radically dependent for its activation on a family’s voluntary presentation of itself for treatment, around a presenting issue that the family itself has determined to be problematic. Thus, we view the SFT assessment scheme to be an intrinsically clinical instrument. We do not believe that the scheme should be used to assess and categorize families outside the therapeutic context. Any such extratherapeutic use runs an excessive risk of turning into an exercise in cultural colonialism. Moreover, the mere presentation of a family for treatment is not sufficient to justify the activation of the SFT assessment scheme. Before engaging in assessment, the therapist must assiduously determine whether the family’s presentation for treatment is genuinely voluntary and whether the problem presented as a focus for treatment has genuinely been defined into existence by the family itself. Poor families and families whose members belong to ethnic minority groups are notoriously susceptible to having their inner world judged and defined by outsiders (Minuchin, Colapinto, and Minuchin, 1998; Minuchin et al., 2006). Outside agents, like child welfare workers, family court judges, probation officers, and school personnel, frequently refer these families to treatment to deal with issues that the agents, not the families themselves, have defined to be problematic. Any treatment focused on such presenting problems necessarily will be an exercise in social control, not genuine therapy. Thus, before embarking on the task of assessment, it is incumbent on the therapist to join with a client family sufficiently to allow its real customership for therapy to be revealed. If it turns out that the family has presented itself for therapy under duress, the therapist can offer his or her services to help the family remove itself from the supervision of the outside agent who has pushed the family into therapy. In such circumstances, the therapist functions as a culture broker rather than as a therapist, properly so called. He or she helps the family gain clarity regarding that aspect of its functioning that has run the family afoul of societal powers that be. Without either canonizing the standards being employed by these powers or negatively judging the family’s own idiosyncratic standards, the therapist portrays the family’s predicament as resulting from an inadequacy of fit between the family’s local culture and the dominant culture in which it is immersed: ‘‘You are caught between two cultural worlds, and an either-or solution is not viable’’ (see Simon, 1993). The therapist encourages the family to find alternatives in its repertoire that will assuage the concerns of the outside agents while still preserving the family’s sense of identity. He or she provides support as the family engages in

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266 HANDBOOK OF MULTICULTURAL ASSESSMENT this search for a better fit with the dominant culture. However, the therapist assiduously avoids assessing the family’s structure. It is our experience that many families that find themselves in this predicament welcome an offer by the therapist to function as a neutral, nonjudgmental culture broker. Experiencing the therapist as benign and empathic, some families even go on to volunteer, after a period of time has elapsed, that they do in fact have some problem, different from the one that has occasioned the mandate into treatment, that has been concerning them and that they would like to make the focus of treatment. If such a presentation of a genuinely self-defined problem is forthcoming, only then should the therapist begin to assess the family using the SFT scheme. Otherwise the therapist should restrict herself or himself to helping the family maneuver itself out of the intrusive control being exercised by outside agents.

Communicating Assessment to the Client Family Much of what is written about SFT focuses on the model’s conceptualization of family dysfunction. Whereas it cannot be denied that this conceptualization exerts a powerful influence over the therapeutic process prescribed by SFT, that process is equally influenced by two assumptions about families rarely highlighted in the literature about SFT: the assumption of competence and the assumption of uniqueness (Simon, 1995). SFT’s assumption of competence is that every client family brings to the therapeutic encounter sufficient resources to remediate whatever is amiss in the family’s structure (Minuchin, 1974; Minuchin and Fishman, 1981; Minuchin and Nichols, 1993; Simon, 1995). The assumption of uniqueness is the assumption that ‘‘whatever characteristics it may share with other families, each family is fundamentally unique’’ (Simon, 1995, p. 20; see also Minuchin and Nichols, 1993). It is the assumption of uniqueness that makes SFT ripe for being cast into the kind of nomothetic-idiographic blend that we are presenting here. These assumptions exert a powerful influence over SFT’s view of the general goal of therapeutic intervention. Specifically, the assumptions, operating in tandem, lead the SFT therapist to see her or his interventive role in therapy to be to activate what is already there in the client family rather than to supply what is missing. The SFT therapist’s desire to position himself or herself as an activator of a client family’s latent, idiosyncratic resources exerts a determinative influence on how the therapist executes the task of communicating assessment results to the family. Such communication needs to occur in a way that will orient the family toward its own reservoir of resources rather than toward the therapist as a potential expert provider of ‘‘answers’’ or ‘‘healing.’’ To accomplish such communication, we advocate that the therapist use another element drawn from the idiographic collaborative language systems

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model of therapy. We noted earlier in the chapter the language systems therapist’s signature stance of keen attentiveness to the idiosyncratic language used by clients to make sense of their own situation. It is our view that the SFT therapist should adopt this same stance when communicating the results of assessment to families. Were the therapist to communicate assessment results using the technical language that we have employed in this chapter in our description of the SFT assessment scheme—the language of systems, subsystems, boundaries, enmeshment, and disengagement—the therapist would almost certainly maneuver himself or herself into precisely the ‘‘expert’’ position that he or she wants so much to avoid. The journey from assuming such a position to engaging in therapeutic colonialism is an unfortunately all-too-brief one. Instead, it is our view that the therapist should attend carefully to the client family’s own idiosyncratic language, searching that language for stories, images, and metaphors that refer, in ways that are already meaningful to the family, to those aspects of the family’s functioning about which the therapist wants to talk as he or she shares with the family the results of the assessment. If it receives the results of the assessment cast in its own native language, the client family will be less likely to respond to the assessment by concluding that it needs to import some kind of ‘‘foreign’’ knowledge or expertise in order to resolve its presenting problem. The family is more likely to see itself as the SFT therapist does: as competent to crystallize its own home-grown alternatives to the dysfunctional components of its structure.

CASE ILLUSTRATION We conclude this exposition of our SFT-informed, blended nomotheticidiographic assessment scheme by describing briefly how it was used in the treatment of Curtis and Elana.

The first task for the therapist dictated by our scheme is to decide whether to assess or not to assess. The crucial determinant the therapist uses to make this decision is whether the family presenting itself for treatment is doing so voluntarily around a self-defined problem. Both the content and the tenor of the therapist’s initial telephone conversation with Curtis strongly suggested to the therapist that this was indeed a couple presenting itself voluntarily for treatment. During the conversation, Curtis expressed what sounded like sincere regret for having had yet another extramarital affair and real concern that this might have been the straw that had broken the back of the marriage. He described both himself and Elana as anxious to begin a therapy that would help them save their threatened marriage.

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268 HANDBOOK OF MULTICULTURAL ASSESSMENT Early in the first session, Elana confirmed the voluntary status of her participation in therapy. She reported that she had spoken with no one other than Curtis about his affair and that her decision to enter couple therapy was entirely her own. Meanwhile, Curtis’s behavior during the opening moments of the session did nothing to alter the therapist’s sense that he was genuinely desirous of a therapy aimed at delivering his marriage from the dangerous straits in which it was floundering. Convinced that the couple system before him was presenting itself voluntarily for treatment around a problem that it itself had defined into existence, the therapist decided that it was appropriate to embark on a structural assessment of the system. At the first opportunity, about a third of the way through the first session, he elicited an enactment between Curtis and Elana. The therapist asked the spouses to talk with each other about how they thought they were doing as a couple in the aftermath of Curtis’s most resent affair. As the therapist watched the enactment, he was struck by two characteristics of the interaction between Curtis and Elana that he was observing. First, he noted Elana’s relentless pursuit of information from Curtis, information that Curtis just as relentlessly refused to provide. Second, he noted the halting nature of the interaction, which was filled with embarrassed pauses and averted glances on the part of both spouses. To test whether these structural characteristics were tied to the particular subject matter of the first enactment, the therapist elicited a second one, focused on the more mundane content of the couple’s division of household responsibilities. Around this very different subject matter, Curtis and Elana interacted in exactly the same way that they had around the hot-button issue of Curtis’s affair. When the interactional pattern repeated itself in a third enactment, focused on how the couple relates to members of Curtis’s family, the therapist felt it reasonable to conclude that the pursue-distance dynamic that he had observed in all three enactments was a stable structural element in this couple system. True to SFT’s systemic thinking, the therapist assumed that this dynamic was maintained by circular causality, with Elana’s pursuit of Curtis eliciting and maintaining his withdrawal and Curtis’s withdrawal eliciting and maintaining Elana’s pursuit. As impressed as the therapist was by the ubiquity of Elana and Curtis’s pursuedistance dynamic, he was equally, if not more, impressed by how anxious the couple was to exit the dynamic once it had begun. With each halt and uncomfortable silence in the conversation, of which there were many, the spouses attempted to disengage from each other. As did their interaction with each other, these exits from interaction assumed an unvarying pattern in all three enactments. When the conversation between them lagged, Elana would become pensive, apparently involved in an internal dialogue with her thoughts and feelings. Curtis would attempt to engage the therapist in light, jocular banter. The therapist was struck by how easily conversation came to Curtis when the therapist made himself available to interact with him. Gone were the embarrassed pauses that peppered Curtis’s attempts to talk with his wife. Replacing these was a smooth, genuinely engaging conversational style. When the therapist asked Elana if this was the way that Curtis talked with people, she replied sadly, ‘‘With everybody but me.’’

ASSESSMENT OF DIVERSE FAMILY SYSTEMS As the first session was nearing its end, the therapist felt that he had gleaned sufficient evidence from his experience of how Elana and Curtis had interacted with each other and with him to construct an initial map of this client system’s structure. The therapist assessed that the external boundary around this spousal subsystem was excessively diffuse. Curtis clearly interacted more easily with the therapist than he did with his wife, and this pattern appeared to be isomorphic with the way he interacted with friends, members of his family of origin, and, alas, his lovers. Curtis’s enmeshment with people outside the marriage was recursively linked to disengagement between him and Elana. What engagement there was between the spouses had become organized into a pursue-distance complementarity, which, far from succeeding in increasing the involvement between the two of them, had actually served to increase their disengagement. More disengagement between the spouses led to more enmeshment between Curtis and people outside the marriage, which led in turn to more disengagement in the marriage. The therapist closed the first session by communicating his structural assessment to Elana and Curtis. He endeavored to do so using elements of the couple’s own language that seemed to refer to the structural features that the therapist wished to talk about. The therapist judged that in their frequent use of the words foreigner, home turf , and needy, Curtis and Elana were already referring to their pursue-distance dynamic and to the enmeshment and disengagement to which it was recursively linked. Thus, he employed this language as he shared with them his view of their current dysfunctional structure and of the therapeutic work they would need to do to rectify it: As you both already seem to sense, you have become foreigners to each other since your move from Virginia to Curtis’s home turf. You both seem to want to get closer, but right now, every attempt you make fails. Your eagerness to be close to Curtis, Elana, comes across to him as neediness. He’s not sure that he can meet your needs, and he backs away. Curtis, it is easy for you to back away, because, after all, you are on your home turf. But your backing away only increases Elana’s eagerness, and she winds up looking even needier to you. Curtis, you need to retrieve what you did to successfully meet Elana’s needs when you were not on your home turf and find a way to do those things again now that you are. Elana, you need to retrieve the less panicked ways that you used to show your eagerness for Curtis when you were in Virginia, and you need to give those ways a chance to work now, even though you’re on his home turf. You both need to help each other rebuild the sense that you had early in your marriage that ultimately your relationship is, for both of you, the real home turf.

CONCLUSION One way to think about multiculturalism is as an attempt to discern a fitting relationship between the one and the many, between the universal and the particular. The idiographic models of family therapy champion that aspect of the human spirit found only at the level of the local and the particular. The

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270 HANDBOOK OF MULTICULTURAL ASSESSMENT nomothetic models highlight those elements that are universal in the human spirit. The models that seek to achieve a systematic blending of nomothetic and idiographic elements see the essence of genuinely human accomplishment in the creation of a dynamic balance between the universal and the particular, the one and the many. We subscribe to this latter ethos. The SFT-informed, blended nomotheticidiographic assessment scheme that we have presented in this chapter is based on our belief that it is valuable and clinically useful to think of families as being, all at the same time, both different and the same. We have presented our scheme in the hope that it will spur others to devise blended nomothetic-idiographic assessment schemes that are both the same as and different from our own.

References Anderson, H. (1997). Conversation, language, and possibilities: A postmodern approach to therapy. New York: Basic Books. Anderson, H. (2001). Postmodern collaborative and person-centred therapies: What would Carl Rogers say? Journal of Family Therapy, 23, 339–360. Anderson, H., & Goolishian, H. A. (1988). Human systems as linguistic systems: Preliminary and evolving ideas about the implications for clinical theory. Family Process, 27, 371–394. Atkinson, D. R., Morten, G., & Sue, D. W. (1998). Counseling American minorities (5th ed.). Boston: McGraw-Hill. Berg, I. K., & de Shazer, S. (1993). Making numbers talk: Language in therapy. In S. Friedman (Ed.), The new language of change: Constructive collaboration in psychotherapy (pp. 5–24). New York: Guilford Press. Bowen, M. (1966). The use of family theory in clinical practice. Comprehensive Psychiatry, 7, 345–374. Boyd-Franklin, N. (2003). Black families in therapy: Understanding the African-American experience (2nd ed.). New York: Guilford Press. Falicov, C. J. (1998). Latino families in therapy: A guide to multicultural practice. New York: Guilford Press. Fraenkel, P. (1995). The nomothetic-idiographic debate in family therapy. Family Process, 34, 113–121. Griffith, J. L., & Griffith, M. E. (1994). The body speaks: Therapeutic dialogues for mind-body problems. New York: Basic Books. Gushue, G. V. (1993). Cultural-identity development and family assessment: An interaction model. Counseling Psychologist, 21, 487–513. Gushue, G. V., & Sciarra, D. T. (1995). Culture and families. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (pp. 586–606). Thousand Oaks, CA: Sage.

ASSESSMENT OF DIVERSE FAMILY SYSTEMS Haley, J. (1987). Problem-solving therapy: New strategies for effective family therapy (2nd ed.). San Francisco: Jossey-Bass. Johnson, S. M. (2002). Emotionally focused couple therapy with trauma survivors: Strengthening attachment bonds. New York: Guilford Press. Johnson, S. M. (2004). The practice of emotionally focused therapy: Creating connection (2nd ed.). New York: Brunner-Routledge. Kearney, P., Byrne, N. O., & McCarthy, I. (1989). Just metaphors: Marginal illuminations in a colonial retreat. Case Studies, 4, 14–32. Kerr, M. E., & Bowen, M. (1988). Family evaluation: An approach based on Bowen theory. New York: Norton. McGoldrick, M., Giordano, J., & Garcia-Preto, N. (2005). Ethnicity and family therapy (3rd ed.). New York: Guilford. Miller, G., & de Shazer, S. (1998). Have you heard the latest rumor about. . . ? Solution-focused therapy as a rumor. Family Process, 37, 363–377. Miller, G., & de Shazer, S. (2000). Emotions in solution-focused therapy: A reexamination. Family Process, 39, 5–23. Minuchin, P., Colapinto, J., & Minuchin, S. (1998). Working with families of the poor. New York: Guilford Press. Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press. Minuchin, S., & Fishman, H. C. (1981). Family therapy techniques. Cambridge, MA: Harvard University Press. Minuchin, S., Lee, W.-Y., & Simon, G. M. (2006). Mastering family therapy: Journeys of growth and transformation (2nd ed.). Hoboken, NJ: Wiley. Minuchin, S., & Nichols, M. P. (1993). Family healing: Tales of hope and renewal from family therapy. New York: Free Press. Minuchin, S., Nichols, M. P., & Lee, W. Y. (2007). Assessing families and couples: From symptom to system. Needham Heights, MA: Allyn & Bacon. Nichols, M. P., & Schwartz, R. C. (2006). Family therapy: Concepts and methods (7th ed.). Needham Heights, MA: Allyn & Bacon. Par´e, D. A. (1995). Of families and other cultures: The shifting paradigm of family therapy. Family Process, 34, 1–19. Par´e, D. A. (1996). Culture and meaning: Expanding the metaphorical repertoire of family therapy. Family Process, 35, 21–42. Simon, G. M. (1993). Revisiting the notion of hierarchy. Family Process, 32, 147–155. Simon, G. M. (1995). A revisionist rendering of structural family therapy. Journal of Marital and Family Therapy, 21, 17–26. Simon, G. M. (2003). Beyond technique in family therapy: Finding your therapeutic voice. Needham Heights, MA: Allyn & Bacon.

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272 HANDBOOK OF MULTICULTURAL ASSESSMENT Simon, G. M. (2006). The heart of the matter: A proposal for placing the self of the therapist at the center of family therapy research and training. Family Process, 45, 331–344. Szapocznik, J., & Williams, R. A. (2000). Brief strategic family therapy: Twenty-five years of interplay among theory, research and practice in adolescent behavior problems and drug abuse. Clinical Child and Family Psychology Review, 3, 117–134. White, M. (1991). Deconstruction and therapy. Dulwich Centre Newsletter, 3, 21–40. White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton.

CHAPTER THIRTEEN

Culturally Competent Vocational Assessment with At-Risk Adolescents in Middle and High School Margo A. Jackson Aisha M. B. Holder Morgan T. Ramage

S

ound assessments informing counseling interventions that effectively promote vocational development, particularly in the critically formative adolescent period (Eccles et al., 1993; Raskin, 1994), can increase access to educational and occupational options (Arbona, 2000; Bandura, Barbaranelli, Caprara, and Patorelli, 2001; Constantine, Erickson, Banks, and Timberlake, 1998; Fouad, 1995; Fouad and Smith, 1996; Lapan, 2004). In turn, greater vocational access and options in adolescence can result in higher income, better health care, and enhanced well-being over the life span (Karasek and Theorell, 1990; Wilson, 1996). Research evidence from meta-analyses has demonstrated the effectiveness of career counseling interventions in vocational decision making (Brown et al., 2003; Oliver and Spokane, 1988; Whiston, Sexton, and Lasoff, 1998). This research is grounded in a history of useful career development theories (Lent and Worthington, 2000; Savickas and Lent, 1994) and based on the development of psychometrically sound vocational assessment instruments and methods applied in the context of professional ethics codes (American Counseling Association, 2005; American Psychological Association, 2002), testing standards (American Educational Research Association, American Psychological Association, and National Council on Measurement in Education, 1999), and guidelines for competencies in career counseling (National Career Development Association, 1997). Nevertheless, although a solid body of literature was established in the twentieth century on career development theories, research, and practice,

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274 HANDBOOK OF MULTICULTURAL ASSESSMENT including the vocational assessment tools used to inform interventions, much of this foundational work was narrowly focused on a select and privileged segment of the U.S. population: predominantly college-educated, middle-class, male Caucasians (Blustein, 2006; Lee and Dean, 2004; Leong and Brown, 1995; Richardson, 1993). This remains problematic not only from a scientific perspective (for example, in making untested assumptions of external validity in interpretations of research findings and assessment practice; Sue, 1999) but also from a social justice point of view (Blustein, McWhirter, and Perry, 2005; Gainor, 2005; Peterson and Gonzalez, 2005). For example, population trends cited by the U.S. Bureau of Census show an increasingly large percentage of racial/ethnic minority groups, and projections indicate that the numerical minority will soon become the majority (American Psychological Association, 2003; Trimble, 2003). Yet racial/ethnic minority group members and linguistically diverse immigrants (in particular, those learning English as a second language) remain segregated and restricted in access to educational and vocational options. This population is disproportionately represented among those living in poverty and an estimated 60 to 70 percent of Americans who are employed in a limited range of lower-paying, working-class occupations (Lee and Dean). As a result, individuals from groups that are adversely affected by ‘‘political, economic, social, and cultural conditions have limited access to educational and occupational opportunities. . . . In essence, the people who are in greatest need of assistance with career development are the ones about whom the least is known’’ (Chartrand and Rose, 1996, pp. 341–342). To address this gap in our knowledge base and potentially increase access to expanded educational and occupational options for this growing yet underrepresented population, one promising target for psychoeducational intervention efforts requires that we increase our understanding of the vocational development of culturally diverse adolescents, particularly those in low-income and at-risk environments (Blustein et al., 2002; Chaves et al., 2004; Constantine et al., 1998; Jackson and Nutini, 2002; Juntunen and Wettersten, 2005; Solberg, Howard, Blustein, and Close, 2002; Turner and Lapan, 2003). For example, adolescents living in inner-city environments, from low-income families, members of racial and ethnic minority groups, and recent immigrants to the United States are at risk for low educational attainment, limited future career options, and severely reduced earnings potential (Education Trust, 2000; National Center for Education Statistics, 2001, 2004; U.S. Department of Education, 1996). Risk factors include environmental contexts with high concentrations of poverty and unemployment, exposure to crime and violence, racism and cultural discrimination, and limited access to adequate health care and quality education (Arbona, 1996; Constantine et al., 1998; Newman, 1996; Wilson, 1996). In addition, adolescents’ psychosocial expectations regarding their gender, social

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class status, and ability may limit or circumscribe their consideration of a broad range of career options (Flores and O’Brien, 2002; Fouad, 1995; Gottfredson, 1996; Gottfredson and Lapan, 1997; Turner and Lapan, 2005a). Low-income youth, for example, may foreclose on exploring ambitious occupational preferences or career aspirations because they believe such options are not acceptable or attainable (Arbona, 1996; Gottfredson, 1996; Jackson, Kacanski, Rust, and Beck, 2006). Therefore, both environmental and psychosocial factors may limit learning opportunities for culturally diverse and low-income adolescents and restrict their educational and career development (Jackson and Nutini, 2002). Furthermore, adolescents’ future career options depend on achieving educational success. Substantial research findings conclude that positive relationships exist between increased academic achievement and time spent by students on relevant career development activities (see reviews by Baker and Taylor, 1998; Evans and Burck, 1992). Therefore, school-based interventions may provide particularly useful venues for promoting the vocational development of low-income, culturally diverse youth (Kenny, Blustein, Haase, Jackson, and Perry, 2006; Howard and Solberg, 2006; Solberg et al., 2002; Trusty, Niles, and Carney, 2005). Culturally appropriate assessment tools, methods, and practices are required to inform and implement effective interventions (American Psychological Association, 2003; Garfield and Krieshok, 2002; Krishnamurthy et al., 2004). ‘‘Recent models of assessment have characterized assessment as a collaborative process and as a therapeutic intervention in itself’’ (Krishnamurthy et al., p. 727). Gysbers and Lapan (2002) have aptly noted how career assessment can be used for personal, program, and policy advocacy in schools and education systems. We agree with Vera and Speight (2003) that a commitment to social justice includes expanding counselors’ and psychologists’ roles to culturally competent advocacy at both community and policy levels. However, our current state of knowledge about vocational assessment is more developed at the level of individually focused instruments and procedures, so that is our focus in this chapter. We believe that positive systemic changes can be initiated or influenced through promoting personal advocacy with individual and small group interventions. In particular, in this chapter we review strengths and limitations of current research regarding culturally competent vocational assessment that might be used to inform and promote the vocational development of adolescents in low-income, culturally diverse, urban middle and high schools. We present recommendations for practical applications and future research. We interpret the term culturally diverse as meaning that individuals belong to or identify with many cultural groups (for example, by race, ethnicity, gender, age, socioeconomic status, sexual orientation, health or disability

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276 HANDBOOK OF MULTICULTURAL ASSESSMENT status, and religious affiliation). Thus, all individuals may vary not only in their worldviews but also in their access to power and privilege or vulnerability to discrimination. Therefore, competent psychological assessment and intervention (regardless of the counseling specialty or population) requires attention to the cultural contexts of and meanings attributed by both clients and counselors (Byars-Winston and Fouad, 2006; Krishnamurthy et al., 2004). Furthermore, counselors have an ethical responsibility to attend to the specific cultural factors of vulnerability to discrimination relevant to individuals of racial/ethnic minority groups (Carter, 2007; Constantine, 2007; Ridley, 2005; Sue and Sue, 2003). In this chapter, we focus more narrowly on members of racial/ethnic minority groups in the United States (similar to the focus of the multicultural guidelines for psychologists; American Psychological Association, 2003), and we use the terms culturally diverse and multicultural in reference to these group memberships (while we acknowledge the limitations of these terms noted by Helms, 2003).

CAREER DEVELOPMENT TASKS FOR STUDENTS IN MIDDLE AND HIGH SCHOOL Vocational or career development has been defined as the continuous process by which an individual learns about and develops a vocational identity and work values and integrates these concepts into one’s overall life and identity (Peterson and Gonzalez, 2005). Career development is closely associated with how and why one makes educational and occupational choices. Research evidence suggests that students who learn to negotiate vocational development processes (such as identifying, exploring, and gaining knowledge about their occupational and educational interests, abilities, values, beliefs, options, and goals) also develop more positive academic motivation and skills for educational and occupational planning and achievement (Baker and Taylor, 1998; Evans and Burck, 1992; Lapan, Gysbers, and Petroski, 2001; Lapan, Gysbers, and Sun, 1997; Nelsen and Gardner, 1998; Smith, 2000; Whiston and Sexton, 1998). Thus, one approach to helping all students succeed—and in particular, to reducing the educational and occupational achievement gaps for culturally diverse adolescents in low-income urban schools—may be for counselors to facilitate effective career interventions in schools. Relevant developmental tasks of middle and high school students include negotiating transitions between middle school, high school, and college or work (Eccles et al. 1993; Lent, Hackett, and Brown, 1999; Turner and Lapan, 2005b). Lapan (2004) outlined six developmental tasks for students in kindergarten through twelfth grade. Turner and Lapan (2005b) discussed the importance of

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these tasks for counseling to promote the career development of school-age youth: Although drawn from different theoretical perspectives, young people who accomplish these tasks gain adaptive advantages as they enter a world of work characterized by rapid and unpredictable changes (Savickas, 1995), a high demand for personal responsibility and self-determination (Watts, 1996), and an expectation that people should be both agentic and adapt flexibly to new challenges without losing their core identities (Flum and Blustein, 2000) [p. 418].

Similarly, Lent et al. (1999) proposed six developmental tasks to promote the process of school-to-work transitions from the perspective of social-cognitive career theory (SCCT; Lent, Brown, and Hackett, 1994). As noted by Gainor (2006, p. 162), SCCT is a ‘‘comprehensive theory of academic and career behavior unifying elements of Bandura’s theory [and Hackett and Betz’s (1981) application of self-efficacy to career development] along with other career theories (e.g., Gottfredson, Holland, Krumboltz, Super).’’ Strengths of SCCT include its specific attention to environmental and other contextual variables (for example, cultural) and its applications to assessments and interventions in research over the past twenty-five years (Gainor, 2006). Lent et al. (1999) proposed the following first three of six career developmental tasks for students during the elementary and middle school years (although repeatedly revisited and refined throughout high school and thereafter): (1) acquiring constructive (versus maladaptive) self-efficacy beliefs and outcome expectations, (2) forming interests relevant to careers (as well as abilities, values, and other attributes), and (3) developing linkages to define provisional career goals or aspirations such as interest-goal connections. Related career developmental tasks proposed by Lapan (2004) were (1) forming positive self-efficacy expectations and attributional styles relevant to careers; (2) crystallizing personally valued career interests and constructing a well-informed understanding of self, work world, and adaptive fits between the self and work world; and (3) developing a vocational identity through self-directed career exploration and planning, setting constructive educational and career goals, and committing to achieve these goals. From the perspective of Lent et al. (1999), the additional three of six career developmental tasks that facilitate successful transitions from high school to work or college and beyond are (4) translating goals into actions, (5) developing school or work-related performance skills, and (6) negotiating transition supports and barriers that individuals envision and encounter in pursuing their goals. Related career developmental tasks proposed by Lapan (2004) included (4) becoming self-regulated learners who are empowered to achieve academic goals and (5) learning effective interpersonal, prosocial, and employment

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278 HANDBOOK OF MULTICULTURAL ASSESSMENT readiness skills and behaviors. We submit that the sixth career developmental task discussed by Lent et al., barriers and supports, is related to an element of SCCT that is particularly important for adolescents vulnerable to discrimination in at-risk environments. Throughout this chapter, in our review of recent research findings relevant to culturally competent vocational assessment with low-income and multicultural adolescents, we discuss implications for promoting in middle and high schools the six career developmental tasks that Lent et al. proposed.

RESEARCH ON VOCATIONAL ASSESSMENT WITH CULTURALLY DIVERSE STUDENTS IN MIDDLE AND HIGH SCHOOL School counselors and psychologists need accurate and useful assessment information on which to base their intervention recommendations and plans in order to help students develop academic and vocational competencies. Culturally appropriate assessment is the basis for ethical and effective interventions (Fouad, 1993; Gainor, 2001; Padilla, 2001; Ridley, Hill, and Wiese, 2001). This section focuses primarily on three recent reviews of empirical research on culturally relevant vocational assessment: Subich’s review (2005) of literature on career assessment with culturally diverse individuals, Fouad and Byars-Winston’s meta-analysis (2005) of racial/ethnic differences in career choice, and Gainor’s review (2006) of self-efficacy in career counseling assessment and practice. We evaluate the merits and shortcomings of this knowledge base for applications to adolescents of color in low-income, urban middle and high schools. Subich (2005) conducted a review of research on career assessment from 1994 to 2003 that focused on the applicability of commonly used assessment tools with members of culturally diverse groups. Strengths of this review include its focus on (1) widely used assessment tools of well-defined constructs in career development with theoretical grounding; (2) evaluation of psychometric evidence (for example, reliability, validity, and measurement equivalence with the population on which the instrument is normed or referenced); and (3) adherence in assessment research and practice to the Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists (American Psychological Association, 2003). Because most of the studies cited used samples of college students and employed adults, it is apparent from this review that there remains a dearth of empirical research on theoretically grounded, psychometrically sound, and culturally relevant career assessment tools for students in low-income middle and high schools. Nevertheless, we discuss the relatively few findings relevant to our focus from

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Subich’s review in four areas: assessment of interests, values, career decision status, and self-efficacy beliefs.

Interests The Strong Interest Inventory (SII; Harmon, Hansen, Borgen, and Hammer, 1994) is one of the most widely used and psychometrically sound measures for assessing career-related interests with adults, college students, and high school students ages fourteen and up, based primarily on data from Caucasian samples (Subich, 2005; Whiston, 2005). The SII is a computer-scored inventory that compares individuals’ responses to items with the response patterns of people in various occupations. Score reports are organized, moving from general to more specific information, in relation to Holland’s six vocational interest themes (1997; the General Occupational Themes, or GOTs), general content areas (the Basic Interest Scales; for example, under the Social GOT are Teaching, Social Service, Medical Service, and Religious Activities), and a large number of occupations (the Occupational Scales). The 1994 version of the SII is written at an eighth- to ninth-grade reading level in standard English, and it has been translated into the languages of French, French-Canadian, and Italian. The newly revised version has expanded and updated the Basic Interest Scales (for example, adding Computer Hardware and Electronics) and Occupational Scales, for example, adding Network Administrator and ESL Instructor (Donnay, Thompson, Morris, and Schaubhut, 2004). The Self-Directed Search (SDS; Holland, Fritzsche, and Powell, 1994) is another commonly used and frequently researched measure for assessing Holland’s (1997) six interest domains with adults and students in college, high school, and middle school (again, based mostly on data from Caucasian samples). It is a self-administered and -scored inventory of respondents’ interests in various activities and occupations and their self-estimates of different competencies and skills. The SDS has associated materials (including The Occupations Finder and The Educational Opportunities Finder) to help individuals find occupations similar to their interests and related educational requirements. The middle school version (Career Explorer; SDS-CE) is written at a fourth-grade reading level in English only. The SDS-R (Form R: 4th Edition) is written at a seventh- to eighth-grade reading level and has been translated into Spanish, English-Canadian, French-Canadian, and braille (as well as many other languages in international adaptations). In her review of recent research on the cultural validity of the SII and SDS, Subich (2005) noted that studies addressed three main areas: the structure of interests, criterion-related validity, and group differences. Studies using the SDS were conducted more often with international samples than with members of U.S. racial and ethnic minority groups. The latter is the focus of our discussion of research using the SII or the SDS.

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280 HANDBOOK OF MULTICULTURAL ASSESSMENT Structure of Interests. In Holland’s (1997) theory, the interrelations among the six interest types—Realistic, Investigative, Artistic, Social, Enterprising, and Conventional (collectively termed RIASEC)—can be represented in order by a hexagon structure with types most similar to each other falling next to each other and those least similar falling across the hexagon from one another. Subich’s (2005) review concluded that research has supported a similar circular model, or circumplex structure, of interests reflected in SII GOT scores for samples of college students and employed adults across U.S. racial and ethnic groups. However, some variations from a model of equidistant interrelations among the six interest types (different clustering arrangements) were found by race/ethnicity. For example, the interest structures reflected in SII responses of employed African American and Hispanic American adults differed from those of employed Asian American and Caucasian American adults (Armstrong, Hubert, and Rounds, 2003). Armstrong et al. also examined a high school sample. They found support for a generally circumplex structure of interests for African American, Asian American, Caucasian American, and Hispanic American eleventh- and twelfth-grade college-bound students (who took the unisex edition of the ACT Interest Inventory, UNIACT; Swaney, 1995). Regarding implications of this research for culturally competent vocational assessment with at-risk adolescents, there is some empirical support for using the SII or UNIACT for exploring interests relevant to careers with culturally diverse eleventh and twelfth graders. In addition, we found some limited evidence for the construct validity of the SII with academically gifted middle school students (Schmidt, Lubinski, and Persson Benbow, 1998) as well as with samples of Hispanic and African American students in urban middle schools (Davison Aviles and Spokane, 1999; Jackson, Potere, and Brobst, 2006). Some psychometric evidence supports the use of the SDS-CE with African American urban middle school students at risk of dropping out of school (Osborn and Reardon, 2006). In contrast, Rounds and Tracey (1996) found that the structural equivalence of Holland’s circular order model of interests was not supported in using a variety of measures (including the SDS) with samples of African American, Hispanic, and Native American high school students. Clearly, further research is needed to investigate the structure of interests among culturally diverse students in low-income, at-risk middle and high schools. Group Differences in Interests. Subich’s (2005) review found few group differences in SII GOT scores or criterion-related validity for members of U.S. racial/ethnic groups. Studies using the SDS with multicultural college students and adults found some racial and ethnic group differences in Holland interest type scores; however, due to small sample sizes, conclusions from these results remain tentative.

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Fouad and Walker (2005) noted that recent studies examining mean scale scores on measures of Holland’s (1997) six interest types have found small racial/ethnic group differences for samples of professional adults and students (specifically, for a sample of Hispanic, African American, and Caucasian urban middle school students at risk for dropout; Davison Aviles and Spokane, 1999), whereas ‘‘Fouad (2002) found that within group differences (age and gender within racial/ethnic group) were greater than differences between ethnic groups’’ (Fouad and Walker, 2005, p. 105). Fouad and Byars-Winston (2005) conducted a methodologically sound metaanalysis of studies from 1991 to spring 2004 that examined race/ethnicity differences in career choice. They excluded studies of within-group differences and focused on studies that compared two or more racial/ethnic groups, as between-group differences was the independent variable in their meta-analysis. One dependent variable that they examined associated with making an initial career choice was career aspirations, that is, future occupations that individuals considered of interest or planned to attain. Their results indicated no significant differences between racial/ethnic groups in the careers to which they aspired. High school student samples were used in three of the four studies they examined. Two of these studies used nationally representative samples (Mau and Bikos, 2000; Tracey and Hopkins, 2001). One study’s participants were Native Americans, Caucasians, and Hispanics in ninth and eleventh grade from middleto low-SES rural communities (Lauver and Jones, 1991). Further research is needed to examine whether the findings by Fouad and Byars-Winston of no race/ethnicity differences in high school students’ career aspirations also apply for students in low-income urban middle and high school settings. Jackson, Kacanski, et al. (2006) found that culturally diverse students (mostly African Americans, Hispanics, and Caribbean immigrants) in ninth and tenth grade from urban low-income communities reported high educational and career aspirations for their first-choice occupations (most of which required college or an advanced degree). Nevertheless, while ‘‘race and ethnicity do not appear to curtail the career dreams that people have . . . clearly, something occurs between the time that those dreams and aspirations emerge and the time that individuals enter an occupation, because racial/ethnic minorities are not proportionately represented across career fields in the labor force’’ (Fouad and Byars-Winston, 2005, p. 228). Some researchers have suggested that while racial/ethnic groups may not differ in their responses to interest inventories at the scale level, they may differ in their responses at the item level due to differences in perceptions of opportunities or barriers for access and attainment of a broad (or limited) range of occupations (Fouad and Walker, 2005; Rounds and Tracey, 1996). For example, low-income inner-city multicultural adolescents may have

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282 HANDBOOK OF MULTICULTURAL ASSESSMENT high career aspirations but low expectations of their accessibility for themselves (Jackson, Kacanski, et al., 2006). Using an item analysis methodology (differential bundle functioning, DBF) to examine cultural influences on SII responses, Fouad and Walker found that racial/ethnic groups did not differ on mean interest scale scores (SII GOTs) but did differ in endorsement patterns at the item level. Most of their hypotheses were supported, suggesting that racial/ethnic group differences in vocational interests were in part due to opportunities for same-race occupational role modeling, perceptions of opportunities or barriers, familiarity with activities, or cultural expectations to endorse certain occupations. Their sample was composed of the five major U.S. racial/ethnic groups, and participants were mostly students in high school or college. Future studies might use this promising approach to item analysis of interest inventory responses to increase understanding of cultural and social influences with low-income, urban, and culturally diverse middle and high school students.

Values Forming values as well as interests relevant to careers is a vocational development task in middle to high school (Lent et al., 1999). Culturally competent vocational assessment of values should include not only work-related values but also values related to other life domains, because the interrelationships among work and other life domains vary across cultures (Fouad and Zao, 2000). Subich’s (2005) review of psychometrically and multiculturally sound vocational assessment focused on research using the Values Scale (VS; Super and Nevill, 1985), a self-report inventory of respondents’ ratings of the importance of work-related life values. The VS is grounded in Super’s (1990) theory and was developed as part of the multinational Work Importance Study that examined the role of cultural factors. The VS is written at an eighth-grade reading level and is designed for individuals aged sixteen and older. In Subich’s review, only one of the studies using the VS included U.S. racial/ethnic minority high school students. With a sample of predominantly African American and Hispanic American students (mean age of seventeen), Vacha-Haase et al. (1994) found that both male and female participants endorsed a higher value on being able to express their cultural identity in their work roles when compared to respondents in the VS normative samples of predominantly Caucasian American high school students. Subich concluded that the evidence suggests that the VS is sensitive to cultural differences; however, caution is warranted in using the VS norms with individuals other than Caucasian Americans. Furthermore, research is needed to investigate the reliability, validity, and utility of the VS with culturally diverse students in low-income, at-risk high schools. Also, at the middle school level, the development of culturally relevant and psychometrically sound assessment tools is needed for students to learn about and explore their values relevant to vocational, educational, and life roles.

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Status in the Process of Career Decision Making and Exploration The third and fourth career developmental tasks outlined by Lent et al. (1999) important for middle and high school students are connecting interests and values (as well as self-efficacy beliefs) to defining career goals and translating goals into actions. In their meta-analysis, Fouad and Byars-Winston (2005) found no significant differences among racial/ethnic groups in career decision status in the process of making an initial career choice. In three of the four studies they examined regarding the dependent variable of career decision status, the samples included multicultural urban high school students. Subich’s (2005) review, however, concluded that too little research exists to date to adequately support or contradict using common measures of career decision status with members of U.S. racial/ethnic groups. She examined nine studies related to the assessment of career decision status, three of which included samples of multicultural high school students. Rojewski (1994) found preliminary support for the use of the Career Decision Scale (CDS; Osipow, Carney, Winer, Yanico, and Koschier, 1987) with at-risk rural African American adolescents. Although support for the use of the original version of the Career Maturity Inventory was found by one study with African American college students, Powell and Luzzo (1998) found inadequate support for the use of the revised version (CMI-R; Crites and Savickas, 1995) with African American urban high school students. Lundberg, Osborne, and Miner (1997) used the Career Development Inventory (CDI; Super, Thompson, Lindeman, Jordaan, and Myers, 1981) with urban ninth-grade students. Their results indicated that Anglo and Mexican American students did not differ in their scores on the subscales of Career Exploration and Career Planning. However, the Mexican American students scored substantially lower than the Anglos on the CDI subscales of Decision Making and World of Work Information. If in future research the latter finding is replicated along with adequate evidence of the psychometric and cultural validity of the CDI, then interventions might effectively target developing career decision-making skills and expanding knowledge about occupational and work world information with Hispanic or Latino/a American students in urban high schools.

Self-Efficacy Beliefs ‘‘One important construct in academic and vocational achievement is confidence (or self-efficacy), which is hypothesized to relate to the initiation of career-related activities, persistence despite obstacles, and eventual success’’ (O’Brien, Dukstein, Jackson, Tomlinson, and Kamatuka, 1999, p. 217). A primary developmental task in middle to high school is to acquire self-efficacy beliefs that will facilitate one’s educational and career attainment (Lent et al., 1999). Self-efficacy has been defined as confidence in one’s ability to perform

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284 HANDBOOK OF MULTICULTURAL ASSESSMENT a specific behavior or task (Bandura, 1997). In the years since the construct of self-efficacy has been applied to vocational behavior (spurred by Hackett and Betz, 1981, and the social cognitive career theory of Lent et al., 1994), a significant body of research has emerged on the measurement and functioning of self-efficacy beliefs. Although initial studies were conducted with predominantly Caucasian middle-class students, recent research includes an increasing number of culturally diverse samples. In her review of the research, Gainor (2006) indicated that self-efficacy beliefs have been shown to help explain the career-related behavior of Caucasians as well as people of color. In her review of research on career assessment with culturally diverse individuals, Subich (2005, p. 414) concluded ‘‘it appears that when theoretically and methodologically sound measurement procedures are followed, self-efficacy can be assessed in a reliable and valid manner with members of racial and ethnic groups.’’ Nevertheless, research on the assessment of career and educational selfefficacy beliefs among multicultural individuals has been conducted mostly with college student samples. As the research on constructive self-efficacy beliefs has clearly demonstrated the positive effect on persistence and successful performance in a wide range of domains, there is clearly a need to extend this research to investigate vocational assessment with culturally diverse, low-income, and at-risk middle and high school students. Next, we discuss the relatively few studies reviewed by Subich (2005) and Gainor (2006) that used assessments to measure career-related self-efficacy with multicultural adolescents in low-income, urban, and at-risk schools. Subich (2005) noted that due to Bandura’s theoretical assertion that selfefficacy measures should be specific to the domain under investigation, a multitude of individualized measures have been developed to assess career-related self-efficacy. However, the most frequently used measures have been the Career Decision-Making Self-Efficacy Scale (CDMSE; Taylor and Betz, 1983), its short form (CDMSE-Short Form; Betz, Klein, and Taylor, 1996), and the Skills Confidence Inventory (SCI; Betz, Borgen, and Harmon, 1996). Self-Efficacy in the Process of Career Decision Making. Hackett and Betz (1981) conceptualized the construct of career self-efficacy in terms of two aspects: (1) the process of career decision making (tasks relevant to the five areas identified by Crites, 1961, of self-appraisal, gathering occupational information, selecting goals, future planning, and problem solving) and (2) the content of career choice in a specific area, such as math, science, or writing). The CDMSE (Taylor and Betz, 1983) assesses the degree to which respondents have confidence in their ability to complete tasks in the process of career decision making. Several short versions of the CDMSE have been modified for use with middle and high school students (Anderson and Brown, 1997;

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Betz, Klein, et al., 1996). Gainor (2006) reviewed three studies that used the CDMSE (or a short version) with high school students and found support for its use as a valid measure: McWhirter, Rasheed, and Crothers (2000) with mostly Caucasian urban tenth graders; O’Brien et al. (2000), with a short version of the CDMSE with low-income, predominantly African American high school students; and Kraus and Hughey (1999) with culturally diverse urban high school students. Also, Brown, Darden, Shelton, and Dipoto (1999) found psychometric support for use of the CDMSE with culturally diverse students in urban and suburban eleventh and twelfth grades (Fouad and Byars-Winston, 2005; Subich, 2005). Self-Efficacy for Career Choice, Attainment, or Performance in a Specific Career Domain. The SCI is a measure of career self-efficacy related more to the content than the process of career decision-making tasks. Although not focused on specific career domains, the SCI (Betz, Borgen et al., 1996) assesses respondents’ level of perceived confidence in their own capabilities to perform activities related to six General Confidence Themes that correspond with the same six vocational interest types or GOTs of the SII. The SCI was designed for use with college-age students or adults, and it was developed with mostly Caucasian samples. Yet Jackson, Potere, et al. (2006) found preliminary psychometric evidence supporting the use of the SCI with a sample of Hispanic and African American students in a low-income urban middle school. Nevertheless, most of the studies reviewed by Subich (2005) and Gainor (2006), including assessment of the content aspect of career-related self-efficacy, used measures that focused more specifically on math, science, or nontraditional (by gender or culture expectations) domains of academic or vocational tasks. Results supported the reliability and validity of the Middle School SelfEfficacy Scale (Fouad, Smith, and Enochs, 1997) as a measure of self-efficacy for career decision making, math, and science with seventh- and eighth-grade low-income Hispanic students (Subich, 2005). Gainor (2006) reviewed three studies examining the effectiveness with middle school students of self-efficacybased interventions regarding occupations deemed nontraditional (or disproportionately represented) by their gender. Dawes, Horan, and Hackett (2000) used a measure developed for their study to assess general and specific self-efficacy for technical and scientific careers with culturally diverse seventhand eighth-grade students in an urban Southwest community (approximately 62 percent Caucasian, 20 percent Mexican American, and 7 percent African American). They reported high score reliability for the use of this measure in their study. O’Brien et al. (1999) focused on improving general academic and career self-efficacy with a group of low-income, mostly African American students entering the seventh grade who had been identified by

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286 HANDBOOK OF MULTICULTURAL ASSESSMENT school counselors as at risk for educational or vocational underachievement. As a measure of career-related self-efficacy, O’Brien et al. used the Missouri Comprehensive Guidance Evaluation Survey: Grades 6–9 (MCGES; Gysbers, Lapan, Multon, and Lukin, 1992). Preliminary psychometric support was found for using the MCGES with this sample of at-risk middle school students. Turner and Lapan (2005a) found additional psychometric support for using the MCGES to assess career-related self-efficacy with culturally diverse middle school students in low- to middle-income midwestern communities. Flores and O’Brien (2002) assessed self-efficacy for nontraditional careers of young Mexican American women in twelfth grade in large public high schools in the Southwest. The results from using a scale developed for a previous study indicated adequate reliability and validity (Subich, 2005). Evidence has supported the psychometric properties of career-related self-efficacy measures used in two other studies with multicultural high school students (Gainor, 2006). Speight, Rosenthal, Jones, and Gastenveld (1995) evaluated an intervention to increase adolescents’ self-efficacy for medical careers. With Caucasian and African American students entering the ninth grade, Speight et al. used several self-efficacy scales developed specifically for their study. Psychometric support was also found for the Educational Self-Efficacy-Adolescents Scale (a measure developed for a previous study) by Kerr and Kurpius (2004), with girls earning high grades in math and science but at risk for not achieving high math/science potential. These adolescent girls were culturally diverse students (mostly Caucasian and Hispanic) in high schools (the majority in tenth grade) in low-income communities (including rural, urban, suburban, and Native American reservations). In summary, limited but promising research exists on theoretically grounded and psychometrically sound assessment tools of career-related self-efficacy with culturally diverse students in middle and high schools in low-income, at-risk environments. The use and development of such assessment tools may better inform effective interventions to facilitate constructive self-efficacy beliefs related to the initiation, persistence, and achievement in education and career pursuits with at-risk youth.

PERCEPTIONS OF CAREER OPPORTUNITIES AND SUPPORTS AND BARRIERS In addition to developing confidence in their ability to perform given academic and occupational tasks, students need to learn how to effectively negotiate supports and barriers they encounter in their transitions from high school to college or work (Lent et al., 1999). While Fouad and Byars-Winston (2005) found no

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group differences by race/ethnicity in career aspirations or decision-making and exploration status, they did find significant differences in perceptions of expected career attainment or barriers to career attainment. The results of their meta-analysis (including one study with Mexican American eleventh and twelfth graders; McWhirter, 1997) indicated that members of racial/ethnic minority groups perceived fewer career opportunities and greater career barriers than did Caucasian individuals. Fouad and Byars-Winston noted that this finding is consistent with the sociopolitical context in which people of color work and live. An implication for both research and practice highlights the need to incorporate in culturally relevant assessment and intervention an examination of supports and barriers, both intraindividual (psychological) and extraindividual (contextual) factors, that may facilitate or impede one’s career development. This is a particularly important implication for multicultural youth in at-risk environments who are adolescents vulnerable to discrimination (Jackson and Nutini, 2002).

RECOMMENDATIONS FOR PRACTICAL APPLICATIONS AND FUTURE RESEARCH NEEDED In this chapter, we focused primarily on three recent reviews of empirical research on culturally relevant vocational assessment (Subich, 2005; Fouad and Byars-Winston, 2005; Gainor, 2006). We discussed strengths and limitations of this knowledge base for applications to students of color in low-income, at-risk middle and high schools. We found limited but promising research relevant to this focus in five areas of vocational assessment: interests, values, decision-making status, self-efficacy beliefs, and perceptions of supports and barriers. Our review of this research suggests several strengths and gaps for promoting the six career developmental tasks proposed by Lent et al. (1999) relevant for students in middle and high school. Regarding the developmental task of forming career-related interests, research has generally supported the use of vocational interest measures with culturally diverse youth. Some differences, however, have been found in interest patterns by race/ethnicity. Item response analysis approaches (Fouad and Walker, 2005) show promise for refining culturally relevant assessment of vocational interests. Also, as Fouad and Zao (2000) suggested, ‘‘interest inventories must include both collectivistic and individualistic items, and . . . values assessment must include work-related values as well as values related to nonwork domains because the boundaries between the two arenas vary across cultures’’ (p. 406). Far less research has been conducted on vocational assessment of abilities, values, and other attributes of self-knowledge needed to facilitate the

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288 HANDBOOK OF MULTICULTURAL ASSESSMENT career development of at-risk adolescents. Unlike most Caucasian Americans, adolescents of color have the additional developmental task of racial/ethnic identity to negotiate (Carter and Constantine, 2000; Jackson and Neville, 1998). Therefore, culturally competent vocational assessment with culturally diverse middle and high school students should incorporate measures of racial/ethnic identity development—for example, the Multi-Group Ethnic Identity Measure (Phinney, 1992) or the Visible Racial/Ethnic Identity Attitude Scale (Helms and Carter, 1986). Clearly more research is also needed to develop culturally relevant vocational assessments that inform interventions to promote the process of connecting self-knowledge to defining provisional career goals, translating goals into actions, and developing educational and vocational performance skills (career developmental tasks proposed by Lent et al., 1999, salient in middle and high school). Our review of recent research found theoretical grounding and psychometric support for culturally relevant assessment measures of career-related self-efficacy beliefs with at-risk middle and high school students. In contrast, the related but distinct construct of outcome expectations (SCCT; Lent et al., 1994) has received very little attention in empirical research in vocational psychology (Fouad and Guillen, 2006). Bandura (1997) described outcome expectations as the rewards or consequences anticipated by an individual as a result of engaging in a particular behavior. One example of an outcome expectation is that engaging in academic effort will lead to obtaining a desired career in the future. Research has shown that high school students from various ethnic and socioeconomic groups understand that a good education leads to good jobs (Steinberg, Dornbusch, and Brown, 1992). However, faced with limited access to educational attainment and occupational choice, many low-income and African American and Hispanic students expect that academic effort and achievement will not pay off for them (Graham, Taylor, and Hudley, 1998; Jackson, Kacanski, et al., 2006; Ogbu, 1989). These understandable but maladaptive outcome expectations could be helpfully addressed by developing culturally relevant assessments to inform effective interventions. There is some preliminary support in recent research for assessments measuring perceptions of career-related supports and barriers with culturally diverse students in low-income, at-risk middle and high schools. This area seems especially important for understanding and promoting the career development of at-risk youth who may not consider a broad range of careers of interest because of perceived barriers to access and achievement (Jackson and Nutini, 2002). In addition, we noticed that very little research has been conducted on assessing strategies for negotiating career-related supports and barriers. In other words, awareness of supports and barriers may be a useful

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first step, whereas learning to implement constructive strategies for negotiating supports and barriers is the main objective of this career developmental task. For example, strategies for urban youth to promote critical consciousness in overcoming sociopolitical barriers (Diemer and Blustein, 2006) and social support for career adaptability (Kenny and Bledsoe, 2005) merit further study. Furthermore, Fouad and Walker (2005) noted that in recognition of the significant underrepresentation of racial/ethnic minority people in higher-paying careers in math and science, intense study has been devoted to mechanisms to increase interests in math and science activities for youth of color, including a congressionally mandated program funded by the National Science Foundation. Ironically, Fouad and Walker’s research found that racial/ethnic minority individuals (including high school students) endorsed high interests in math and engineering activities. Therefore, they concluded, investigations might more effectively be aimed at examining ‘‘other systemic reasons and barriers that are preventing racial/ethnic minorities from entering those fields’’ (p. 121). Finally, we suggest that one potentially helpful approach to addressing systemic barriers to vocational access and options for adolescents vulnerable to discrimination begins with career counselors themselves learning how to examine their own hidden biases and resources in practical applications of multicultural vocational assessment (Jackson and Nutini, 2002). One core competency for conducting sound psychological assessment that transcends specialties is ‘‘self-assessment, inclusive of a cultural self-awareness (i.e., reflecting on personal biases, assumptions, and values, and evaluating their potential impact on clients and the processes of psychological work),’’ for example, examining influences on the inferences made from assessment data (Krishnamurthy et al., 2004, p. 737). Relevant general resources include the multicultural guidelines for psychologists (American Psychological Association, 2003) and models for culturally appropriate career assessment (Flores, Spanierman, and Obasi, 2003; Ridley, Li, and Hill, 1998). Byars-Winston and Fouad (2006) have proposed an expanded model for culturally appropriate career counseling that incorporates self-reflective metacognitive strategies to help counselors explicitly examine and address the impact of their own cultural frameworks, values, and worldview on their work with clients; ‘‘these strategies provide a mechanism for counselors to uncover their personal hidden assumptions throughout the counseling process’’ (p. 197). Efforts in research and practice to expand career counselors’ multicultural self-awareness can improve vocational assessments and inform effective interventions that promote broader educational and occupational achievement among at-risk students in middle and high school.

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CULTURALLY COMPETENT VOCATIONAL ASSESSMENT WITH AT-RISK ADOLESCENTS Lauver, P. J., & Jones, R. M. (1991). Factors associated with perceived career options in American Indian, White, and Hispanic rural high school students. Journal of Counseling Psychology, 38, 159–166. Lee, R. M., & Dean, B. L. (2004). Middle-class mythology in an age of immigration and segmented assimilation: Implication for counseling psychology. Journal of Counseling Psychology, 51, 19–24. Lent, R. W., Brown, S. D., & Hackett, G. (1994). Toward a unifying social cognitive theory of career and academic interest, choice, and performance [Monograph]. Journal of Vocational Behavior, 45, 79–122. Lent, R. W., Hackett, G., & Brown, S. D. (1999). A social cognitive view of school-to-work transition. Career Development Quarterly, 47, 297–311. Lent, R. W., & Worthington, R. L. (2000). On school-to-work transition, career development theories, and cultural validity. Career Development Quarterly, 48, 376–384. Leong, F.T.L., & Brown, M. T. (1995). Theoretical issues in cross-cultural career development: Cultural validity and cultural specificity. In W. B. Walsh & S. H. Osipow (Eds.), Handbook of vocational psychology (2nd ed., pp. 143–180). Mahwah, NJ: Erlbaum. Lundberg, D. J., Osborne, W. L., & Miner, C. U. (1997). Career maturity and personality preferences of Mexican-American and Anglo-American adolescents. Journal of Career Development, 23, 203–213. Mau, W., & Bikos, L. H. (2000). Educational and vocational aspirations of minority and female students: A longitudinal study. Journal of Counseling and Development, 78, 186–194. McWhirter, E. H. (1997). Perceived barriers to education and career: Ethnic and gender differences. Journal of Vocational Behavior, 50, 124–140. McWhirter, E. H., Rasheed, S., & Crothers, M. (2000). The effects of high school career education on social cognitive variables. Journal of Counseling Psychology, 47, 330–341. National Career Development Association. (1997). Career counseling competencies. Retrieved December 1, 2006, from http://www.ncda.org/. National Center for Education Statistics. (2001). The condition of education. Washington, DC: U.S. Department of Education. National Center for Education Statistics. (2004). Indicators of school crime and safety. Washington, DC: U.S. Department of Education. Nelsen, D. E., & Gardner, J. L. (1998). An evaluation of the comprehensive guidance program in Utah public schools. Salt Lake City: Utah State Office of Education. Newman, K. S. (1996). Working poor: Low-wage employment in the lives of Harlem youth. In J. A. Grager & J. Brooks-Gunn (Eds.), Transitions through adolescence: Interpersonal domains and context (pp. 323–343). Mahwah, NJ: Erlbaum.

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296 HANDBOOK OF MULTICULTURAL ASSESSMENT O’Brien, K. M., Bikos, L. H., Epstein, K. L., Flores, L. Y., Dukstein, R. D., & Kamatuka, N. A. (2000). Enhancing the career decision-making self-efficacy of Upward Bound students. Journal of Career Development, 26, 277–293. O’Brien, K. M., Dukstein, R. D., Jackson, S. L., Tomlinson, M. J., & Kamatuka, N. A. (1999). Broadening career horizons for students in at-risk environments. Career Development Quarterly, 47, 215–229. Ogbu, J. U. (1989). Cultural boundaries and minority youth orientation toward work preparation. In D. Stern & D. Eichorn (Eds.), Adolescence and work: Influences of social structure, labor markets, and culture (pp. 101–140). Mahwah, NJ: Erlbaum. Oliver, L. W., & Spokane, A. R. (1988). Career intervention outcome: What contributes to client gain? Journal of Counseling Psychology, 35, 447–462. Osborn, D. S., & Reardon, R. C. (2006). Using the Self-Directed Search: Career Explorer with high-risk middle school students. Career Development Quarterly, 54, 269–273. Osipow, S. H., Carney, C. G., Winer, J. L., Yanico, B. J., & Koschier, M. (1987). Career Decision Scale (3rd rev. ed.). Odessa, FL: Psychological Assessment Resources. Padilla, A. M. (2001). Issues in culturally appropriate assessment. In L. A. Suzuki, J. G. Ponterotto, & P. J. Meller (Eds.), Handbook of multicultural assessment: Clinical, psychological, and educational applications (2nd ed., pp. 5–28). San Francisco: Jossey-Bass. Peterson, N., & Gonzalez, R. C. (2005). The role of work in people’s lives: Applied career counseling and vocational psychology (2nd ed.). Pacific Grove, CA: Brooks/Cole. Phinney, J. S. (1992). The Multi-Group Ethnic Identity Measure: A new scale for use with diverse groups. Journal of Adolescent Research, 7, 156–176. Powell, D. F., & Luzzo, D. A. (1998). Evaluating factors associated with the career maturity of high school students. Career Development Quarterly, 47, 145–158. Raskin, P. M. (1994). Identity and the career counseling of adolescents: The development of vocational identity. In S. L. Archer (Ed.), Interventions for adolescent identity development (pp. 155–173). Thousand Oaks, CA: Sage. Richardson, M. S. (1993). Work in people’s lives: A location for counseling psychologists. Journal of Counseling Psychology, 40, 425–433. Ridley, C. R. (2005). Overcoming unintentional racism in counseling and therapy (2nd ed.). Thousand Oaks, CA: Sage. Ridley, C. R., Li, L., & Hill, C. L. (1998). Revisiting and refining the multicultural assessment procedure. Counseling Psychologist, 6, 939–947. Ridley, C. R., Hill, C. L., & Wiese, D. L. (2001). Ethics in multicultural assessment: A model of reasoned application. In L. A. Suzuki, J. G. Ponterotto, & P. J. Meller (Eds.), Handbook of multicultural assessment: Clinical, psychological, and educational applications (2nd ed., pp. 29–48). San Francisco: Jossey-Bass. Rojewski, J. W. (1994). Career indecision subtypes for rural adolescents from disadvantaged and nondisadvantaged backgrounds. Journal of Counseling Psychology, 41, 356–363.

CULTURALLY COMPETENT VOCATIONAL ASSESSMENT WITH AT-RISK ADOLESCENTS Rounds, J., & Tracey, T. J. (1996). Cross-cultural structural equivalence of RIASEC models and measures. Journal of Counseling Psychology, 43, 310–329. Savickas, M., & Lent, R. W. (Eds.). (1994). Convergence in career development theories: Implications for science and practice. Palo Alto, CA: CPP Books. Schmidt, D. B., Lubinski, D., & Persson Benbow, C. (1998). Validity of assessing educational-vocational preferences dimensions among intellectually talented 13-year-olds. Journal of Counseling Psychology, 45, 436–453. Smith, A. E. (2000, Summer). Middle school career exploration: The role of teachers and principals. Education, 120, 626–631. Solberg, V. S., Howard, K., Blustein, D. L., & Close, W. (2002). Career development in the schools: Connecting school-to-work-to-life. Counseling Psychologist, 30, 705–725. Speight, J. D., Rosenthal, K. S., Jones, B. J., & Gastenveld, P. M. (1995). Medcamp’s effect on junior high school students’ medical career self-efficacy. Career Development Quarterly, 43, 285–296. Steinberg, L., Dornbusch, S. M., & Brown, B. B. (1992). Ethnic differences in adolescent achievement: An ecological perspective. American Psychologist, 47, 723–729. Subich, L. M. (2005). Career assessment with culturally diverse individuals. In W. B. Walsh (Ed.), Handbook of vocational psychology: Theory, research, and practice (pp. 397–421). Mahwah, NJ: Erlbaum. Sue, D. W., & Sue, D. (2003). Counseling the culturally diverse (4th ed.). Hoboken, NJ: Wiley. Sue, S. (1999). Science, ethnicity, and bias: Where have we gone wrong? American Psychologist, 54, 1070–1077. Super, D. E. (1990). A lifespan/lifespace approach to career development. In D. Brown, L. Brooks, & Associates (Eds.), Career choice and development: Applying contemporary theories to practice (2nd ed., pp. 197–261). San Francisco: Jossey-Bass. Super, D. E., & Nevill, D. D. (1985). The Values Scale. Palo Alto, CA: Consulting Psychologists Press. Super, D. E., Thompson, A. S., Lindeman, R. H., Jordaan, J. P., & Myers, R. A. (1981). Career Development Inventory. Palo Alto, CA: CPP. Swaney, K. B. (1995). Technical manual: Revised unisex edition of the ACT Interest Inventory (UNIACT). Iowa City: American College Testing. Taylor, K. M., & Betz, N. E. (1983). Applications of self-efficacy theory to the understanding and treatment of career indecision. Journal of Vocational Behavior, 22, 63–81. Tracey, T.J.G., & Hopkins, N. (2001). Correspondence of interests and abilities with occupational choice. Journal of Counseling Psychology, 48, 178–189. Trimble, J. E. (2003). Foreword. In D. B. Pope-Davis, H.L.K. Coleman, W. M. Liu, & R. L. Toporek (Eds.), Handbook of multicultural competencies in counseling and psychology (pp. x–xiii). Thousand Oaks, CA: Sage.

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298 HANDBOOK OF MULTICULTURAL ASSESSMENT Trusty, J., Niles, S. G., & Carney, J. V. (2005). Education-career planning and middle school counselors. Professional School Counseling, 9, 136–143. Turner, S. L., & Lapan, R. T. (2003). The measurement of career interests among at-risk inner-city and middle-class suburban adolescents. Journal of Career Assessment, 11, 405–420. Turner, S. L., & Lapan, R. T. (2005a). Evaluation of an intervention to increase non-traditional career interests and career-related self-efficacy among middle-school adolescents. Journal of Vocational Behavior, 66, 516–531. Turner, S. L., & Lapan, R. T. (2005b). Promoting career development and aspirations in school-age youth. In S. D. Brown & R. W. Lent (Eds.), Career development and counseling: Putting theory and research to work (pp. 417–440). Hoboken, NJ: Wiley. U.S. Department of Education. (1996). Urban schools: The challenge of location and poverty. Washington, DC: U.S. Government Printing Office. Vacha-Haase, T., Walsh, B. D., Kapes, J. T., Dresden, J. H., Thomson, W. A., Ochoa-Shargey, B., et al. (1994). Gender differences on the Values Scale for ethnic minority students. Journal of Career Assessment, 2, 408–421. Vera, E. M., & Speight, S. L. (2003). Multicultural competence, social justice, and counseling psychology: Expanding our roles. Counseling Psychologist, 31, 253–272. Whiston, S. C. (2005). Principles and applications of assessment in counseling (2nd ed.). Belmont, CA: Thomson Brooks/Cole. Whiston, S. C., & Sexton, T. L. (1998). A review of school counseling outcome research: Implications for practice. Journal of Counseling and Development, 76, 412–426. Whiston, S. C., Sexton, T. L., & Lasoff, D. L. (1998). Career-intervention outcome: A replication and extension of Oliver and Spokane (1988). Journal of Counseling Psychology, 45, 150–165. Wilson, W. J. (1996). When work disappears: The world of the new urban poor. New York: Vintage Books.

CHAPTER FOURTEEN

Cross-Cultural Considerations in Quality-of-Life Assessment Shawn O. Utsey Mark A. Bolden

Q

uality of life (QOL) and subjective well-being (SWB) are two interrelated and interdependent constructs that have received increased attention in the psychological and health-related literature during the past decade. Historically, QOL and SWB have been concerned with describing individuals’ level of satisfaction with their life as a whole or in general (Anderson and Robinson, 1991; Diener and Diener, 1995). Chambers and Kong (1996) describe the concept of QOL as being based on subjective perceptions of well-being as well as the ability to function in daily life. Others have suggested that QOL is determined by satisfaction with one’s role at home, work, and in the community (Croog, Levine, and Testa, 1986). QOL is defined by the World Health Organization (WHO) as ‘‘an individual’s perception of their position in life in the context of the culture and value system in which they live and in relation to their goals, expectations, standards, and concerns’’ (WHOQOL Group, 1994, p. 28). Moreover, WHO views QOL as a broad concept influenced by physical health, psychological well-being, personal beliefs, social relationships, and relationship with the environment. In this chapter, we discuss the theoretical ambiguity inherent in crosscultural applications of QOL concepts and technical considerations in assessing QOL across cultures, and we review several QOL measures. We first compare QOL concepts in collectivistic versus individualistic cultures. Concepts such as spirit, harmony, and time orientation are presented as important aspects of QOL in many collective cultures. We next address technical issues

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300 HANDBOOK OF MULTICULTURAL ASSESSMENT related to QOL assessment across cultures, such as conceptual equivalence, semantic equivalence, item equivalence, and scalar equivalence. Finally, we review several QOL measures, including phenomenological approaches, in the light of the relevant factors associated with assessing QOL across cultures. Although QOL and SWB have received increased attention in the psychological and health-related literature, some ambiguity still exists with regard to the components that comprise the construct and the applicability of these components across cultures (Collinge, Rudell, and Bhui, 2002; Tann, 2005; Warner, 1999). Chambers and Kong (1996) posit that SWB is a psychological summary of an individual’s quality of life and that psychological concepts such as depression, self-esteem, anxiety, and alienation indirectly tap aspects of QOL. According to King and Napa (1998), QOL and SWB are determined by an individual’s perceived happiness, sense of purpose in life, and financial security. They note, however, that concern for internal states such as happiness and personal fulfillment are Western notions of SWB and QOL. In contrast, Kagawa-Singer (1988) proposed a conceptual framework of QOL that is transcultural and heuristic in its focus and application. This framework is inclusive of the basic need for safety and security (food, shelter, clothing, and physical comfort), a sense of integrity and purpose (for example, contributing to the well-being and support of one’s group), and a sense of connectedness and belonging. Another component not included in Western conceptualizations of QOL and SWB but necessary for cross-cultural applications of these constructs is the dimension of existential and spiritual well-being (Nobles, 1990; Ferriss, 2002; SPRB Group, 2006). Understanding QOL and SWB in the context of culture and worldview is especially relevant given that cultural beliefs and behaviors play a considerable role in determining how quality of living is defined for individuals across cultures (Collinge et al., 2002; Gotay, 2004; Padilla and Kagawa-Singer, 1998; Staniszewska, Ahmed, and Jenkinson, 1999). Moreover, it should be noted that questions remain as to whether the concept of QOL can be accommodated in cross-cultural translation given that some cultures have no equivalent concept (for example, the Japanese; see Kuyken, Orley, Hudelson, and Sartorius, 1994) or where QOL has a different meaning (as in Africa; see Nobles, 1990). Other researchers not only concur that it is inappropriate to assume cultural universality with regard to the concept of QOL, but go further in questioning whether the research methods currently being used are capable of detecting a universal dimension of QOL, should one exist (Greenfield, 1997; O’Boyle, 1994). A major issue in the conceptualization and measurement of QOL is that both the construct and the existing instrumentation are steeped in a Western cultural epistemological framework and worldview. For example, in accordance with

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Western worldviews, most definitions of QOL (Anderson and Robinson, 1991; Chambers and Kong, 1996; King and Napa, 1998; WHOQOL Group, 1994) focus on individualism and personal happiness. In the Western worldview, personhood is synonymous with autonomy, individual rights, self-determination, and privacy (O’Boyle, 1994). In contrast, traditional societies (African, Asian, and Aboriginal, for example) view personhood as intricately linked to family, ethnic group, village, or social group membership; the individual perceives himself or herself as an extension of the group (the family or clan, for example), as well as an intermediary between ancestors and future generations (Kimweli and Stilwell, 2002; Nobles, 1990). Here the emphasis is not on the self but the ‘‘familial self,’’ which is characterized by a close emotional bond among family members, a sense of interdependence among members of the closely knit family unit, and a sense of togetherness among all members of the clan or village (O’Boyle, 1994). Inherent in most definitions of QOL, including those intended for international and cross-cultural application (for example, that of the WHOQOL Group), is a focus on the individual and his or her perceived well-being and adaptive functioning. In a study by Schalock (2004), an examination of sixteen published articles on QOL revealed eight common themes of the definitions given: interpersonal relations, social inclusion, personal development, physical well-being, self-determination, material well-being, emotional well-being, and rights. Moreover, concepts such as life satisfaction, self-esteem, and happiness, all of which have been linked to QOL in research with Western cultures (Chambers and Kong, 1996; Diener and Diener, 1995), are manifestations of individualist cultures such as those in the United States and Western Europe. In individualist cultures, people are motivated to feel good about themselves, strive for the attainment of personal goals, and become independent of others by developing personal qualities that serve to distinguish them from others (Suh, Diener, Oishi, and Triandis, 1998). In contrast, persons from collectivist cultures view QOL and related concepts as ultimately and inextricably linked to family, community, or their ethnic/racial group (Arrindell et al., 1997). In collectivist cultures, individuals seek fulfillment through cultivating and maintaining harmony within the group (the family, community, or nation) as well as in interpersonal relationships (Kwan, Bond, and Singelis, 1997). Often fostering group harmony and interpersonal relationships is done at the expense of personal goals and aspirations (Arrindell et al., 1997). Note that the primary focus of the concept of relationship harmony is the relationship itself, not the satisfaction or support that the individual derives from the relationship. Given the fundamental differences between collectivist and individualist cultures, it may be necessary to arrive at both emic and etic definitions of QOL for conceptual clarity (Jenaro et al., 2005; Warner, 1999).

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CONCEPTUAL ISSUES RELATED TO ASSESSING QOL ACROSS CULTURES Numerous authors have suggested that QOL concepts have an inherent cultural context (Keith et al., 1996; Kuyken et al., 1994; Kwan et al., 1997; Padilla and Kagawa-Singer, 1998; Saxena, 1994). Moreover, each culture, along with its related QOL concepts, evolves from a specific philosophical origin. Consequently efforts aimed at providing a cultural context to QOL concepts must include the philosophical branches of cosmology, ontology, axiology, and epistemology (Kwan et al., 1997; Saxena, 1994). Understanding the philosophical underpinnings of QOL concepts is all the more important given that concepts are names that, when written or spoken, assume the language context of the culture of origin (see Table 14.1). Note: Babalawa is a title denoting a priest in the Ifa divination system of the Yoruba people of Nigeria, West Africa. Santero is the title denoting a priest in the Santeria divination system of Cuba and other parts of the Caribbean. Santeria has its origins in West African religious systems similar to Yoruba. Naming is an act of empowerment when the context is culturally and linguistically congruent with the philosophical framework of the population being studied (Nobles, 1990). Conversely, naming, when externally imposed by an alien culture, is oppressive if it is not authenticated by the indigenous population for whom the concept is intended (Freire, 1994). Therefore, the phrase quality of life, how people subjectively place value (quality) on their views of existence (life), contains inherent assumptions that may pose a conceptual dilemma if culturally appropriate contexts are ignored. This is especially problematic since both values and views of existence are influenced by culture (Hall, 1966). According to Kroeber and Kluckhohn (1952) culture consists of ‘‘patterns, explicit and implicit of and for behavior acquired and transmitted by symbols. Constituting the distinctive achievement of human groups . . . the essential core of culture consists of traditional . . . ideas and . . . attached values; culture systems may, on the one hand, be considered as products of action, on the other as conditioning elements of further action’’ (p. 127). Within the context of QOL, culture shapes accepted behavior for individuals within a communal context (Padilla and Kagawa-Singer, 1998). Along with shaping behavior, culture provides a group with a shared notion of historic reality that explains past behavior and conditions for elements of further action. It is within this context that a proper cultural analysis of QOL conceptualizations must occur. As applied to cross-cultural assessment of QOL, Western psychology’s interpretation of Greek philosophy is inadequate and potentially offensive and oppressive (Freire, 1994). Western cosmology separates the material basis

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Table 14.1. Cultural Group, Worldview, Quality-of-Life Concepts, and Instrumentation for Assessing Quality of Life Across Cultures Cultural Group

Worldview

Quality-of-Life Concepts

Assessment

Evaluator

African

Collective, harmony with nature, flexible time orientation, relationship with ancestors, spiritually centered

Group/relationship Phenomenological, Babalawa, harmony, harmony divination diviners, with nature and minister, spirit world santeros

Asian

Mind and body indivisible, group/collective consciousness, familism, hierarchical relationship structure

Ki, harmony with nature, balance of mind-body-spirit

Phenomenological Monk, Mudang, or mansin

Indian

Collectivistic, mind and body indivisible, all living things possess spirit

Familial, social, cosmic harmony, balance between mind and body, liberation of the spirit, darma

Phenomenological Shaman, Yogi

Native Wellness is Harmony with American harmony of nature and spirit world, reciprocity spirit-mind-body; plants, animals, humans are all part of spirit world

Phenomenological, Medicine ceremonial man, angakok

European Individualism, action orientation, time is rigid and linear, focus on quantifying human experiences

Paper-and-pencil measures, structured interview

Self-esteem, individual happiness, material wealth, satisfaction with life

Psychologist

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304 HANDBOOK OF MULTICULTURAL ASSESSMENT of the world from its spiritual basis by dichotomizing God, humans, and nature through science (specifically physics), which denies the presence of a pervasive universal spirit acknowledged by the metaphysical systems of all collective cultures (Ani, 1994). The axiological perspectives of Western cultures determine one’s worth by quantifying the person’s material acquisitions (Ani, 1990, 1994; Hall, 1966). Moreover, in a Western cultural context, the nature of knowing (epistemology) occurs through an individual’s rational and logical thought, in stark contrast to Eastern cultures, where approaches to knowledge combine logic with intuition and affect. In Western cultures, truth is proven through measurement through the five physical senses that account for the tangible quality and quantity of a phenomenon (Ani, 1994). For example, Descartes’ premise, ‘‘I think. Therefore, I am,’’ is incompatible with an African ontological perspective (Mbiti, 1969) that posits, ‘‘I am because we are, and since we are, therefore I am.’’ Thus, in order to assess QOL in collective cultures, the indigenous philosophy must be understood in order to have an authentic, culturally congruent perspective of how different cultures define, conceptualize, and assess QOL.

QOL CONCEPTS IN COLLECTIVE CULTURES The assessment of QOL in most collective cultures includes conceptualizations of spirit, harmony, and cyclical time orientations (Saxena, 1994). The spirit, which according to Nobles (1998) differs from spirituality, is ‘‘the energy, force or power that is both the inner essence and the outer envelope of human beingness. . . . Human beings experience their ‘Spiritness’ simultaneously as a metaphysical state and an ethereal extension or connection into and between the supra world of Deities, the inter world of other beings, and the inner world of the self’’ (p. 193).

Spirit Quality-of-life assessments need to include methods of assessing an individual’s internal energy (spirit/soul/vitality). Internal energy, known by different names across cultures, is the ethereal source endowed by the creative force that allows one to exist. The concept of internal energy is known as Kı´ (pronounced ‘‘chi’’) in Buddhist cultures (Furuya, 1996), num among the Kung of southern Africa (Katz, 1982), and Ash´e in the African religious system of Yoruba (Gonzalez-Wippler, 1992). In the Bantu tradition, the concept of vitality (or spirit) is known as Moyo (Fu-Kiau, 1991), while the Yogis of India call it prana or kundalini (Ornstein, 1972). Given its fundamental importance among many collective cultures and worldviews the concept of spirit should be included in the conceptualization of QOL. Its absence in Western QOL assessments

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stems from the absence of spirit and related concepts in the study of human behavior (Saxena, 1994). Research by the WHOQOL SRPB Group (2006) found religion, personal beliefs, and spirituality to be highly correlated with specific spheres of QOL (physical, psychological, level of independence, environment, and social).

Harmony Collective cultures that conceptualize the universe as a pervasive spirit require ‘‘total harmony . . . with the global unit of the social body of the community . . . also with the wholeness of the universe because the human being is only a kengele (‘tiny element, electron’) in the bungila kia makengele (‘body of tiny elements or electronic body’)’’ (Fu-Kiau, 1991, p. 39). Thus harmony is a key component of QOL (Kwan et al., 1997). Kimweli and Stilwell (2002) defined QOL as ‘‘a function of belongingness and a constellation of community bound homeostatic systems as well as self-integration and synchronization with others’’ (p. 201). In collective cultures, harmony is a core component of group identity. Individual self-esteem is secondary to the healthy functioning of group relationships (Saxena, 1994). Indeed, subjective well-being, while positively correlated with subjective psychological health, has been found to be positively correlated with harmony and congruence with one’s community and a perception of future success for one’s self and community (Kimweli and Stilwell, 2002). Interpersonal relationships are therefore the most important factor in collectivist cultures. In fact, communal living ‘‘requires a certain ability to subordinate private needs and wants to the good of the collective’’ (Finch, 1991, p. 72). The notion of harmony is essential to conceptualizations of QOL across cultures (Kwan et al., 1997). Harmony is the maintenance of balance in a relationship between interdependent entities. It provides a society with rhythm and manifests in the relationships that human beings have with nature: human beings, invisible spirits, ancestors, land, plants, animals, and the metaphysical higher force (Jahn, 1961). This cosmology is present in the following metaphysical systems: Japan’s Shintoism and China’s Taoism (Axelson, 1999); Mali’s Dogon (Ani, 1994), Kˆongo’s Bˆantu (Fu-Kiau, 1991, 2001), and Ghana’s Akan (Ephirim-Donkor, 1997); India’s Buddhism and Hinduism (Saxena, 1994); and the Native American Sioux and Cherokee (Axelson, 1999). Thus, relationship harmony requires polymetric syncopation with all of the elements of nature. Polymetric syncopation is the essence of rhythm in collective societies (Nobles, 1990). In this sense, rhythm relates to behavioral movement according to the natural environment. Hence, harmony maintains a natural rhythm that necessitates a time orientation congruent with nature’s harmony.

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Time Orientation Conceptualizations of time are an essential aspect of cross-cultural assessment (Pennington, 1990). Many collective cultures have circular time orientations that stem from a cosmological perspective in which spirit is the essence of life (Ani, 1994; Kuyken et al., 1994). The notion of a pervasive universal spirit allows collective societies to function according to a natural universal order and provides a cultural time orientation that focuses on the spirit’s cultivation and infinitude (Pennington, 1990). Hence, time consciousness focuses on being ‘‘in time’’ and is marked by fluidity (Adam, 2006; Ornstein, 1972). The notion of an ‘‘in time’’ perspective allows one to affectively engage in the interaction of the present moment. The in-time orientation necessitates not only harmony with nature but oneness, which typifies the connectedness of collective cultures (Ani, 1990). The idea of oneness manifests broadly under the umbrella of mindfulness. Largely understood by Western scholars under its Buddhist manifestations, though rooted in many cultural traditions, mindfulness is a state of awareness and attention that centers one in the here and now both internally and externally (Brown and Ryan, 2003; Csordas, 2004). Becoming mindful involves lifestyle practices that include breathing, nutrition, and movement such that one’s existential being is involved in mundane experiences (Oken et al., 2006; Michalsen et al., 2005). This is in stark contrast to Western time orientations. Time orientations in Western psychological constructs of QOL are linear with a definite beginning and a finite end (Adam, 2006; Hall, 1966, 1969). European or Western culture focuses on maximizing efficiency, which is the notion of producing a higher volume of product in a shorter amount of time with less effort and cost. Progress occurs, and QOL is enhanced when mechanical technology, the tool of efficiency, achieves the desired result (Ani, 1994). This is a future time orientation, which is unidimensional, linear, and limited. Moreover, the North American (Western) time orientation has a present-centered aspect that manifests in a need for immediate gratification (Hall, 1966). In collective cultures with a cyclical time orientation, the life span is dependent on the spirit and soul of a person; therefore, attention must be given to the quality of a person’s spirit (Nobles, 1990). Hence, in the context of collectivistic cultures, QOL is viewed as a developmental process in which one returns to one’s ethereal source. This return is manifest in the symbolic cosmological concept of Sankofa in the Akan metaphysical system (Ephirim-Donkor, 1997). Similarly, other cultures have metaphysical explanations through their cosmology about what occurs after physical death. For example, Indian philosophies posit that one’s dharma, or reincarnation, is influenced by one’s karma, the consequence of one’s actions (S. Kheper, personal communication,

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September 8, 1999). In African cultures, the physically deceased continue to exist in the form of the living dead and their ancestors (Fu-Kiau, 2001; Mbiti, 1969; for a thorough review on the Bˆantu-Kˆongo system, see Fu-Kiau, 1991). The concept of an afterlife focuses on continuity of spirit, which requires balance, rhythm, and harmony while in the manifestation of a human being. Spirit continuity is part and parcel of a cyclical time orientation.

TECHNICAL ISSUES IN ASSESSING QOL ACROSS CULTURES The technology available for assessing QOL in a cultural context consists primarily of paper-and-pencil measures. For the most part, these instruments ask respondents to indicate, on a Likert scale, whether they strongly agree, agree, disagree, or strongly disagree with a given statement regarding their QOL. Several researchers have noted the inherent difficulty with this simplified approach to developing measures suitable for use across cultures (Collinge et al., 2002; Keith et al., 1996; Kuyken et al., 1994). Specifically, successfully transporting psychological measures across cultures depends in large part on the researcher’s ability to establish conceptual, semantic, item, and scalar equivalence between the host culture and the target culture (Kuyken et al., 1994).

Conceptual Equivalence Conceptual equivalence relates to the existence of a given concept in both the host and the target cultures. For conceptual equivalence to be achieved, the concept must exist in both cultures, and its expression must be identical across cultures. Establishing conceptual equivalence is of considerable importance in determining whether a measure is valid for use in both the host and target cultures. With regard to QOL assessment, conceptual equivalence is particularly relevant where a measure has been developed for use in an individualistic culture and attempts are made to transport that measure to a collectivistic culture.

Semantic Equivalence Semantic equivalence in cross-cultural assessment is determined by the denotative and connotative uniformity of words (Kuyken et al., 1994). The denotative meaning of a word refers to its symbolic representation and is primarily determined by its dictionary meaning. The primary mode of evaluating the denotative meaning of a word is through linguistic analysis. Connotative equivalence is the meaning implied by a word. For example, words associated with happiness (such as satisfied, gratified, and fulfilled) in Western culture may evoke different associations in Asian or African cultures (harmony, balance,

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308 HANDBOOK OF MULTICULTURAL ASSESSMENT spiritness). For cross-cultural assessment to be effectively carried out, both denotative and connotative equivalence must exist.

Item Equivalence Cross-cultural assessment requires the contextual equivalence of the items belonging to the measure being used to evaluate the construct of interest (Kuyken et al., 1994). Without contextual equivalence, the validity of the evaluative process will be compromised. For example, researchers who want to measure the effects of depression on QOL across cultures must first establish that depression occurs in the same context across cultures and that the items intended to measure depression have the same ability to do so in each culture.

Scalar Equivalence Scalar equivalence is whether the measurement scale of a given instrument intended for cross-cultural assessment has equivalent value in both cultures for which it is intended for use (Kuyken et al., 1994). For example, a QOL measure that employs a Likert scale with a range of 1 to 7, with 1 meaning very happy and 7 very unhappy, assumes that happiness can be quantified in a linear fashion in both the host and target culture. In addition, Likert scales have been found to be ineffective in cultures where adhering to the social norm is desirable (Mertens, 1998). In such cases, respondents are likely to choose a response typifying the tendency to select a value close to the middle of the scale so as not to appear different from the group.

REVIEW OF INSTRUMENTS AND TECHNIQUES FOR ASSESSING QOL IN A CULTURAL CONTEXT A number of scholars have noted the paucity of research focused on culturally sensitive QOL measures (Kuyken et al., 1994; Padilla and Kagawa-Singer, 1998). The majority of QOL assessment tools operate on the premise that instruments normalized on majority society are applicable and relevant to all populations (Keith et al., 1996). However, most models are grounded in majority society cultural values and consequently may be inappropriate for use in cross-cultural assessment. While most research supports the universal properties of the QOL concept, more research is necessary to explore the emic validity of QOL measures (Jenaro et al., 2005). Three assessment instruments have emerged in the psychological literature that employ culturally sensitive approaches to assessing QOL with minority populations (see Table 14.2).

CROSS-CULTURAL CONSIDERATIONS IN QUALITY-OF-LIFE ASSESSMENT

Table 14.2. Reliability and Validity Coefficients for Quality of Life Measures

Schedule for the Evaluation of Individual Quality of Life

World Health Organization Quality of Life—100

Authors

Validity Coefficients

Broadhead et al. (1998)

.70

Cronbach’s alpha = .74

.70

None reported

O’Boyle (1994)

.49–.74∗

None reported

De Vries & Van Heck (1997)

.60–.70∗

Cronbach’s alpha = 96

.58–.72∗

None reported

.89

None reported

WHOQOL Group (1998)

Cross-Cultural Assessment of Quality of Life Concepts Questionnaire ∗ Validity

Reliability

Skevington & Wright (2001)

None reported

Cronbach’s alpha = .96

Skevington, O’Connell, & the WHOQOL Group (2004)

None reported

Cronbach’s alpha = .84

Keith et al. (1996)

.64

None reported

coefficients are reported in ranges.

Schedule for the Evaluation of Individual Quality of Life The Schedule for the Evaluation of Individual Quality of Life (SEIQoL), a phenomenological approach to measuring QOL, may be an ideal method for obtaining subjective QOL data in cross-cultural situations (Broadhead, Robinson, and Atkinson, 1998; O’Boyle, 1994). The subjective nature of the scale is favorable because it does not impose a standard format. Rather, the participant selects important life domains that reflect his or her own needs and goals. Quality of life is then constructed from the description of each cue as appropriated by the client. Each cue is identified and described in order that the practitioner may assess the specific meaning and degree of life satisfaction it affords the client. When participants are administered the instrument, they are asked to divide a pie diagram into five parts, each differing in size depending on the

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310 HANDBOOK OF MULTICULTURAL ASSESSMENT significance attached to each part. Measuring the size of each part of the pie diagram results in scores on the QOL life dimensions. This approach yields five independent and continuous scores, ranging from 0 to 100. Whereas traditional QOL scales may assess concerns such as self-esteem and job satisfaction, the SEIQoL allows participants to identify salient life satisfaction domains unique to the individual. For example, an economically disadvantaged first-generation Asian couple may be less interested in personal status and income and more interested in their children’s education. If their children are excelling in school, they may report a relatively high quality of life, despite what most from majority society would regard as a poor quality of life. Although this measure welcomes a diverse span of content domains in regard to life satisfaction, clients from some cultural backgrounds may be hesitant to nominate certain domains because of fear of how they will appear to the researcher. Therefore, they may alter their choices to appear socially appropriate (Kazdin, 1982). For instance, the domain of sexuality may be embarrassing for an Asian participant who may want to avoid the possibility of bringing shame on herself or himself. She or he may choose another socially acceptable domain such as job satisfaction instead. In order to reduce the chances of this type of error occurring, it may be helpful to include a qualitative method of inquiry to add clarity. Information regarding the validity and reliability of the SEIQoL can be found in Table 14.2.

World Health Organization Quality of Life—100 The World Health Organization Quality of Life—100 (WHOQOL-100) purports to evaluate a person’s overall quality of life (De Vries and Van Heck, 1997; WHO Group, 1998). It focuses on an individual’s objective state, behaviors, and capacity and the evaluations of those aspects. The WHOQOL-100 was developed by QOL experts from around the world in order to ensure that the measure embodied and reflected the worldviews of an international population. Unlike traditional QOL instruments, there are no standard questions addressing the client’s personal health and life satisfactions. The instrument is considered a generic measure that assesses both positive and negative components of QOL. Following a rigorous process of development and construct clarification (Kuyken, 1994), WHO produced the WHOQOL-100 instrument for measuring individuals’ perceptions on the quality of their life. The measure consists of one hundred questions that assess six domains of quality of life within which twenty-four facets are considered. The six domains covered are physical health, psychological functioning, level of independence, social relationships, environment, and spirituality/religion/personal beliefs. Items are rated on a five-point scale. The WHOQOL-100 has been shown to have adequate internal consistency and validity (see Table 14.2).

CROSS-CULTURAL CONSIDERATIONS IN QUALITY-OF-LIFE ASSESSMENT

WHO’s purpose in developing the WHOQOL-100 emerged out of the scant availability of genuinely cross-culturally sensitive instruments. Because this scale was developed within a number of field centers in pluralistic cultures, it transcends the values and worldviews of any one culture. The instrument is available in over twenty languages and reflects the organization’s commitment to a holistic perspective on health. The WHOQOL-100 can be used in a medical context, for psychological evaluation, for research, and for policy development.

Cross-Cultural Assessment of Quality of Life Concepts Questionnaire The Cross-Cultural Assessment of Quality of Life Concepts Questionnaire (CCAQLCQ; Keith et al., 1996) assesses ten QOL domains for persons with disabilities. Quality of life experts from eight countries (Australia, England, Finland, Germany, Taiwan, Republic of China, United States, and Japan) were consulted to translate the scale into their respective languages. The questionnaire was then translated back into English to ensure that the meaning and intent of words were not lost in the conversion. Each representative was then responsible for distributing the scale to at least ten people who had obtained a bachelor’s degree. The ten QOL domains were determined by reviewing salient themes in the QOL literature. Each domain was assessed using a seven-point Likert scale. Concepts were rated based on three bipolar adjective pairs: value (for example, good/bad), potency (for example, strong/weak), and activity (for example, active/inactive). Among six of the seven national samples that participated in a study using the scale, concepts such as relationships, health, inclusion and growth were especially valued (Keith et al., 1996). Economic security (financial status) and personal control were found to have less value. Although this scale has considerable international consistency, Keith et al. (1996) contend that it may not be appropriate for those who hold to a collectivistic value system. Validity and reliability coefficients are reported in Table 14.2.

QUALITATIVE INQUIRY AND QOL ASSESSMENT Phenomenological The phenomenological approach to assessing QOL is focused on understanding the meaning that events have for the persons being evaluated. In this framework, the emphasis is on what people say and do as a reflection of how they interpret the world (Warner, 1999; Mertens, 1998; Taylor and Bogdan, 1998). Those using the phenomenological approach to assessing QOL should base

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312 HANDBOOK OF MULTICULTURAL ASSESSMENT their interpretations of events on the indigenous cultural perspectives of the target population (Taylor and Bogdan, 1998). Thus, in assessing QOL across cultures, it is essential for the evaluator to step outside the comfort zone of his or her own worldview so that the individuals being evaluated may be viewed in the context of their own unique reality. Feminist research, symbolic interactionism, grounded theory, and naturalistic observation are related methods of phenomenological inquiry that can be applied to QOL assessment (Mertens, 1998).

Interpretive-Constructivist According to the interpretive-constructivist perspective, the type of inquiry used to understand a given phenomenon should not impose its structure on the person’s worldview; rather, the individual’s worldview should inform the type of assessment to be used. The interpretive-constructivist view posits that ‘‘multiple realities exist that are time and content dependent’’ (Mertens, 1998, p. 168). In QOL assessment, it is important for researchers to explore and understand the indigenous culture’s worldview in order to develop appropriate instrumentation and techniques (Warner, 1999). If QOL can be assessed only through cultural emergence, then the ethnographic approach would be the most appropriate course of study.

Ethnography Ethnography has been described as the most frequently used qualitative method in educational and psychological research (Mertens, 1998). This method of inquiry can be used to describe and analyze QOL across cultures and communities. Ethnographical research is informed by anthropological, psychological, or educational theory (Mertens, 1998). This approach to qualitative inquiry can be used to understand concepts related to QOL from within the culture (emic) and from the outside (etic). Traditionally researchers who use the ethnographical approach to study QOL make the decision as to what and who will be studied and how the data will be analyzed and interpreted. In this light, it is important that researchers using this approach avoid imposing their reality on the participants they are studying. In assessing QOL cross-culturally, the ethnographical approach requires experience and firsthand knowledge of the culture being studied (Taylor and Bogdan, 1998). The general ethnographical approach to studying QOL cross-culturally occurs through observing participants followed by open-ended discussions and interviews (Warner, 1999; Greenfield, 1997). Ethnographical observation helps to determine learning styles and cognitive abilities specific to that culture, which facilitates knowledge of the axiology, epistemology, and communication present in that culture. Ethnography also provides the

CROSS-CULTURAL CONSIDERATIONS IN QUALITY-OF-LIFE ASSESSMENT

detection, correction, and prevention of errors in cross-cultural assessment by grounding researchers (Greenfield, 1997).

CONCLUSION Assessing QOL across cultures is a complex and multifaceted task that requires conceptual flexibility and appropriate instrumentation. Currently QOL is conceptually trapped in a Western worldview and epistemological framework. This is also true of the instrumentation available for assessing QOL across cultures. There is a clear need to move beyond simply translating traditional paper-and-pencil QOL measures into the language of the target culture and proceed with the business of assessment as if this procedure alone is adequate (Tann, 2005; Novelli, Rovere, Nitrini, and Caramelli, 2005). As we continue to move toward a global community, there is increasingly a greater need for researchers to recognize the limitations of transporting so-called etic conceptualizations of QOL across cultures. Instead, efforts should be directed at employing qualitative methods of inquiry that allow indigenous ontological, axiological, and epistemological influences to determine conceptualizations of QOL. In our review of QOL concepts across cultures, one salient theme that emerged was the focus on such metaphysical concepts as spirit, internal energy, and Chi as important factors influencing the quality of life. Given the focus on spirituality and other metaphysical phenomena by people living in collectivistic cultures, researchers are encouraged to update their theory, instrumentation, and methodology in an effort to provide more appropriate cross-cultural assessment. Another theme that emerged from the literature on quality of life as experienced across cultures was a focus on harmony. Harmony with the environment, nature, and others was an important factor in almost all of the collectivistic cultures sampled in this chapter. It will be important for future research to place more of an emphasis on examining the nontangibles when assessing QOL across cultures.

References Adam, B. (2006). Time. Theory, Culture, and Society, 23, 119–126. Anderson, M., and Robinson, J. (1991). Measures of subjective well-being. In J. P. Robinson, P. S. Shaver, & L. S. Wrightsman (Eds.), Measures of personality and social psychological attitudes (pp. 61–114). Orlando, FL: Academic Press. Ani, M. (1990). Let the circle be unbroken: The implications of African spirituality in the diaspora. New York: Nkonimfo Publications. Ani, M. (1994). Yurugu: An African-centered critique of European cultural thought and behavior. Trenton, NJ: African World Press.

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314 HANDBOOK OF MULTICULTURAL ASSESSMENT Arrindell, W. A., Hatzichristou, C., Wensink, J., Rosenberg, E., Twillert, B., Stedema, J., et al. (1997). Dimensions of national culture as predictors of cross-national differences in subjective well-being. Personality and Individual Differences, 23, 37–53. Axelson, J. A. (1999). Counseling and development in a multicultural society (3rd ed.). Pacific Grove, CA: Brooks/Cole. Broadhead, J. K., Robinson, J. W., & Atkinson, M. J. (1998). A new quality of life measure for oncology: The SEIQOL. Journal of Psychosocial Oncology, 16, 21–35. Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822–848. Chambers, J. W., & Kong, B. W. (1996). Assessing quality of life: Construction and validation of a scale. In R. L. Jones (Ed.), Handbook of tests and measurements for Black populations. Hampton, VA: Cobbs and Henry. Collinge, A., Rudell, K., & Bhui, K. (2002). Quality of life assessment in non-Western cultures. International Review of Psychiatry, 14, 212–218. Croog, S. H., Levine, S., & Testa, M. A. (1986). The effects of antihypertensive therapy on the quality of life. New England Journal of Medicine, 314, 1657–1664. Csordas, T. J. (2004). Healing and the human condition: Scenes from the present moment in Navajoland. Culture, Medicine, and Psychiatry, 28, 1–14. De Vries, J., & Van Heck, G. (1997). The World Health Organization quality of life assessment instrument (WHOQOL-100): Validation study with the Dutch version. European Journal of Psychological Assessment, 13, 164–178. Diener, E., & Diener, M. (1995). Cross-cultural correlates of life satisfaction and self-esteem. Journal of Personality and Social Psychology, 68, 653–663. Ephirim-Donkor, A. (1997). African spirituality: On becoming ancestors. Trenton, NJ: African World Press. Ferriss, A. L. (2002). Religion and the quality of life. Journal of Happiness Studies, 3, 199–215. Finch III, C. S. (1991). Echoes of the old darkland: Themes from the African Eden. Decatur, GA: Khenti. Freire, P. (1994). Pedagogy of the oppressed (new rev. 20th anniversary ed.). New York: Continuum. Fu-Kiau, K.K.B. (1991). Self healing power and therapy: Old teachings from Africa. New York: Vantage Press. Fu-Kiau, K.K.B. (2001). Tying the spiritual knot: African cosmology of the Bantu-Kˆ ˆ ongo. Brooklyn, NY: Athelia Henrietta Press Furuya, K. (1996). Kodo ancient ways: Lessons in the spiritual life of the warrior/martial artist. Santa Clarita, CA: Ohara Publications. Gonzalez-Wippler, M. (1992). The power of the orishas: Santeria and the worship of saints. Plainview, NY: Original Publications.

CROSS-CULTURAL CONSIDERATIONS IN QUALITY-OF-LIFE ASSESSMENT Gotay, C. C. (2004). Quality of life in culturally diverse cancer patients. In R. J. Moore & D. Spiegal (Eds.), Cancer, culture, and communication. New York: Kluwer Academic. Greenfield, P. M. (1997). You can’t take it with you: Why ability assessments don’t cross cultures. American Psychologist, 52, 1115–1124. Hall, E. T. (1966). The dance of life: The other dimension of time. New York: Doubleday. Hall, E. T. (1969). The hidden dimension. New York: Doubleday. Jahn, J. (1961). Muntu: An outline of the new African culture. New York: Grove Press. Jenaro, C., Verdugo, M. A., Caballo, C., Balboni, G., Lachapelle, Y., Otrebski, W., et al. (2005). Cross-cultural study of person-centred quality of life domains and indicators: a replication. Journal of Intellectual Disability Research, 49, 734–739. Kagawa-Singer, M. (1988). Bamboo and oak: A comparative study of adaptation to cancer by Japanese-American and Anglo-American patients. Unpublished doctoral dissertation, University of California, Los Angeles. Katz, R. (1982). Boiling energy: Community healing among the Kalahari Kung. Cambridge, MA: Harvard University Press. Kazdin, A. (1982). Observer effects: Reactivity of direct observation. In D. P. Hartmann (Ed.), Using observers to study behavior (pp. 5–19). San Francisco: Jossey-Bass. Keith, K., Heal, L., & Schalock, R. (1996). Cross-cultural measurement of critical quality of life concepts. Journal of Intellectual and Developmental Disability, 21, 273–293. Kimweli, D.M.S., & Stilwell, W. E. (2002). Community subjective well-being, personality traits and quality of life therapy. Social Indicators Research, 60, 193–225. King, L. A., & Napa, C. K. (1998). What makes a life good? American Psychologist, 75, 156–165. Kroeber, A. L., & Kluckhohn, C. (1952). Culture: A critical review of concepts and definitions. New York: Random House. Kuyken, W. (1994). Development of the WHOQOL: Rationale and current status. International Journal of Mental Health, 23, 24–56. Kuyken, W., Orley, J., Hudelson, P., & Sartorius, N. (1994). Quality of life assessment across cultures. International Journal of Mental Health, 23, 5–27. Kwan, V.S.Y., Bond, M. H., & Singelis, T. M. (1997). Pancultural explanations for life satisfaction: Adding relationship harmony to self-esteem. Journal of Personality and Social Psychology, 73, 1038–1051. Mbiti, J. S. (1969). African religions and philosophies (2nd ed.). Portsmouth, NH: Heinemann. Mertens, D. M. (1998). Research methods in education and psychology: Integrating diversity with quantitative and qualitative approaches. Thousand Oaks, CA: Sage. Michalsen, A., Hoffman, B., Moebus, S., Backer, M., Langhorst, J., & Dobos, G. J. (2005). Incorporation of fasting therapy in an integrative ward: The evaluation of outcome, safety, and effects on lifestyle adherence in a large prospective cohort study. Journal of Alternative and Complementary Medicine, 11, 601–607.

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316 HANDBOOK OF MULTICULTURAL ASSESSMENT Nobles, W. (1990). African philosophy: Foundation of Black psychology. In R. E. Jones (Ed.), Black psychology (pp. 47–63). Berkeley, CA: Cobb & Henry. Nobles, W. (1998). To be African or not to be: The question of identity or authenticity— some preliminary thoughts. In R. E. Jones (Ed.), African American identity development (pp. 185–206). Berkeley, CA: Cobb & Henry. Novelli, M.M.R.C., Rovere, H.H.D., Nitrini, R., & Caramelli, P. (2005). Cross-cultural adaptation of the Life Assessment Scale on Alzheimer disease. Arq Neuropsychology Quarterly, 63, 201–206. O’Boyle, G. A. (1994). The Schedule for Evaluation of Individual Quality of Life (SEIQoL). International Journal of Mental Health, 23, 3–23. Oken, B. S., Zajdel, D., Kishiyama, S., Flegal, K., Dehan, C., Haas, M., et al. (2006). Randomized, controlled, six-month trial of yoga in healthy seniors: Effects on cognition and quality of life. Alternative Therapies, 12, 40–47. Ornstein, R. O. (1972). The psychology of consciousness. New York: Freeman. Padilla, G., & Kagawa-Singer, M. (1998). Quality of life and culture. In C. King & P. Hinds (Eds.), Quality of life from nursing and patient perspectives: Theory, research and practice. Sudbury, MA: Jones and Bartlett. Pennington, D. (1990). Time in African culture. In M. K. Asante & K. Welsh-Asante (Eds.), African culture: The rhythms of unity (pp. 123–140). Trenton, NJ: Africa World Press. Saxena, S. (1994). Quality of life assessments in cancer patients in India: Cross-cultural issues. In J. Orley & W. Kuyken (Eds.), Quality of life assessment: International perspectives. New York: Springer-Verlag. Schalock, R. L. (2004). The concept of quality of life: What we know and do not know. Journal of Intellectual Disability Research, 48, 203–216. Skevington, S. M., O’Connell, K. A., & the WHOQOL Group (2004). Can we identify the poorest quality of life? Assessing the importance of quality of life using the WHOQOL-100. Quality of Life Research, 13, 23–34. Skevington, S. M., & Wright, A. (2001). Changes in the quality of life of patients receiving antidepressant medication in primary care: Validation of the WHOQOL-100. British Journal of Psychiatry, 178, 261–267. SRPB Group. (2006). A cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life. Social Science and Medicine, 62, 1486–1497. Staniszewska, A., Ahmed, L., & Jenkinson, C. (1999). The conceptual validity and appropriateness of using health-related quality of life measures with minority ethnic groups. Ethnicity and Health, 4, 51–63. Suh, E., Diener, E., Oishi, S., & Triandis, H. C. (1998). The shifting basis of life satisfaction judgments across cultures: Emotions versus norms. Journal of Personality and Social Psychology, 74, 482–493. Tann, S. S. (2005). Implications for quality of life research in Latino populations. Journal of Transcultural Nursing, 16, 136–141.

CROSS-CULTURAL CONSIDERATIONS IN QUALITY-OF-LIFE ASSESSMENT Taylor, S. J., & Bogdan, R. (1998). Introduction to qualitative research methods: The search for meaning (3rd ed.). Hoboken, NJ: Wiley. Warner, R. (1999). The emics and etics of quality of life assessment. Social Psychiatry and Psychiatric Epidemiology, 34, 117–121. WHOQOL Group. (1994). Development of the WHOQOL: Rationale and current status. International Journal of Mental Health, 23, 24–56. WHOQOL Group. (1998). Group development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28, 551–558.

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PART TWO

TESTING ISSUES

SECTION ONE

PERSONALITY ASSESSMENT

P

art Two of the Handbook of Multicultural Assessment focuses on testing issues, specifically personality assessment (Section One) and assessment of cognitive abilities (Section Two). We have added a new section that focuses on forensic assessment. The chapters in Part Two address the use of major instruments and assessment procedures with members of different racial and ethnic groups. The five chapters in Section One address some of the most popular measures used in personality assessment: the Tell-Me-A-Story test, projective measures, the 16PF (Fifth Edition) and CPI-434, the Myers-Briggs Type Indicator, and the MMPI-2 and MCMI-III. Chapter Fifteen, by Rosemary Flanagan, Giuseppe Costantino, and Elsa Cardalda, with a contribution from Erminia Costantino, provides extensive information about the TEMAS, a narrative/thematic apperception test. The authors note that the TEMAS provides culturally based norms and present information on how to interpret and integrate findings with other measures administered as part of a comprehensive evaluation. Tests that fall within the category of projective assessment—drawings, narratives (thematic apperception), and inkblot—are covered in Chapter Sixteen, by Giselle B. Esquivel, Geraldine V. Oades-Sese, and Sarah Littman Olitzky. All three of these projective formats are widely used in clinical and school settings. The authors provide an overview of the theory, research, and best practice issues involved in multicultural projective assessment.

322 HANDBOOK OF MULTICULTURAL ASSESSMENT Chapter Seventeen, by Kristen M. Strack, Marcella H. Dunaway, and Stefan E. Schulenberg, reviews applications of the 16PF-5 and CPI-434 with racial and ethnic minorities in the United States. The authors describe these measures and make recommendations for future research. Information regarding specific studies conducted, including different racial and ethnic groups, is presented in a table format. Chapter Eighteen, by Mary H. McCaulley and Raymond A. Moody, covers the use of the Myers-Briggs Type Indicator (MBTI) with multicultural populations. The authors begin with a description of the MBTI and Jung’s psychological theory of type. In addition, they provide information regarding reliability, validity, and use of the text in different cultural contexts. Chapter Nineteen examines the multicultural applications of the most widely used personality measure in the United States: the MMPI-2 and the MCMI-III. Written by Kwong-Liem Karl Kwan and Michael Lynch Maestas, this comprehensive review highlights the performance of non-White groups on these tests.

CHAPTER FIFTEEN

TEMAS: A Multicultural Test and Its Place in an Assessment Battery Rosemary Flanagan Giuseppe Costantino Elsa Cardalda Erminia Costantino

T

EMAS has the same meaning in several languages. In English, TEMAS is an acronym for tell me a story; in Spanish, it means themes, and in Italian, TEMA means theme. This creative cross-linguistic combination of names represents the most appropriate title for a narrative test (Costantino, 1987; Costantino, Malgady, & Rogler, 1988; Ritzler, 1993). The TEMAS represents a number of departures and improvements relative to previous narrative and thematic apperception tests. First, the test was developed for use with children and adolescents (Ritzler, 1993). Second, the test comprises two parallel sets of stimulus cards: one set for minorities and the other for nonminorities, thus making it multicultural in nature. Third, the test abandons the construct of pictorial ambiguity common to the TAT and Rorschach to pull for specific conflicts or problems and uses structured stimuli with pictorial problem solving (Costantino, Flanagan, and Malgady, 2001; Flanagan, Losapio, Costantino, Greenfeld, and Hernandez, 2004; Flanagan and DiGiuseppe, 1999). Fourth, the test has normative data for Black, Puerto Rican, other Hispanic, and White children ages five to thirteen, thus increasing multicultural validity and diminishing test bias against minorities (Dana, 1993, 1996, 1998, 2000; Ritzler, 1996). Fifth, the stimulus cards are in color, which attracts and maintains children’s interest (Costantino, 1987), and facilitates psychologically meaningful stories (Costantino, Flanagan and Malgady, 1995; Lubin, 1995; Murstein, 1963; Exner, 1991, 2003; Thompson and Bachrach, 1951). The TEMAS was developed to meet the need for reliable and valid diagnosis and personality assessment of culturally and linguistically diverse children as well as nonminority children. Moreover, culture-specific norms for projective tests have been developed (Costantino, 1992; Costantino and Malgady, 1996;

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324 HANDBOOK OF MULTICULTURAL ASSESSMENT Costantino et al., 2001; Dana, 1996; Flanagan and DiGiuseppe, 1999; Ritzler, 1993, 1996).

RATIONALE FOR TEMAS AS A NARRATIVE INSTRUMENT The theoretical formulation of TEMAS is based on multiple models. Social learning, cognitive, and narrative theoretical models posit that personality development occurs within a sociocultural system, where individuals internalize the cultural values and beliefs of family and society (Bandura, 1977, 1986, 1989, 1991; McAdams, 1994; McAdams and Pals, 2006; Piaget and Inhelder, 1971; Sullivan, 1953). Personality functions are learned initially through modeling (Bandura, 1977) and are then developed through verbal-narrative and imaginal processes (McAdams and Pals, 2006; Paivio, 1971; Piaget and Inhelder, 1971; Singer and Pope, 1978). When narrative test pictorial stimuli are similar to the situations in which the personality functions were originally learned, these functions are attributed to the characters and situations in the cards and narrated as personal life events and life stories (Auld, 1952, 1954; Bandura, 1986; Bruner, 1986; Mancuso and Sarbin, 1983; Sarbin, 1986; Teglasi, 2001). The emphasis on cognitive processes in projective and narrative testing was the natural progression of the theoretical development of cognitive psychology in the 1970s. In the past two decades, there has been a movement among cognitive-behavioral psychologists to integrate the basic assumptions of ego psychology and cognitive psychology in the application of projective analyses (Anderson, 1981; Singer and Pope, 1978; Sobel, 1981; Teglasi, 2001). Sobel (1981) proposed the development of a projective-cognitive instrument to assess an individual’s problem-solving strategies, coping skills, and self-instructional styles. Narrative psychology has not yet fully emerged as a separate field (Sarbin, 1986) but is gaining popularity as narrative theory (Kirkman, 2002) in the form of both narrative assessment (Costantino, 1978; Costantino, Flanagan and Malgady, 2001; Costantino et al., 1988; Teglasi, 2001) and narrative treatment (Bracero, in press; Costantino, Malgady and Rogler, 1994; Freedman and Combs, 1996; Howard, 1991). Nonetheless, within the context of this chapter, we will present sufficient theoretical evidence to discuss the value of the TEMAS test as a narrative assessment tool. Bruner (1986) posited that there are two modes of thought in obtaining knowledge: the paradigmatic mode, which deals with general causes and effects in the discovery of empirical truth, and the narrative mode, which deals with the way individuals understand the vicissitudes of their own lives. Traditionally psychology has been using mechanistic laboratory and experimental methods to obtain knowledge about individuals. Sarbin (1986)

TEMAS

and Mancuso and Sarbin (1983) proposed the narrative mode as a root metaphor in psychology, which allows psychologists to understand individuals through their narratives or life histories. Narrative theory suggests that that there is an interrelationship between cultural narratives and personal narratives because culture influences the individual and the individual narrative reflects the culture of the storyteller (Kirkman, 2002). In addition, there is a mutual relationship between individual and cultural narratives and the sociocognitive psychology of human development (Bandura, 1986; Piaget and Inhelder, 1971; Singer and Pope, 1978) because social learning theories can be used to explain the development of the self through different stages of the life span through the narrative identity of the individual. Narrative identity is developed within the matrix of social and cultural milieu (Bruner, 1990), and through telling about ourselves, we develop a sense of the self (Mancuso and Sarbin, 1983). Within the cognitive development of the child, the relationship between images and words is a complementary process of concreteness and abstractness, whereby images indicate concrete objects and words signify concepts. Consequently the role of modeling and symbolic representation in early and middle childhood, and even in adolescence (Singer, 1973), seems to be an important factor in the development of symbolic functioning. Since narrative theory posits that self-identity develops through life story construction by linking social-cognitive psychology and narrative psychology, we can confidently assume that narrative assessment is the most important and valid technique in understanding personality functioning. In addition, the linguist Charlotte Linde (1993, as reported in Kirkman, 2002) stated that individuals need a coherent life story in order to be able to adaptively function in their environment. However, quite often, life stories go wrong, and it is the responsibility of psychologists to understand these ‘‘broken’’ life stories and engage in ‘‘story repair’’ (Howard, 1991). Teglasi (2001), in her reformulation of the theoretical framework of the TAT, wrote that the projective hypothesis and cognitive schema theory are essentially similar because both assume the importance of the role of previous learned mental sets in responding to projective stimuli, and both indicate that these responses fall outside the realm of consciousness. Since these modes of thought are organized into narratives, storytelling becomes a valid medium in personality assessment while using the TAT. In the tradition of psychologists who have proposed a narrative conceptualization of human thinking and personality within a multicultural context, McAdams and Pals (2006) wrote that the complex interplay between culture and personality functioning seems to be most apparent in narrative identity as revealed in individuals’ life stories. Life stories tell much about the individual and, at the same time, about the culture in which the individual lives. In addition, Howard (1991) suggested that storytelling is fundamental

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326 HANDBOOK OF MULTICULTURAL ASSESSMENT to the development of self-identity, which he calls ‘‘life story construction.’’ Psychopathology occurs when life stories go awry. The effectiveness of a culturally competent multicultural narrative technique in personality assessment provides a perfect fit with the reformulation of personality as narrative identity by McAdams and Pals (2006) and with Howard’s view (1991) of psychotherapy as a technique in story repair (Costantino et al., 1994). Hence, the TEMAS narrative test may correspond to a valid multicultural assessment in understanding why life stories go wrong among culturally diverse individuals, offering a link between culturally appropriate assessment and treatment.

TEMAS Development The principal rationale for the development of the TEMAS was to address the emic and etic validity for a psychometrically sound multicultural narrative test. The TEMAS was developed specifically for use with culturally and linguistically diverse children and adolescents (Cardalda, 1995; Costantino, 1978, 1987; Costantino et al., 1988; Dana, 1993). Based on these considerations, the TEMAS narrative technique was developed with culturally relevant stimuli. There are parallel minority and nonminority versions of TEMAS pictures (Costantino, 1978) embodying the following features: structured stimuli, reduced ambiguity to pull for specific personality functions, chromatic attractiveness, ethnic relevance, contemporary characters and settings to elicit diagnostically meaningful stories, representation of both negative and positive intrapersonal and interpersonal functions in the form of conflicts or problems to be solved, and an objective scoring of both narrative structure and content. The TEMAS pictures were drawn by a young professional artist (Phil Jacobs) from psychological situations created by their first author (Costantino, 1987; Costantino, Malgady, and Rogler, 1988). The pictures embody a large variety of problematic life situations in culturally oriented situations and experiences in urban environment, such as a family scene within the home, solitary dreamlike and fantasy states, street scenes involving peers and adults, sport activities, and situations occurring in school settings. The problem-solving situations depicted in the pictures motivate negative and positive ideas and feelings to be embedded in the narratives and manifested as either adaptive or maladaptive solutions of the depicted problem. These situations pull for themes reflecting varying degrees of psychopathology and well-being, ranging from severe pathology, such as suicidal ideation, depression, and aggression, to highly adaptive functioning.

Administration and Scoring The test administration is an integration of the TAT and the Rorschach Comprehensive System (Exner, 2003) administration procedures. The initial part is conducted after establishing rapport with the examinee with the following

TEMAS

instructions: ‘‘I have several interesting pictures that I am going to show you. Look at the characters and places in the pictures and tell me a complete story about each picture that has a beginning and an end.’’ The temporal sequencing part, which follows, reads, ‘‘Each story should answer three questions: What is happening in the picture now? What happened before? And what will happen in the future?’’ Subsequently the examiner records the story verbatim, noting the reaction time and the time engaged in spontaneous story telling. Examinees are given the opportunity to tell a complete story in a spontaneous manner, with minimal clarifying questions. Subsequent to the spontaneous story, the examiner conducts a third part, structured inquiries, if the spontaneous narrative is incomplete. A story is incomplete if it does not relate any of the following indexes: (1a-b) the identities and relationships among the characters, (2a-b) identification of the setting, (3a-b) what the characters are doing and saying, (4a-b) what the characters were doing before, (5a-b) what the characters will be doing in the future, (6a) what the main character is thinking, and (6b) what the main character is feeling. After completing the structured inquiries, the examiners record the total time. The TEMAS stories are scored according to standardized instructions (for details, see Costantino et al., 1988; Costantino, Dana, and Malgady, 2007) on indexes of cognitive, affective and personality functions. The cognitive indexes consist of reaction time, spontaneous time, total time, and fluency, which are scored numerically as given in each story; and recognition and solution (or not) of the depicted conflict or problem, number of omissions and transformations, and others, which are scored as 1 if not present and blank if they are present in the stories. Main affective indexes are based on feelings attributed to the main character at the end of the story such as happy, sad, angry, and fearful, which are scored as 1 if present in the story or blank if not present. The nine personality functions are scored on a four-point rating scale according to age-appropriate behaviors on a maladaptive to adaptive continuum and as N if the personality function designed to be pulled is not present in the story. A score of 1 indicates the presence of a highly maladaptive or pathological solution of the depicted conflict or problem, a score of 2 refers to a moderately maladaptive solution, 3 reflects a partially adaptive solution, and 4 represents a highly adaptive solution. Raw numerical scores and N scores are converted to T scores or clinical cutoff scores (more than the ninetieth percentile), as appropriate. These are compared to the multicultural normative scores of Black, Other Hispanic, Puerto Rican, and White children ages five to thirteen. Scores of adolescents are interpreted clinically (for complete protocols, see Costantino et al., 1988, Costantino et al., 2007).

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328 HANDBOOK OF MULTICULTURAL ASSESSMENT The remainder of this chapter discusses three cases of culturally diverse individuals who illustrate the role of the TEMAS in psychological assessment batteries.

Jane, Referred to a Community Mental Health Center Jane is a thirteen year old of European American background who is placed in a regular education class in a church-run school. She is prone to oppositional behavior characterized by tantrums when she does not get what she wants. Tantrums consist of breaking things, kicking the door, and overall poor interpersonal relationships. Other evidence of noncompliance includes not completing chores. Developmental history indicates that Jane’s difficulty has early roots, although her behavior became problematic when she began preschool. Her school behavior was described as aggressive and impulsive. Nevertheless, Jane was generally manageable from first through seventh grade, when class sizes remained small. She became more difficult in the eighth grade, sometimes choosing not to participate in class activities, and she became somewhat isolated. She also demonstrated a propensity for frequent bouts of anger and irritability. She has been in psychotherapy previously; no medication was prescribed. Minimal improvement was noted. Family history is significant for emotional problems (anxiety and depression). She was not particularly communicative; when she did choose to communicate, it tended to be monosyllabic. She spoke to the mental health professionals conducting the assessment only if her mother was in the room, which is unusual for an early adolescent. Jane’s demeanor was suggestive of sadness. Her self-esteem appeared deficient and confidence low. Continued psychotherapy and a psychoeducational evaluation were recommended; several medications (Risperdal, Zoloft) were prescribed. A number of possible diagnoses, including Oppositional Defiant Disorder, Attention-Deficit Hyperactivity Disorder, Generalized Anxiety Disorder, and Depression, should be considered. Although she is too young to be assigned a diagnosis of a personality disorder, there is merit in determining how she compares to the diagnostic criteria. Psychological Testing Cognitive Assessment The Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV; Wechsler, 2003) indicates that Jane is functioning at the average level (Full Scale IQ = 91) of cognitive ability. Her General Intellectual Ability, which is comprised of the Verbal Comprehension and Perceptual Reasoning factors (Flanagan and Kaufman, 2004) and is exceeded by the Working Memory and Processing Speed factors. This means that her learning and thinking processes are more highly developed than her knowledge base; this is particularly true for verbal reasoning skills, as evidenced by a scaled score of 5 on the similarities subtest. The score on the similarities subtest is not necessarily limited by vocabulary as such because she scored within the average

TEMAS range on vocabulary (scaled score = 9). Scores further indicate that she has knowledge of social norms and a general fund of knowledge typical of her age; the scaled score for the comprehension subtest is 12. This latter score may reflect learned social knowledge and reasoning. Overall test data suggest that her skills are not as highly developed when the task is abstract and possibly novel to Jane, as in the case of the similarities subtest. Extending this line of reasoning to possibly novel social situations, it becomes apparent that she does not use the information she possesses to guide her behavior in an effective manner. Social-Emotional Assessment A number of social emotional measures were administered. TEMAS (Costantino et al., 1988) data (Table 15.1) indicate that Jane was appropriately reflective (Reaction Time), gave considerable time relating the narratives (Total Time), and was verbally productive (Fluency, operationalized as a word count). The fluency score is important because

Table 15.1. T-Scores for Jane’s TEMAS Variable

T Score

Reaction time

42

Total time

71

Fluency

70

Total Omissions

50

Interpersonal Relations

< 28

Aggression

< 28

Anxiety/Depression

< 26

Achievement Motivation

38

Delay of Gratification

40

Self-Concept

49

Sexual Identity

< 37

Moral Judgment

30

Reality Testing

< 32

Happy

50

Sad

59

Angry

55

Fearful

70

T Scores (mean = 50; standard deviation = 10)

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330 HANDBOOK OF MULTICULTURAL ASSESSMENT higher fluency scores may be associated with the increased likelihood that the narrative produced will contain projected material. She was at least as attentive as those in the normative sample in regard to including details in her narrative (Omissions). T scores for the personality functions (operationalized as the adaptiveness of the conflict resolution) generally indicate weak problem solving. Only two of nine personality functions are in the average range, with the remainder falling in the belowaverage range. The nine personality functions are Interpersonal Relations, Aggression, Anxiety/Depression, Achievement Motivation, Delay of Gratification, Self-Concept, Sexual Identity, Moral Judgment, and Reality Testing. Data indicate that her problem solving is most effective when protecting her selfconcept (T = 49), and barely adequate when faced with situations most effectively addressed by delaying gratification (T = 40). Skills decrease somewhat when high achievement motivation (T = 38) would result in a more effective outcome. Of greater concern are the difficulties relating to others and managing negative emotions. When the solution calls for weighing moral imperatives (T = 30) or making choices that will result in improved interpersonal relations (T = 28), she is ineffective. Ineffective management of aggressive (T < 28) impulses, possibly associated with difficulty managing anxiety and depression (T < 26), would clearly contribute to poor problem solving when interpersonal relations are at stake. Not surprising is that reality testing is compromised when addressing situations associated with negative feelings (T = 32). The presence of negative affect apart from its management is evidenced by the scores on the affective functions of Sad, Angry, and Fearful (respectively, T = 59, 55, 70), which are operationalized as the affect of the characters at the point of conflict resolution. Further examination of the data at the item level indicates that Jane detects problems and attempts a resolution rather than avoid challenges. This is evidenced by only one N score for personality functions not pulled. Although the attempt to address a problem is laudable, it is also of concern, as the data suggest her judgment is poor and she may not have appropriate solutions. The solutions were generally scored 2 for mildly maladaptive. Thus, the scorable material reinforced the overall impression that her thinking about social situations and social problem solving is weak. Moreover, it is quite possible that the hypothesized above-average projection (suggested by the high fluency score) does not work in her favor. Jane’s recourse to fantasy activity to address situations does not serve her well and is substantiated by the weak score on reality testing. Because she can be motivated, she will work hard to protect her self-esteem (T = 49) but may not necessarily be successful. Examining the data at the level of narrative content yields important clinical information. The content of Jane’s narratives contains considerable violent and aggressive content, as well as ill-intentioned acts. Common themes involve getting retribution and untoward outcomes for the characters, as evidenced by the main character portrayed as permanently disfigured in one story. Anecdotal information suggests that these themes reflect Jane’s perception of interpersonal relationships and the environment and may provide the reinforcement and impetus for her behavior.

TEMAS

Table 15.2. T-Scores on the Achenbach Teacher Rating Form for Jane TRF Scale

Teacher 1

Teacher 2

Internalizing Problems

72

67

Externalizing Problems

64

56

Withdrawn

85

70

Somatic Complaints

50

50

Anxious/Depressed

69

66

Social Problems

63

64

Thought Problems

70

50

Attention Problems

61

50

Delinquent Behavior

55

0

Aggressive Behavior

64

58

T Scores (mean = 50; standard deviation = 10)

Other-Reported Questionnaire Data Data obtained from the Child Behavior Checklist Teacher Rating Form (TRF; Achenbach and Rescorla, 2003) appear in Table 15.2. Ratings by two teachers indicate the presence of considerable negative affect and behavioral problems consistent with the TEMAS data. Moreover, data indicate that thinking processes as rated by others are compromised. Substantiation of findings by different methods is important, as different methods often produce different results (Achenbach, Dumenci, and Rescorla, 2002; Spangler, 1992). Moreover, if the findings are taken to define constructs such as anxiety or depression, more than one method of measurement may be needed to capture the complexity of the individual and his or her functioning (Kagan, 1988). Rorschach The Rorschach, scored and interpreted according to the Comprehensive System (Exner, 2003), indicates a number of concerns. Data that assess the capacity for controls and stress tolerance indicate that Jane lacks a clearly defined coping style; she sometimes attempts to address concerns with recourse to fantasy activity and sometimes attempts to address concerns outwardly by expressing her feelings. This is reflected in the Erlebnistypus (EB), which is 3:4 and is operationalized as the ratio of the sum of human movement responses to the sum of weighted color responses or a comparison of internally to externally accessed resources. This suggests that she is equally likely to draw on internal or external resources and has no preferred problem-solving or coping style; this is neither normal nor abnormal. Examination of

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332 HANDBOOK OF MULTICULTURAL ASSESSMENT the scores for the determinants that constitute the four square scores (EB, EA, eb, es) indicates that there are adequate resources available to manage the stimulus demands experienced. The Experience Actual (EA), or the sum of human movement and weighted color responses, is 7; this represents the sum of accessible resources for the individual. The sum of stimulus demands experienced by Jane, indicated by the experience base (eb), is 6. The eb is operationalized as the sum of animal movement, inanimate movement, achromatic color, shading, and vista and texture responses. These data indicate that stimulus demands are balanced by the accessibility of resources, suggesting that all is well. Further examination of the data reveals that four responses were coded for inanimate movement (m). This is important because m is believed to be associated with the presence of internal tension and turmoil. Although data may suggest that the situational stress is ideational, they also suggest that Jane has adequate resources to manage it. Nevertheless, this ideation is disruptive, leaving her to feel helpless at times and experiencing difficulty thinking clearly and concentrating, which could account for the attentional difficulty. In addition, there is evidence suggesting painful negative affect (C’) associated with some tendency to depressive symptoms. Also suggested is a lack of awareness of unmet needs, evidenced by the absence of responses scored for texture (T), shading (Y), or vista (V). Given that Jane tends to have difficulty delaying gratification (TEMAS data), it appears that she may respond in an impulsive manner in order to have her needs met rapidly, with little thought given to the bigger picture. This brings more immediate relief and provides a means of managing (albeit inefficiently) her thought processes, which on occasion appear to reflect more complexity (blend responses) than most other persons her age. Common to Jane’s more complicated responses are determinants associated with tendencies to turmoil and affectivity. Not surprisingly, her thinking processes may not result in cohesive and comprehensible solutions, reflected in abnormal verbalizations (INCOM, DV). At such times, the observed ineffective oppositional behavior, reflected in the large number (7) of white space (S) responses, may occur, which is an ineffective way of addressing difficulty. Data that assess information processing indicate that Jane tends to prefer simple solutions (W:D:Dd = 9:13:7). She tends to offer the obvious response (D, common detail) rather than attempt to integrate information to yield a meaningful whole (W, whole blot responses) or attend to details (Dd, uncommon details). Her response style is marked by constriction, as there is a preponderance of Pure Form responses (lambda = 1.64), which attribute the perception of the inkblot to the shape of what is seen as compared to responses that are associated with thinking or affect. Importantly, her aspirations may exceed her capabilities (W:M = 9:3); as she attempts to integrate information (W, whole blot responses) but is limited in her ability to perceive complexities (M, human movement responses). The data in this grouping corroborate other test data. Her problem solving as measured by the TEMAS lacks complexity and sophistication, despite adequate motivation. Overall Rorschach data also indicate less complexity of thought (Blends/R = 3/29) than her age peers. The cognitive assessment data indicate that her ability is at the lower end of the average range. Taken together, these variables could be consistent with the low frustration tolerance that often accompanies

TEMAS the reported bouts of aggression, as well as related poor interpersonal relationships and the insecurity that may often accompany poor relationships. Interpretive Procedures The general interpretive strategy began by reviewing interview data and progressively examining test data that increasingly relies on inference for interpretation. Thus, an emerging picture of social–emotional functioning began at intake and progressively developed by interpreting questionnaire data, the TEMAS, and then the Rorschach. Data indicate that Jane is experiencing a number of comorbid concerns. Although there is a need to assign a DSM-IV-TR (American Psychiatric Association, 2001) diagnosis in order to communicate with other professionals, the diagnosis does not necessarily inform treatment and is not necessarily useful for educational planning, given that the school system relies on educational criteria to determine whether there is a problem in evidence. Thus, it is sufficient to assign a diagnosis of Generalized Anxiety Disorder and Depressive Disorder, Not otherwise specified, as diagnoses using DSM-IV-TR criteria. Although Jane is too young to be assigned a diagnosis of a personality disorder, the data suggest one may be incipient.

Interview data and developmental history provide the basis for a referral, but the quality of the information varies as a function of the integrity and insight of the informant, as well as the informant’s behavioral and affective functioning. In the case of a child whose behavior is a problem, it is possible that the information provided by parents and teachers can reflect the difficulty managing the child and may be tainted. With that noted, it remains important to collect questionnaire data. Omnibus measures such as the Achenbach System of Empirically Based Assessment (Achenbach and Rescorla, 2003) are an efficient means of collecting considerable information in varied domains from several informants. In this situation, only teacher-reported data were collected because the parents found the questionnaire difficult and the child was not cooperative. Nevertheless, it is desirable to collect questionnaire data from the parent and child as well. The information obtained is a numerical score that is compared to norms. It may also be desirable to administer additional questionnaires that focus on specific concerns that may be elevated, such as attentional difficulty. This is an especially effective way of assessing comorbid concerns and rule-outs. Narrative measures such as TEMAS provide a means of assessing a youth based on stories told about standard stimulus cards. Reading difficulties are circumvented, and telling stories may seem less threatening for the child than responding to questions. Moreover, an opportunity is provided to observe the child responding to a standard situation (Flanagan, 2003), during which information is provided about the child’s thinking process and problem-solving abilities. This is clearly different from asking either the child or a significant adult to complete a questionnaire that provides the respondent’s perceptions of

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334 HANDBOOK OF MULTICULTURAL ASSESSMENT clarity of thought and problem solving. TEMAS data are qualitatively different from questionnaire data. Interpretation of the content is not precluded. The types of information that the Rorschach may provide when administered, scored, and interpreted according to the Comprehensive System (Exner, 2003) are qualitatively different from other assessment data, particularly questionnaire data. Central to appropriate interpretation procedures is considering data from groupings or indexes as an integrated unit; thus, data are contextualized within the assessment. There is a data–supported interpretive strategy that guides the order in which the variables are interpreted (see Exner, 1991). Individual pieces of data that are salient (that is, uncommon) are interpreted in terms of the hypotheses they suggest. Although most practitioners use multiple measures and methods in assessment practice, there is a paucity of professional literature to guide this practice. Research integrating various measures emphasizes the assessment of adults (Meyer, Riethmiller, Brooks, Benoit, and Handler, 2000); the assessment of youth is potentially more complex because what is considered appropriate adjustment is a function of the developmental trajectory. Data from two additional cases will be presented to provide further illustration of the interpretive strategy.

Tiffany, Referred to the School Psychologist Tiffany, an African American youngster aged eight years, was referred for an evaluation by her parents because of concerns with her affect and general adjustment. Tiffany resides with her parents and five-year-old younger sister. She was the product of an uneventful, full-term pregnancy. Developmental milestones were generally reached within normal limits; parental report indicates that some milestones may have been reached early. Recent family stressors include both parents being unemployed for six months. Tiffany attended Head Start at age four and subsequently attended parochial school, where she continues. Some mild reading difficulty was reported but has since been overcome. Tiffany is described as a cooperative and affectionate child. Although Tiffany came to the evaluation in an appropriate manner, there was some mild difficulty establishing rapport. She nevertheless became comfortable in the presence of the examiner and appeared to have given her best effort. Effort varied across tests, with some test stimuli appearing to be more emotionally moving for Tiffany. Some mild teariness was observed. Psychological Testing The tests administered were the Self-Report of Personality of the Behavior Assessment System for Children (BASC-SRP; Reynolds and Kamphaus, 1992), the Children’s Depression Inventory (CDI; Kovacs, 1992), the TEMAS (Costantino, Malgady, and Rogler, 1988), and the Piers Harris Self-Concept Scale (Piers, 1984).

TEMAS Questionnaires The BASC is an omnibus system for rating the behavior and affect of youth. Development was empirical and psychometric properties are good (Flanagan, 1995). Both desirable and undesirable aspects of functioning are rated. BASC data reported in Table 15.3 indicate that Tiffany’s overall functioning is within normal limits on a wide array of positive and negative characteristics. Within the Clinical Maladjustment Composite, Tiffany rated herself as in control of situations as much as her age peers (Locus of Control = 52); her perceived levels of stress (Social Stress = 42) and anxiety (T = 42) are similar to other youngsters her age, and she has no

Table 15.3. Tiffany’s Scores on the Self-Report of Personality of the Behavior Assessment System for Children BASC Scale

T Score

Percentile

Attitude to School

49

56

Attitude to Teachers

48

51

Atypicality

48

51

Locus of Control

52

61

Social Stress

42

25

Anxiety

42

28

Depression

46

47

Sense of Inadequacy

63

87

Relations with Parents

39

13

Interpersonal Relations

49

30

Self-Esteem

52

39

Self-Reliance

28

4

Clinical Maladjustment

45

37

Personal Adjustment

40

15

Emotional Symptoms Index

48

52

School Maladjustment

53

68

Clinical Scales

Adaptive Scales

Composites

T Scores (mean = 50; standard deviation = 10)

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336 HANDBOOK OF MULTICULTURAL ASSESSMENT Table 15.4. Tiffany’s Scores on the Children’s Depression Inventory CDI Scale

T Score

Total Depression

44

Negative Mood

40

Interpersonal Problems

78

Ineffectiveness

41

Anhedonia

45

Negative Self-Esteem

40

T Scores (mean = 50; standard deviation = 10)

more unusual thoughts than others her age (Atypicality = 48). On additional clinical scales that are not part of any composite, ratings indicate that she tends to feel somewhat more inadequate than her age peers, falling within the at-risk range (T = 63). Depression, however, is within normal limits, with a T score of 46. Further evaluation with the Children’s Depression Inventory (CDI; Kovacs, 1992) provides additional data. Data in Table 15.4 indicate that similar to the BASC, overall tendency to depression is within normal limits, falling in the nonclinical range. Examination of the CDI subscales reveals that interpersonal difficulties are an area of concern, and she experiences considerable negative affect about her functioning (T = 78). One interpretation is that this finding is consistent with her tendency to feel inadequate. Overall Personal Adjustment is barely within normal limits (T = 40). Although Tiffany rates herself positively and reports good relationships with most individuals, her relationships with her parents are viewed as somewhat less positive, falling just below the normal range (T = 39). Of greater concern is that she tends not to rely on herself to address concerns (T = 28). This could reflect two possibilities: the nature of the difficulty may be overwhelming and beyond that which she (or any other eight year old) is able to handle, or she has doubts about her competency (apart from whether she feels adequate). On a positive note, self-report of school functioning is within normal limits, indicating age-appropriate attitudes toward her teachers and the school experience overall. It is possible that the normalcy and predictability of the school experience is a safe haven for her. TEMAS TEMAS data expand on questionnaire data. Tiffany’s TEMAS narratives are characterized by adequate time on task (Total time = 54) somewhat brief story length (Fluency = 38), and considerable thoughtfulness (Reaction time = 72) when initially viewing and processing the information in the stimulus cards. These scores are an indication of having obtained a useful and valid protocol. Examination of the TEMAS data (Table 15.5) indicates strengths and difficulty in Tiffany’s functioning. Important

TEMAS

Table 15.5. Tiffany’s Scores on the TEMAS Cognitive Personality Functions and Affective Functions TEMAS Scale

T Score

Cognitive Functions Reaction Time

72

Total Time

54

Fluency

38

Personality Functions Interpersonal Relations

27

Aggression

40

Anxiety/Depression

56

Achievement Motivation

22

Delay of Gratification

41

Self-Concept

32

Moral Judgment

29

Reality Testing

29

Affective Functions Happy

46

Sad

69

Fearful

54

T Scores (mean = 50; standard deviation = 10)

to note is that the TEMAS personality functions do not simply measure the construct for which the scale is named. Rather, personality functions are defined as the adaptiveness of the conflict resolution (Costantino et al., 1988) when presented with a stimulus card that is believed to pull (determined by expert judges prior to standardization) for the named construct. One interpretation of this operational definition is that the personality functions assess social problem solving. Many T scores are below normal limits (Interpersonal Relations, Achievement Motivation, Self-Concept, Moral Judgment, Reality Testing), which indicate less adaptive social problem solving. Although Tiffany addressed the conflicts depicted in the stimulus cards on most occasions, she often did so poorly. Other data indicate a more positive picture. Data suggest that Tiffany may be expending considerable effort and energy to manage her feelings and respond effectively when faced with situations that would prompt many individuals to feel anxious

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338 HANDBOOK OF MULTICULTURAL ASSESSMENT or depressed (Anxiety/Depression = 56). In addition, she is capable of thinking situations through when provoked (Aggression = 40) and can exercise self-control and wait for a longer-term solution, albeit less effectively (Delay of Gratification = 41) than her problem-solving skills in regard to anxiety and depression. This is impressive given her weak problem solving in other domains. The effective problem solving evident when she is anxious or depressed may be at the expense of problem solving in regard to other areas of her functioning, such as interpersonal relations, achievement, self-concept, and moral judgment. The specific difficulty with interpersonal situations also appears in the CDI data; thus, it might be said that she knows she is doing poorly in this area and is concerned. This is not the case for self-esteem. Self-ratings on the Piers-Harris Self- Concept Scale indicate that she maintains a good opinion of herself (T = 66), which is corroborated by BASC data (T = 52) and CDI data (Negative Self-Esteem = 40). The data on the TEMAS affective functions are quite informative. Although she appears to be as happy (T = 46) as most other youngsters, it is also clear that she is sad (T = 69). This seemingly puzzling information may reflect some tendency to moodiness. Examination of the narratives reveals that she used the word furious to describe how individuals in the stimulus card may feel. This seems extreme but may truly parallel her mood. Moreover, this illustrates that one can feel negatively but not draw on those feelings to solve problems. TEMAS data suggest that she can exhibit good social problem solving when faced with situations that are anxiety provoking and saddening. She works hard and invests emotional energy in this activity; at the same time, she tends not to choose aggressive means for addressing concerns, although she may feel considerable anger. It would appear that this is a self-protective device to assist her in addressing weaknesses of which she is painfully aware. This may also be a means by which she compensates for feelings of powerlessness that are beneath a facade of adequate self-esteem. Such a coping device may not continue to serve her as situations become more complex.

Maria, a Typically Functioning Public School Child Maria is a bilingual eleven-year-old Latina who is functioning adequately in public school. She is an average student. She was referred for an evaluation because her parents and teachers thought that despite adequate work, she might not have been working up to her ability. Her family of origin is intact; in addition to the parents and Maria, there are two other children, a girl aged eight and a boy aged twelve. Test Data The BASC (Reynolds and Kamphaus, 1992) Self-Report of Personality (Table 15.6) indicates functioning within normal limits on all Clinical and Adaptive Scales. Given that the BASC is an omnibus measure that assesses strengths and weaknesses, it appears that this provides sufficient social-emotional assessment data. Additional test data, however, reveal areas of concern. The TEMAS scores (Table 15.7) indicate varied functioning. While Maria was appropriately reflective before responding to the

TEMAS

Table 15.6. Maria’s Scores on the Self-Report of Personality of the Behavior Assessment System for Children BASC Scale

T Score

Percentile

Attitude to School

53

65

Attitude to Teachers

53

70

Atypicality

48

51

Locus of Control

52

61

Social Stress

54

66

Anxiety

51

38

Depression

46

47

Sense of Inadequacy

55

74

Relations with Parents

51

38

Interpersonal Relations

58

80

Self-Esteem

46

26

Self-Reliance

47

31

Clinical Maladjustment

51

58

Personal Adjustment

51

41

Emotional Symptoms Index

50

59

School Maladjustment

53

68

Clinical Scales

Adaptive Scales

Composites

T Scores (mean = 50; standard deviation = 10)

TEMAS stimulus cards and provided narratives of average length, she spent considerably less time on task than her age peers (T < 26). She failed to detect the conflict in the stimulus card to a clinically significant extent. Six of nine personality functions are within normal limits, indicating good ability to provide a narrative that is complete and effectively addresses the conflicts depicted. Further examination of the data indicates that three personality functions fall outside normal limits. When faced with dilemmas that exist in fantasy only, Maria’s skills for developing adequate narratives to address the dilemmas are slightly weak (T = 37), suggesting mild difficulty using this modality to solve problems. Noted is a highly developed, perhaps punishing, superego. Maria provides narratives that depict individuals as having exemplary ability to delay desires or rewards (T > 69), perhaps

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340 HANDBOOK OF MULTICULTURAL ASSESSMENT Table 15.7. Maria’s T Scores on the TEMAS Cognitive Personality Functions and Affective Functions That Are Quantitatively Scored TEMAS Scale

T Score

Cognitive Functions Reaction Time Total Time Fluency

51 < 26 51

Personality Functions Interpersonal Relations

52

Aggression

42

Anxiety/Depression

43

Achievement Motivation

56

Delay of Gratification

> 69

Self-Concept

49

Sexual Identity

51

Moral Judgment Reality Testing

> 72 37

Affective Functions Happy

53

Sad

51

Angry

48

Fearful

61

T Scores (mean = 50; standard deviation = 10)

because the individuals depicted will allow others to have rewards first. In addition, the standards for moral behavior are quite high (T = 72). Taken together, this suggests that Maria may feel that it is important to delay pleasure. Although these tendencies are something of a ‘‘high road,’’ it is not without personal cost. Noted is a greater tendency to fearfulness in the narratives than is typical (T = 61) of youngsters. It is possible that she may fear negative consequences if she is not selfsacrificing. There is additional personal cost in evidence, as the score on the Anhedonia subscale of the Children’s Depression Inventory (Table 15.8) is within the clinical range (T = 70), despite an overall score on depression that is within normal limits. The Anhedonia scale reflects lack of pleasure. Item analysis reveals that Maria’s lack

TEMAS

Table 15.8. Maria’s T Scores on the Children’s Depression Inventory CDI Scale

T Score

Total Depression

56

Negative Mood

54

Interpersonal Problems

45

Ineffectiveness

48

Anhedonia

70

Negative Self-Esteem

47

T Scores (mean = 50; standard deviation = 10)

of pleasure is moderate, as she generally endorsed the response option corresponding to ‘‘sometimes’’ rather than ‘‘never’’ or ‘‘always.’’ This was the case for every item on the subscale, suggesting a pervasive concern. Additional evidence consistent with blunted affect is found within the TEMAS scales assessing absence of affect (Neutral) and failure to project (Imagination). Important in this case is that the overall scores on scales that measure depressive affect on three measures (BASC, TEMAS, CDI) are within normal limits. Had subscale data not been examined, the painful affect that accompanies characteristics that might be considered exemplary would have been missed.

More on Interpretive Procedures Much of the interpretive strategy that applied to the ‘‘Jane’’ case was followed for both ‘‘Tiffany’’ and ‘‘Maria.’’ Modifications were made to account for differences in tests administered and differences across the three youngsters. Interpretation begins with the omnibus measure, which was either the Teacher Report Form of the Child Behavior Checklist or the Behavior Assessment System for Children. The results of the Children’s Depression Inventory and the Piers-Harris Self-Concept Scale were integrated with the BASC data as appropriate. TEMAS and Rorschach data were subsequently examined to expand on the questionnaire findings to develop a broader description of each youngster’s functioning.

CONCLUSION This chapter discusses the theoretical basis, research findings, and multicultural clinical utility of the TEMAS (Costantino, 1978, 1987; Costantino et al., 1988, 2007; Costantino, Flanagan and Malgady, 2001) as well as illustrating its use

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342 HANDBOOK OF MULTICULTURAL ASSESSMENT in a test battery. The use of multiple methods has utility for different purposes (Teglasi, Simcox, and Kim, 2007). Assessment using multiple methods ideally includes performance measures of personality, such as the TEMAS, that measure implicit motives, while questionnaires measure self-attributed motives (McClelland, Koestner, and Weinberger, 1989). Implicit motives address the enduring aspects of personality, and self-attributed motives assess that which the respondent is willing to reveal (McClelland et al., 1989). TEMAS data illustrate the manner in which negative affect is managed and problems are solved; both are enduring features of personality. In contrast, questionnaire data reflect the respondent’s impression of personality features at the time the data are collected. Because it was demonstrated (Bornstein, 2002) that correlations between measures of implicit motives and self-attributed motives are often weak, there is additional reason to use multiple methods in a test battery. Although it is important to use multiple methods, the integration of data is of greater importance. Divergence in findings requires that interpretations be modified as additional data are considered in order to capture the uniqueness of the individual. Numerical data can guide diagnostic decisions, while clinically oriented methods, such as the TEMAS, can be used in conjunction with the questionnaire data to develop a description of the individual and his or her functioning (Flanagan, 2007). This application of these notions to test interpretation is illustrated in the chapter.

References Achenbach, T. M., Dumenci, L., & Rescorla, L. A. (2002). Ten-year comparisons of problems and competencies for national samples of youth: Self, parent and teacher reports. Journal of Emotional and Behavioral Disorders, 10 (4), 194–203. Achenbach, T. M., & Rescorla, L. (2003). The Achenbach System of empirically based assessment. Burlington, VT: University of Vermont. American Psychiatric Association. (2001). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author. Anderson, M. P. (1981). Assessment of imaginal process: Approaches and issues. In T. Merluzzi, C. Glass, & M. Genest (Eds.), Cognitive assessment. New York: Guilford Press. Auld, F., Jr. (1952). Influence of social class on personality and test responses. Psychological Bulletin, 49, 318–322. Auld, F. (1954). Contribution of behavior theory to projective testing. Journal of Projective Techniques, 18, 129–142. Bandura, A. (1977). Social learning theory. Upper Saddle River, NJ: Prentice Hall. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Upper Saddle River, NJ: Prentice Hall. Bandura, A. (1989). Social cognitive theory. Annals of Child Development, 6, 1–60.

TEMAS Bandura, A. (1991). Social cognitive theory of self-regulation. Organizational Behavior and Human Decision Processes, 50, 248–287. Bornstein, R. F. (2002). A process dissociation approach to objective-projective test score interrelationships. Journal of Personality Assessment, 78, 47–68. Bracero, W. (in press). Between the worlds: The assessment and treatment of the culturally diverse. Northvale, NJ: Jason Aronson. Bruner, J. (1986). Actual minds, possible worlds. Cambridge, MA: Harvard University Press. Bruner, J. (1990). Acts of meaning. Cambridge, MA: Harvard University Press. Cardalda, E. (1995). Socio-cognitive correlates to school achievement using the TEMAS (Tell-Me-A-Story) culturally sensitive test with 6th, 7th, and 8th grade Puerto Rican students. Unpublished doctoral dissertation, New School for Social Research. Costantino, G. (1978, November). TEMAS, a new thematic apperception test to measure ego functions and development in urban Black and Hispanic children. Paper presented at the Second Annual Conference on Fantasy and the Imaging Process, Chicago. Costantino, G. (1987). TEMAS (Tell-Me-A-Story) pictures. Los Angeles: Western Psychological Services. Costantino, G. (1992). Overcoming bias in educational assessment of Hispanic students. In K. Geisinger (Ed.), The psychological testing of Hispanics (pp. 89–97). Washington, DC: American Psychological Association. Costantino, G., Dana, H. R., & Malgady, R. G. (2007). TEMAS (Tell-Me-A-Story) assessment in multicultural societies. Mahwah, NJ: Erlbaum. Costantino, G., Flanagan, R., & Malgady, R. (1995). The history of the Rorschach: Overcoming bias in multicultural projective assessment. In I. B. Weine (Ed.), Rorschachicana, (Vol. XX) (pp. 148–171). Seattle: Hogrefe & Huber. Costantino, G., Flanagan, R., & Malgady, R. G. (2001). Narrative assessment: TAT, CAT and TEMAS. In L. Suzuki, J. Ponterotto, & P. Meller (Eds.), Handbook of multicultural assessment (2nd ed., pp. 217–236). San Francisco: Jossey-Bass. Costantino, G., & Malgady, R. G. (1996). Development of TEMAS, A multicultural thematic apperception test: Psychometric properties and clinical utility. In G. R. Sodowsky & J. Impara (Eds.), Multicultural assessment in counseling and clinical psychology (pp. 85–136). Lincoln: University of Nebraska. Costantino, G., Malgady, R. G., & Rogler, L. H. (1988). TEMAS (Tell-Me-a-Story) manual. Los Angeles: Western Psychological Services. Costantino, G., Malgady, R. G., & Rogler, L. H. (1994). Storytelling through pictures: Culturally sensitive psychotherapy for Hispanic children and adolescents. Journal of Clinical Child Psychology, 23, 13–20. Dana, R. H. (1993). Multicultural assessment perspectives for professional psychology. Boston: Allyn & Bacon. Dana, R. H. (1996). Culturally competent assessment practice in the United States. Journal of Personality Assessment, 66, 472–487.

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344 HANDBOOK OF MULTICULTURAL ASSESSMENT Dana, R. H. (1998). Understanding cultural identity in intervention and assessment. Thousand Oaks, CA: Sage. Dana, R. H. (2000). Multicultural assessment of child and adolescent personality and psychopathology. In A. L. Comunian & U. Gielen (Eds.), International perspectives on human development (pp. 233–258). Lengerich, Germany: Pabst Science Publishers. Exner, J. E. (1991). The Rorschach: A comprehensive system: Vol. 2, Interpretation (2nd ed.). Hoboken, NJ: Wiley. Exner, J. E. (2003). The Rorschach: A comprehensive system: Vol. 1, Basic foundations (4th ed.). Hoboken, NJ: Wiley. Flanagan, D. P., & Kaufman, A. S. (2004). Essentials of WISC-IV assessment. Hoboken, NJ: Wiley. Flanagan, R. (1995). A review of the Behavior Assessment System for Children: Assessment consistent with the requirements of the Individuals with Disabilities Education Act. Journal of School Psychology, 33, 177–186. Flanagan, R. (2003). A place for projective assessment in school psychology practice? School Psychologist, 57, 116–118, 121. Flanagan, R. (2007). Comments on the miniseries: Personality assessment in school psychology. Psychology in the Schools, 44, 311–318. Flanagan, R., & DiGiuseppe, R. (1999). A critical review of the TEMAS: A step within the development of thematic apperception instruments. Psychology in the Schools, 36, 21–30. Flanagan, R., Losapio, G., Costantino, G., Greenfeld, R., & Hernandez, A. (2004, July). The use of narratives to assess children’s social problem solving skills. Poster presented at the Annual Convention of the American Psychological Association, Honolulu. Freedman, J., & Combs, G. (1996). Narrative therapy: The social construction of preferred realities. New York: Norton. Howard, G. S. (1991). Cultural tales: A narrative approach to thinking, cross-cultural psychology and psychotherapy. American Psychologist, 46 (3), 187–197. Kagan, J. (1988). The meanings of personality predicates. American Psychologist, 43, 614–620. Kovacs, M. (1992). Manual for the Children’s Depression Inventory. North Tonawanda, NY: Multi Health Systems. Kirkman, M. (2002). What’s the plot? Applying narrative theory to research psychology. Australian Psychologist, 37, 30–38. Lubin, N. M. (1995). The effect of color in the TAT on production of mentally retarded subjects. American Journal of Mental Deficiency, 60, 336–370. Mancuso, J. C., & Sarbin, T. R. (1983). The self-narrative in the enactment of roles. In T. R. Sarbin & K. E. Scheibe (Eds.), Studies in social identity (pp. 233–253). New York: Praeger. McAdams, D. P. (1994). The person: An introduction to personality psychology (2nd ed.). Fort Worth: Harcourt Brace.

TEMAS McAdams, D. P., & Pals, J. L. (2006). A new Big Five: Fundamental principles for an integrative science of personality. American Psychologist, 6 (3), 204–217. McClelland, D. C., Koestner, R., & Weinberger, J. (1989). How do self-attributed and implicit motives differ? Psychological Bulletin, 96, 690–702. Meyer, G. J, Riethmiller, R. J., Brooks, R. D., Benoit, W. A., & Handler, L. (2000). A replication of Rorschach and MMPI-2 convergent validity. Journal of Personality Assessment, 74, 175–215. Murstein, B. I. (1963). Theory and research in projective techniques (emphasizing the TAT). Hoboken, NJ: Wiley. Paivio, A. (1971). Imagery and verbal processes. New York: Holt. Piaget, J., & Inhelder, B. (1971). Mental imagery in the child: A study of the development of imaginal representation. New York: Basic Books. Piers, E. V. (1984). Manual for the Piers-Harris Self-Concept Scale for Children. Los Angeles: Western Psychological Services. Reynolds, C. R., & Kamphaus, R. W. (1992). Manual for the Behavior Assessment System for Children. Circle Pines, MN: AGS Publishing. Ritzler, B. (1993). TEMAS (Tell-Me-A-Story) review. Journal of Psychoeducational Assessment, 11, 381–389. Ritzler, B. A. (1996). Projective methods for multicultural personality assessment: Rorschach, TEMAS, and early memory procedures. In L. A. Suzuki, P.J. Meller, & J. G. Ponterotto (Eds.), Handbook of multicultural assessment: Clinical, psychological and educational applications (pp. 115–136). San Francisco: Jossey-Bass. Sarbin, T. R. (1986). Narrative psychology: The storied nature of human conduct. New York: Praeger. Singer, J. L. (1973). The child’s world of make believe: Experimental studies of imaginative play. Orlando, FL: Academic Press. Singer, J. L., & Pope, K. (Eds.). (1978). The power of human imagination: New methods in psychotherapy. New York: Plenum Press. Sobel, H. J. (1981). Projective methods of cognitive analysis. In T. Merluzzi, C. Glass, & M. Genest (Eds.), Cognitive assessment (pp. 127–148). New York: Guilford. Spangler, W. D. (1992). Validity of questionnaire and TAT measures of need for achievement. Psychological Bulletin, 112, 140–154. Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: Norton. Teglasi, H. (2001). Essentials of TAT and other story telling assessment. Hoboken, NJ: Wiley. Teglasi, H., Simcox, A. G., & Kim, N. (2007). Personality constructs and measures. Psychology in the Schools, 44, 215–228. Thompson, C. E., & Bachrach, J. (1951). The use of color in the Thematic Apperception Test. Journal of Projective Techniques, 15, 173–184. Wechsler, D. (2003). The Wechsler Intelligence Scale for Children (4th ed.). Orlando, FL: Harcourt.

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CHAPTER SIXTEEN

Multicultural Issues in Projective Assessment Giselle B. Esquivel Geraldine V. Oades-Sese Sarah Littman Olitzky

P

rojective methods of personality assessment consist of a set of techniques that are characterized by stimuli such as pictures, inkblots, and incomplete sentences with varying degrees of structural ambivalence to elicit responses that reflect a person’s thoughts, associations, percepts, feelings, needs, and other relatively covert processes (Hilsenroth, 2004). The term projective was coined by Frank (1939) as the process of thrusting out, or externalizing, one’s subconscious associations or subjective experiences when assigning meaning to ambiguous stimuli. The goal of this kind of assessment process is to interpret an individual’s subjective or ideographic data in order to provide a descriptive profile of personality characteristics or to diagnose emotional disorders and pathology. Although the underlying premise of projective methods was initially linked to psychoanalytical theory, it has recently become associated with other integrative personality assessment paradigms, such as Gestalt psychology, cognitive schema theories, and personology (Leichtman, 2004; McAdams, 2001; Teglasi, 2001; Wiggins, 2003). Similarly, projective techniques have become increasingly connected to normative scoring systems and a combination of clinical and empirical methods of analysis (Flanagan and Esquivel, 2006). Projective assessment methods have been the subject of criticism from psychologists with differing theoretical orientations and personality assessment perspectives (for example, empirical, behavioral, multivariate). While recent researchers question the psychometric standing and cross-cultural validity of projective tests (Lilienfeld, Wood, and

346

MULTICULTURAL ISSUES IN PROJECTIVE ASSESSMENT

Garb, 2000), others argue in favor of their clinical utility (Karon, 2000; Meyer and Archer, 2001; Woike and McAdams, 2001). The lack of consensus and clarity on the applicability of projective techniques is even more salient regarding persons from culturally diverse background and highlights the need to explore and decipher the critical multicultural issues involved in projective methods of personality assessment (Dana, 2005; Kohn, Conti, and Esquivel, 2006). This chapter provides an overview of the theoretical, research, and best practice issues involved in multicultural projective assessment. The focus is on three distinct types of projective techniques: drawings, narratives (Thematic Apperception), and inkblots (the Rorschach). Each of these is considered to represent a distinct type of projective (expressive, constructive, and constitutive, respectively); studies have addressed their cultural sensitivity in assessing aspects of personality based on cultural group membership (emic) or universal (etic) processes (Ritzler, 2004), and all three are widely used in clinical and school settings.

DRAWING ASSESSMENT TECHNIQUE Drawings are considered to be an expressive type of projective technique, given their dual diagnostic and therapeutic value. The assumption is that drawings both represent conscious mental processes and abilities (cognitive, perceptual motor) and reflect inner subconscious and symbolic expressions of feelings, conflicts, and needs. The use of drawings as an assessment tool is embedded in cognitive, perceptual, developmental, and psychodynamic perspectives. For over eight decades, drawings made by children, adolescents, and adults, particularly human figure drawings, have maintained their popularity and have been rated as one of the top ten psychological instruments that psychologists and counselors use (Camara, Nathan, and Puente, 2000; Cummings, 1986; Hojnoski, Morrison, Brown, and Matthews, 2006; Yama, 1990). Popularity in using drawings as part of a larger battery of psychoeducational or psychological assessment may be explained by factors such as simplicity of test administration and scoring, time efficiency, appeal to children, nonverbal and nonthreatening medium, and a means to establish rapport with clients. Human figure drawings have been used as diagnostic tools to estimate cognitive or intellectual maturity and assess aspects of personality in children, adolescents, and adults (Goodenough and Harris, 1950; Koppitz, 1966; Machover, 1949). Inferences of psychopathology (such as anxiety and depression), sex role identification, sexual abuse, self-esteem (Groth-Marnat and Roberts, 1998; Tharinger and Stark, 1990), and racial identity have been made during interpretation of drawings. Variations of human figure drawing

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348 HANDBOOK OF MULTICULTURAL ASSESSMENT techniques include the Draw-A-Person (Goodenough, 1926; Harris, 1963) and the House-Tree-Person (Buck, 1948) and have been extended to include the ecological context of the family in the Draw-A-Family (Hulse, 1951) and the Kinetic Family Drawing (Burns and Kaufman, 1972). In a recent survey, school psychologists ranked the House-Tree-Person test third, the Kinetic Family Drawing test as fourth, and the Draw-A-Person test in fifth place among projective techniques, despite evidence of poor test-retest and interrater reliability, and predictive validity (Hojnoski et al., 2006). In terms of clinical utility, these tests were ranked eighth, seventh, and sixth, respectively. The top two projective techniques were Sentence Completion and the Bender-Gestalt, with the Rorschach and the Children’s Apperception Test as being the least used by school psychologists. Lilienfeld et al. (2000) cautioned that these instruments may have the tendency to overidentify psychopathology and may not be appropriate for use with culturally and ethnically diverse populations (Garb, Wood, Lilienfield, and Nezworski, 2002). Hojnoski et al. (2006) stated, ‘‘Perhaps a less esoteric explanation for the continued use of these instruments may be a lack of knowledge of best practices, inadequate professional training in other methods of assessment, and simple habit’’ (p. 156). On the contrary, others have argued that these projective personality tests are valuable tools in assessing overall cognitive ability and social-emotional functioning and that poor research methodology underlies unwarranted conclusions of lacking reliability and validity (Riethmiller and Handler, 1997). Cross-cultural studies, however, have been inconsistent with regard to the utility of children’s drawings used with culturally diverse children and remain unexplored in adults. An overview of cross-cultural research studies on the most widely used drawing techniques with children and adolescents forms the basis for an understanding of culturally sensitive practice and research in projective assessment.

CROSS-CULTURAL RESEARCH ON DRAWING TECHNIQUES Human Figure Drawings The Draw-A-Man Test was introduced by Florence Goodenough in her seminal book, Measurement of Intelligence by Drawings (1926), to measure the cognitive development of children. This was the first attempt to standardize and validate this instrument, which Goodenough hoped to be universally applicable across cultures (Dennis, 1957). Findings from cross-cultural studies, however, indicated that significant differences were found across cultures, including cultures that have adapted Westernized schools. For example, school-aged Native American children performed significantly higher on the Goodenough IQ than their White counterparts (Havighurst, Gunther, and Pratt, 1946), while

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Dennis (1957) found scores on the Goodenough declined with age among five- to ten-year-old Near Eastern children. A post hoc explanation of Dennis’s findings was the limited experiences of children with visual representation of human figures. Replicating Dennis’s study, Sundberg and Ballinger (1968) also found declining Goodenough scores (using American norms) after the age of six among children from Nepal. Moreover, illiterate and ‘‘normal’’ functioning bedouin children, adolescents, and adults scored within the retarded range of the Draw-A-Man Test (Dennis, 1960). Therefore, the Draw-A-Man Test was found to be a culturally insensitive measure of cognitive development among children and adolescents. The Draw-A-Man Test was later revised by Machover (1949) and renamed the Draw-A-Person Test (DAP) to not only measure intelligence but infer personality characteristics and social-emotional adaptation. Researchers, however, have found the DAP of little value as a projective technique, when basing interpretations on single-item indicators (Klopfer and Taulbee, 1976; Swensen, 1968), as well as the approach’s failure to account for the cultural influences on children’s drawings (Wilson, 1985). The Draw-A-Person Test was further revised by Harris (1963) to include new scoring tables to measure intellectual maturity. As evidence of developing a culture-free measure of intelligence, the Goodenough-Harris Draw-A-Person Test was found to be applicable to Peruvian children and adolescents (Weiss, 1980). In 1968, Koppitz created developmental scales that measured ‘‘expected’’ (included by 86 to 100 percent of children), ‘‘common’’ (occur 51 to 85 percent), ‘‘not unusual’’ (occur 51 to 50 percent), and ‘‘exceptional’’ (include by 0 to 15 percent of children) items of human figure drawings (HFD) with associated IQ scores for children ages five to twelve years. These developmental items were associated with age and maturation but excluded other relevant factors such as school exposure, instructions given, artistic ability, or drawing medium. Catte and Cox (1999) question, however, the clinical utility of Koppitz’s HFD in differentiating between emotionally disturbed and welladjusted children. While many have criticized the lack of psychometric integrity (reliability and validity) for the DAP (Groth-Marnat and Roberts, 1998; Smith and Dumont, 1995; Swensen, 1968), others have supported its utility. Researchers have found that the DAP is a good measure of cognitive development in terms of its relationship with the Piagetian stages of development and levels of human figure drawings (Chappell and Steitz, 1993; Ter Laak, De Goede, Aleva, and Van Rijswijk, 2005). The DAP was found to be useful in differentiating normal and developmentally delayed children (Cox and Howarth, 1989) as well as emotionally disturbed children (Naglieri and Pfeiffer, 1992; Smith and Dumont, 1995; Yama, 1990). In addition, the DAP correlated with standardized norm-referenced intelligence scales (Wechsler, 1989).

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350 HANDBOOK OF MULTICULTURAL ASSESSMENT Interpretation of human figure drawings has been found to be more valid when global and holistic scoring procedures rather than single indicators have been used (Koppitz, 1966; Matto, 2002; Swensen, 1968; Tharinger and Stark, 1990). Reliability and validity of human figure drawings were supported by using scoring systems such as those developed by Naglieri, McNeish, and Bardos (1991).

Universality of Stages of Human Figure Drawing Underlying the concern with cross-validation of drawings as a projective technique and as a measure of cognitive development across cultures lies the fundamental question of universality. There is an assumption of universality (etic) among the development of children’s drawings that coincides with the emergence of cognitive and physical development of young children (Arnheim, 1969; Golomb, 1992; Goodnow, 1977; Kellogg, 1969). Drawings, a visual form of communication, have been paralleled with artistic and linguistic development (Alland, 1983). For example, the scribbling stage may be akin to the babbling stage of young children. Cross-culturally, children’s drawings follow a common progression from simplistic to complex representation (Paget, 1932). The universality of the development of children’s drawings, however, has been debated against a more cultural-specific (emic) perspective, as evidenced by research examining cultures that lack or have limited exposure to visual representation (Andersson and Andersson, 1997; Golomb, 2002; Paget, 1932). This is supported by research that examined cross-cultural differences in spatial development (relationship between figure and ground line) among Japanese children (Toku, 2000). Children’s drawings are unequivocally influenced by their cultural environment (their peers and adult models, emphasis on art education, and exposure to paper and pencil, for example), unique experiences, and societal levels of technological sophistication. The earliest representation of human figures following the stage of scribbling is drawing ‘‘tadpole’’ figures, which consist of a single circle with no torso and two single lines for legs. They may or may not include facial features (Freeman, 1980). The omission of the torso in tadpole figures may be a result of young children having ‘‘not yet devised a suitable graphic schema for it, perhaps because the torso is deemed to be less important than the head and the legs’’ (Cox, 1993, p. 41) rather than having been simply forgotten or that the mental model for human figures is incomplete in young children (Cox and Mason, 1998; Golomb, 1992). Some children may move into the ‘‘transitional’’ human figure where parts associated with the torso are now attached to or placed between the legs. By ages four to six years, children develop ‘‘conventional’’ figures where a true torso emerges along with arms. As children mature with age, their human figure drawings become more realistic. Cox and Parkin (1986) have found that children may spend a few

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days or months in this stage. Cross-cultural studies have found the transition from scribbling to representation of tadpole figures to simple human figures within a single testing session (Andersson and Andersson, 1997; Court, 1989). For young Japanese children, however, tadpole and stick figures were absent in their representation of human figures because of the cultural emphasis on art education (Alland, 1983). Universality regarding spatial development (relationship between figure and ground line) in drawings has also been questioned. Masami Toku (2000) examined the spatial development between U.S. and Japanese elementary school children living in Chicago (n = 425) and urban Champaign (n = 825). Toku used Eisner’s fourteen spatial categories to describe spatial order and artistic development. In the first category, figures appear to be floating in space without any defined ground line. Category 1 drawings are exhibited by young children who have not developed spatial and depth perception. With age, children use the bottom edge of the drawing paper as the ground line for figures to stand on (categories 2 and 3). Drawing a ground line instead of using the bottom edge of the paper indicates category 4. Category 13 drawings are characterized by the presence of overlapping figures, objects, and ground line to exhibit two-dimensionality. Advanced drawing techniques such as using a bird’s-eye view and multiple perspectives are classified as category 14 drawings. Findings from Toku’s study indicated group differences in spatial development, group-specific use of color, and depiction of human figures. In terms of figure and ground relationships, there were almost no Japanese drawings in category 1 and 2, while 10 percent of U.S. figure drawings by fourth and sixth graders were floating in space. The rapid progression from lower-level categories to higher level was exhibited by more Japanese children than U.S. children. By fourth grade, more than 60 percent of Japanese drawings were in categories 11 to 14 compared to less than 20 percent among U.S. children. The advanced development of drawings among Japanese children may be explained by (1) Japan’s emphasis for a nationwide art curriculum in grades 1 to 9, (2) kindergarten teachers who were well trained in art and music and invested a lot of time on these subjects, (3) the strong influence of the ever-growing popularity of Japanese anime (cartoons) and manga (comic books), and (4) the systematic nature of Japanese written language, which may be related to the cognitive and perceptual development of children (Stevenson and Stigler, 1992; Vygotsky, 1978). Failure to acknowledge these cultural differences may lead to inaccurate interpretation. Findings from this study indicated cultural influences in the depiction of human figure drawings and use of color, as well as the presence of gender differences. Given the influence of Japanese manga and anime, item characteristics of human figure drawings may be mistakenly interpreted as

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352 HANDBOOK OF MULTICULTURAL ASSESSMENT emotional indicators. Japanese girls tend to draw the idealized self with large eyes, invisible nose (line or dot), skinny bodies, and long legs. Similarly, Japanese boys portray the idealized face and body by having muscular bodies and exaggerated movements. The color choice for clothing on figures may appear to be influenced by the way Japanese children are dressed by their parents: female figures are drawn with warm-colored clothing (red, yellow, orange) and male figures are drawn with cool-colored clothing (blue, green, purple). Parenthetically, Japanese concepts of anime and manga have expanded in popularity to include U.S. children. Therefore, awareness of the influences of other cultures on U.S. children is also important to consider when interpreting projective drawings.

Japanese Children’s Human Figure Drawings Cultural values and beliefs are significant factors that influence the content of children’s drawings (Daoud, 1976; Dennis, 1966; La Voy et al., 2001; Schofield, 1978); as a result, caution must be taken during interpretation. La Voy et al. evaluated human figure drawings made by fifty-two Japanese and American children ages seven and eight years. Human figures were evaluated according to cultural values in displaying public emotions, attention to detail, and social evaluation of self. Findings from this study indicated that Japanese human figure drawings had lower frequencies of smiles, greater attention to detail, and depiction of larger figures when compared with American children. Lower frequency of smiles in Japanese figure drawings requires understanding the differences in cultural values in expression of emotions. The Japanese culture values emotional restraint in public, while American culture values outward expression of emotions. Cultural differences also existed in the amount of detail included in drawings (Alland, 1983). La Voy et al. (2001) state that Japanese culture trains young children to be detail oriented in school and places a high value on process as well as the quality of perseverance, order, and concentration. Although no group differences were found in the sizes of trees and houses, larger-sized human figures by Japanese children may reflect the culture’s collectivistic orientation. Large-size figures may signify the greater emphasis of group belongingness or sense of sociocultural worth. La Voy et al. state that American culture’s emphasis on the individual may have affected the size or ‘‘esteem’’ of their drawings.

Middle Eastern Human Figure Drawings Religious beliefs and traditions may also influence children’s representation of human figures. Application of the Goodenough’s Draw-A-Man Test among 708 Lebanese and Egyptian children indicated an average score of 100 for children ages five and six years and a decrease in score after the age of six

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years (Dennis, 1957). The downward trend of scores may have been due to the limited exposure of visual representation of human figures among children due to limited accessibility to books, magazines, and posters (common to Western schools). Furthermore, the Islamic world’s taboo against representation of human figures, along with an approval of and preference for geometrical art, may have influenced these drawings at the time of this study. Typically human figures are represented in the form of dolls, wood carvings, masks, sculpture, and paintings. Children enrolled in the American University of Beirut in this study did not exhibit this downward trend in scores because of the likely influence of Westernized schools. In the context of religious and political conflicts, significant differences in human figure drawings were found among Israeli Arab, and Jewish children. In terms of drawing complexity and use of color, a study conducted by Teichman and Zafrir (2003) on human figure drawings by 365 Jewish and Arab children ages seven to thirteen years indicated greater complexity and higher-quality drawings made by Jewish children despite the fact that Islamic and Jewish religions denounce the drawing of human figures. Findings related to color use to indicate complexion in figure drawings showed that younger children of both groups preferred to use light colors and older children used darker colors to signify complexion of both groups (toward realism). In addition, Jewish children displayed in-group preferences and portrayed Arabs as aggressive and negative, in contrast to findings of Israeli Arab children’s drawings (see Teichman and Zafrir, 2003, for further details).

House-Tree-Person Drawings The House-Tree-Person (H-T-P) developed by Buck (1948), originally as a measure of cognitive functioning in adults, is a popular projective personality test. Among a group of culturally diverse children in a city, the H-T-P (using the Van Hutton scoring) was unable to differentiate between sexually abused and nonabused children (Palmer et al., 2000). Variation in children’s drawings may have been due to differences in age, cultural background, gender, and personal history. A current use of and adapted version of H-T-P called the Synthetic H-T-P was developed by Mikami in 1979 where the house, tree, and person were drawn on the same sheet of paper and assessed as a whole in relation to each other. This technique was used in a cross-cultural study conducted by Dewaraja, Sato, and Ogawa (2006) to determine anxiety between tsunami-affected and tsunami-unaffected children in Sri Lanka. Although findings indicate that tsunami-affected boys were more anxious and displayed more negative psychological characteristics than girls did, interpretation of the Synthetic H-T-P was used with caution because it lacked normative data for this

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Kinetic Family Drawing Hulse (1951) created the Family Drawing Test to determine a child’s perception of family relationships. This test was later modified by Burns and Kaufman (1970, 1972) to include a ‘‘kinetic’’ factor by asking the child to draw a family ‘‘doing something together.’’ This method, known as the Kinetic Family Drawing (KFD) test, provides a window to view the dynamic patterns of family relationships. Handler and Habenicht (1994) considered KFD to be a valid instrument to investigate the impact of normal and dysfunctional family relations on different cultural groups. Past researchers have found the KFD applicable to Black, Hispanic, and White children (Magnum, 1976; Walton, 1983). Qualitatively, the KFD was also found to be useful in facilitating openness of Hispanic mothers of Mexican and Puerto Rican descent in viewing family relationships in relation to their children’s problems in school (Graf, 1986). Similarly, Nuttall, Chieh, and Nuttall (1988) found that social values and norms were depicted in KFD among Chinese and U.S. children. Moreover, the KFD was able to tap into the acculturation process of Chinese American families (Chuah, 1992). In contrast, Wegmann and Lusebrink (2000) found statistically significant differences among seven- to ten-year-old children’s drawings from the United States, Taiwan, and Switzerland. There were forty-four variables, including twenty-four ‘‘objects and symbols’’ categorized, under family composition, distance and closeness, interactions and relationship, activities, developmental level, and sexual identification. Only variables for major figure missing, major figure’s erasure, extended family members added, distances between figures, encapsulation, self sharing activity with, and incomplete faces attained good reliability. Differences were found for compartmentalization, barrier, facing, incomplete body, figure ascendance, akinesis, activity level, and sexual differentiation. As an example of compartmentalization, Taiwanese children tend to draw X-ray houses with each family member in separate rooms. Therefore, the reliability of the KFD across cultures remains questionable.

Family Drawings from Cuban Rafter Children A number of researchers have argued for the clinical utility of family drawings among immigrants. For example, de Valle, McEachern, and Sabina (1999) have found family drawings to be a culturally sensitive technique in counseling Cuban refugee children, balseritos, who experienced trauma and separation during their arduous journey to the United States. These children experienced loss, cultural shock, adaptation, and social, emotional,

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and behavioral difficulties. Drawings by these children depicted their escapes with family members. Drawings of self and family members were small in size and were stick figures, possibly reflecting the children’s insecurity and low self-assurance. Another common theme was anxiety, as depicted by drawings of clouds. Many objects in drawings were compartmentalized, using rigid lines and boxes, reflecting feelings of isolation. These drawings were also highly detailed, incorporating objects from their experiences: planes, rafts, boats, and sharks. Utilization of drawings in combination with writing activities produced positive outcomes for these children, as measured by academic grades, classroom behavior, attendance, and teacher feedback after the first marking period.

Implications for Practice The cultural influences on drawings reflected by research studies makes salient the need to adapt existing drawing techniques to be congruent with the cultural backgrounds of clients and use these techniques in the context of a culturally sensitive assessment process. Development of Culturally Sensitive Techniques. Given the need for more low cultural and linguistic demand measures to assess culturally and linguistically diverse individuals, human figure drawings are a possible alternative in estimating cognitive maturity and tapping social-emotional functioning. Eloy Gonzales (1982) administered the DAP to 3,067 Mexican American, Pueblo Indian, Navajo Indian, African American, and Anglo elementary children five to ten years old to develop regional and ethnic norms and compared them against the Koppitz norms. Gonzales found that cultural variables may explain inclusion and exclusion of expected and exceptional items, which often resulted in unwarranted concerns of emotional disturbances. Findings from her study indicated a significant drop in expected items for Pueblo and African American girls. Some other findings indicated that (1) Mexican American boys included two-dimensional feet and hair significantly more often at all ages than the Koppitz norms, (2) African American boys included hair significantly more often, while the Koppitz norms included eyebrows and profiles significantly more often at all ages, (3) African American females included five fingers and profiles significantly less often than the Koppitz norms, and (4) Navajo and Anglo males included two-dimensional feet significantly more often, while eyebrows and profiles were included significantly less often than the Koppitz norms. Gonzales concludes the necessity of developing regional and ethnic norms as well as conducting regional and cross-cultural studies. The Draw-A-Person: Screening Procedure for Emotional Disturbance (DAP: SPED; Naglieri et al., 1991) was developed as a global indicator of emotional disturbance and a more objective scoring system in response to poor reliability and validity problems of human figure drawings (Matto, 2002). Matto and

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356 HANDBOOK OF MULTICULTURAL ASSESSMENT Naglieri’s (2005) study of youths ages six through seventeen years indicated no significant differences in item composites (small and large figure items or shading) of the DAP:SPED among 276 White-Hispanic pairs and 118 Black and White pairs, evidencing clinically utility across groups (Matto and Naglieri, 2005). The Draw-A-Person Questionnaire (DAPQ), developed by Karp (1999), provided a free- and fixed-response measure to human figure drawings. The DAPQ demonstrated good reliability and validity. There were no significant differences in scores found among Caucasian Americans (n = 142), African Americans (n = 132), Hispanic Americans (n = 81), and Asian Americans (n = 76) in the original standardization sample. Franco, Karp, and Schottenbauer (2005) developed a Spanish version of the DAPQ in response to providing appropriate norms and to difficulties in developing personality tests for Hispanics due to the complex relationship among culture, ethnic status, language, and personality functioning. Overall, the Spanish version of the DAPQ was stated to be a reliable and useful measure for Hispanics. The authors, however, stated that distinctions among subgroups of Hispanics (for example, Latino, Cuban, Mexican American), immigration status, and level of acculturation were important factors that were not accounted for in the study. Culturally Sensitive Assessment Process. In the light of the inconsistent findings on the reliability and validity of drawings as part of the assessment process with culturally and linguistically diverse children, adolescents, and adults, it is incumbent on psychologists and counselors to interpret drawings within a sociocultural context. Using measures that have found no significant differences among groups such as the DAP:SPED and translated versions of questionnaires such as the DAPQ is just a first step toward a culturally sensitive assessment process. Incorporation of acculturation measures and clinical interviews that tap into the stressors of adapting and assimilating into a new culture, as well as accounting for the circumstances surrounding immigration experiences, are needed. Creating regional and local norms is also needed to reduce psychopathologizing culturally different responses to human figure and family drawings. These norms may possibly tap into the unique experiences of immigrants toward Americanization and therefore may identify unique indicators that have not been previously accounted for during interpretation.

Implications for Research Future cross-cultural studies are needed to examine the influence of culturespecific variables on projective drawings. Salient factors such as country of origin, reason for immigration, and level of acculturation need to be examined. Given that drawing styles may have changed over time, whether due to technological advancements or influences from other cultures, updated studies and

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renorming of data are needed. Catte and Cox (1999) indicated that the Koppitz scheme was devised over thirty years ago, and it may be that indicators are outdated and not applicable. Therefore, recommendations for future research include validating original emotional indicators with current norms and possibly devising new emotional indicators. In addition, cross-cultural studies with methodological integrity and inclusion of larger sample sizes are needed to determine the universality and culture-specific characteristics of projective drawings.

NARRATIVE ASSESSMENT TECHNIQUES Narrative assessment is a qualitative method of analysis used in psychology to understand the implicit meaning of subjective experiences through personal anecdotes, journals, autobiographies, and other storytelling forms. Narrative methods are based on constructivist theories of personality emphasizing that individuals assign meaning to their lives through storytelling-like processes. Further support for this perspective may be attributed to Bruner (1986), who proposed that human thought is characterized by two related yet distinct ways of knowing: one based on narrative (propositional) thinking and the other on logical (logicoscientific) thought processes. Narrative assessment focuses on the underlying meaning of experiences as expressed through narrative thought (Esquivel and Flanagan, 2007). The influence of narrative thinking in personality development has been empirically validated by research (Cramer, 2004). The formation of personal narrative processes follows a developmental path from egocentric (sensory motor) associations of experiences in early childhood to more fully developed schemas (cognitive, social, emotional) that allow socialized interpretations of external reality and the integration of socially shared experiences (Crossley, 1996; Mancuso, 1996). McAdams (1993) formulated a developmental framework to describe and explain the progression of narrative thinking. Young children begin to construct stories based on associations to culturally transmitted values in the form of myths, fables, stories, nursery rhymes, and other folklore. School-age children develop more intentional and goal-oriented schemas for constructing their narratives. Adolescents are able to create their own philosophical schemas for interpreting experiences within a time frame (past, present, and future) and to reconstruct their own stories with an emerging sense of personal and cultural identity. This integrative capacity is reflected by journal writings of that age group, of which the diaries of Anne Frank are a sensitive classical example. Adults are capable of assuming a greater purposeful role as mediating agents in the cultural transmission of stories (anecdotes, autobiographies) and as cocreators of new meaning within the wider community (McAdams, 1993).

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358 HANDBOOK OF MULTICULTURAL ASSESSMENT In essence, narratives are metaphors for the personal inner process of interpreting internal and external reality, the shared sense of meaning among individuals in social relationships, and the communication and creation of new ways of understanding by the cultural group (Howard, 1991). The interactive nature of the narrative process between the individual and the sociocultural group facilitates a sense of personal identity and community cohesiveness under normal circumstances (McAdams and Bowman, 2001). Thus, narratives can capture both individual life stories and patterns of meaning within and across cultures. The emphasis of narrative theory on the development of subjective experience in cultural context (Howard, 1991; Rosenwald and Ochberg, 1992) is consistent with a multicultural perspective of personality development (Hoshmand, 2000) that lends itself to the projective assessment of individuals across the life span and from culturally diverse backgrounds.

Narrative Projective Assessment Techniques The use of narratives as a projective technique is based on a personological assessment paradigm, according to which the person is the focus of study and understanding (Wiggins, 2003). Henry Murray is attributed with the advancement of a personological perspective in projective assessment through the development of the Thematic Apperception Technique, a construction type of projective technique consisting of a series of picture cards depicting situations to elicit narrative processes (TAT; Murray, 1943). Consistent with narrative methods of assessment, the examinee is instructed to create a story that has a beginning (what was happening before), a middle (what is happening now), and an ending (how the story will end). The TAT is based on the projective hypothesis that individuals will project their own perceptions, attitudes, feelings, and needs in assigning meaning to relatively ambiguous stimuli. It is assumed that the examinee will create stories based on past autobiographical accounts, existing situational experiences, and anticipated future outcomes. Psychodynamic TAT interpretation systems (Bellak and Abrams, 1997) focus on the underlying theme of the story and the expression of personal needs, such as autonomy, aggression, and affiliation, in interaction with environmental presses, such as expectations of significant others or the social group. The main character or hero of the story is presumed to represent the examinee’s self-image and personal identity. The characteristics of the hero (interests, behaviors, attitudes, dispositions) may reflect salient personal and cultural identity values. Significant conflicts and coping defenses are also culled from the stories to assess the individual’s ability to resolve problems. A recent approach to thematic test interpretation with children and adolescents (Teglasi, 2001) provides objective criteria for assessing developmental levels of cognitive, perceptual, affective, and social (object relations) schemas derived

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from the narratives. Although this framework is not embedded within a cultural perspective, it offers a template from which to derive culturally sensitive scoring models for culturally diverse children. Dana’s multicultural assessment guidelines (2005) constitute a more comprehensive culturally based approach for assessing adults with the TAT. Potentially the TAT lends itself to incorporating issues of ethnic identity, cultural conflict, acculturation, and the relevance of cultural context. In spite of the integral relation between narrative theory and cultural perspectives and the potential applicability of thematic apperception narrative techniques for assessing persons from culturally diverse backgrounds, there is a need to make this connection a purposeful and explicit component of projective assessment. Concerns have been raised around issues such as the lack of cultural relevance of pictorial stimuli, the ethnic racial mismatch between examiner and characters depicted on the stimulus cards, the limited representation of minorities on standardized norms, and the absence of structured criteria for rating and interpreting stories in terms of cultural factors such as acculturation or within a sociocultural context (Cramer, 2004; Dana, 2000). A number of efforts in cross-cultural research and test development have been attempted to address these concerns (Avila-Espada, 2000; Dana, 2005; Zhang, Xu, Cai, and Chen 1993).

Cross-Cultural Research and Adaptations The Children’s Apperception Test (CAT; Bellak and Abrams, 1997; Bellak and Bellak, 1949), which consists of ten pictures portraying animals, is commonly used to assess children’s developmental themes. The human version (CAT-H) was cross-culturally adapted in countries such as India, Japan, and Indonesia. Adaptations were made to artifacts, furniture, clothing, and other content elements (Bellak and Bellak, 1965). However, these changes failed to recognize developmental differences, child rearing practices, and other culture-specific variations, beyond the items. Cultural adaptations with African American populations are represented by Thompson (1949), who modified the skin color of characters on the TAT to be relevant to Black children, and Bailey and Green (1977) who made changes to the facial features, hair texture, and styles of clothing of characters. Overall, these adapted versions provided inconclusive or insufficient validity evidence. Tell-Me-A-Story (TEMAS; Costantino, Malgady, and Rogler, 1988) is a cross-culturally sensitive thematic apperception technique normed on an urban New York City sample of children ages six to thirteen from Puerto Rican, Black (minority version), and White backgrounds (nonminority version). The TEMAS consists of twenty-three cards with chromatic color (which has been found to elicit lengthier responses from the examinee) that depict characters of Hispanic or Black ethnicity and portray culturally relevant situations in familiar urban

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360 HANDBOOK OF MULTICULTURAL ASSESSMENT settings. The stories are scored along personality variables, affective states, and structural dimensions. The TEMAS is considered a major milestone in personality assessment as a culturally sensitive projective instrument developed and normed on a representative population of urban and culturally diverse children and youth (Ritzler, 1993, 2004). Research has shown that while the instrument is reliable and valid for inner-city Latino students, its clinical utility does not generalize to other Hispanic populations (Costantino, Malgady, Casullo, and Castillo, 1991). Nonetheless, TEMAS stands as an example of a culturally sensitive narrative technique based on local norms and focused on a specific cultural group.

Implications for Practice The importance of multicultural competencies in the administration and interpretation of thematic apperception techniques is evident. This involves the attainment of cultural awareness of both commonalities (etic) in personality functioning across cultures, along with culture-specific (emic) modal personality styles; knowledge of specific cultural values, folklores, and traditions of clients; understanding of the acculturation process; skills in discerning the cultural elements of storytelling; and diagnostic expertise in determining the relative influence of culture from other factors in differentiating normative personality functioning from psychopathology in individual clients. Cramer (2004) highlights the importance of understanding the situational aspects of the testing situation; the value of the stimulus pull; the personal context of the storyteller (for example, health status, ethnicity, age, gender, language expression, cognitive style); and the need for narrative sensitivity in interpreting the underlying meaning and patterns of stories within a sociocultural context. Dana (2005) provides systematic practical application guidelines for the assessment of culturally diverse populations. Steps in culturally sensitive TAT assessment procedures include (1) posing preliminary questions as to the examinee’s test-taking attitude, extent of acculturation, and (typical-atypical) cultural identification; (2) deciding the best selection of cards based on cultural relevance of stimuli; (3) determining the need to modify standard instructions; (4) scoring according to cultural norms (Avila-Espada, 2000); (4) interpreting content with cultural understanding; and (5) reporting findings in a culturally appropriate manner.

Implications for Research Dana (2005) has proposed a framework for cross-cultural research that comprises attention to the cultural relevance of pictorial stimuli; development of local norms that account for educational level, socioeconomic status, and acculturation; establishment and validation of culturally sensitive criteria along

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universal and culture-specific dimensions; use of local norms or culturally sensitive test adaptations; the development and validation of consensual (professional, community) objective scoring systems; and the compilation of a TAT cross-cultural research database. Exploration of alternative narrative methods of assessment such as autobiographical accounts and the link between narrative assessment and culturally sensitive interventions such as cultural tales or storytelling is also recommended (Esquivel and Flanagan, 2007).

THE RORSCHACH TECHNIQUE For more than half a century, psychologists have extensively employed the Rorschach as a tool for understanding personality and diagnosing psychopathology. This projective personality technique presents subjects with ten standardized inkblots, asking them to freely respond to the examiner’s inquiry, ‘‘What might this be?’’ After transcribing each response verbatim, the examiner presents each stimulus card again. The subject is guided to elaborate on previous responses, such that the examiner is able to code them according to an elaborate coding system (Ritzler, 2001). Although Hermann Rorschach, a well-known Swiss psychologist, died shortly after his test’s unveiling, it is commonly understood that he intended it to be used for two main purposes. First, he believed that it could be employed as a research tool for revealing unconscious components of personality. The second claim, made somewhat later in the test’s development, was that the Rorschach could be used as a diagnostic tool for various types of psychopathology (Hock, 1999). According to a psychodynamic interpretation, the ambivalent stimuli elicit subconscious symbolic associations and tap into the integrity of more conscious cognitive, perceptual, and affective processes, along with pervasive areas of vulnerability and overall adaptive resources. This measure is now a prominent assessment tool, at least in clinical settings, but its developmental path has been anything but straightforward. The ten figures that comprise the stimuli for this projective measure first entered the arena of professional psychology in 1921 with the release of Rorschach’s work Psychodiagnostics. Once published, these inkblots quickly became the subject of much interest, both within fields of research and clinical practice. Having become so popular, the use of this projective technique was ‘‘almost synonymous with clinical psychology’’ (Exner, 1993, p. 3) during the 1940s and 1950s. Although the role of the clinician administering the examination has varied over the decades, the Rorschach has remained one of the most frequently used clinical assessment approaches. Beginning in the 1960s, the Rorschach became the target of much criticism as clinicians began to critique it as subjective in nature. Critics identified

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362 HANDBOOK OF MULTICULTURAL ASSESSMENT problems intricately related to validity and bias, while defenders asserted that criticism of the test was naive (Wood, Nezworski, and Stejskal, 1996). Responding to such criticism, Exner (1974) conducted a survey of preexisting interpretive systems (Beck, 1944; Klopfer and Kelley, 1942; Piotrowski, 1957; Rapaport, Gill, and Schafer, 1946) with the intention of identifying coding variables that passed stringent requirements for reliability and validity (Ritzler, 2001). The findings of this survey informed the composite coding and interpretive system now known as the Comprehensive System (CS; Exner, 1993), which turned it into an assessment instrument ‘‘for which reliability and validity could be empirically examined using . . . classical psychometric theory.’’ The CS is credited as responsible for ‘‘maintaining the prominence of the Rorschach in psychological assessment in the United States’’ (Allen and Dana, 2004, p. 189). Some have even gone so far as to say that in creating the CS, ‘‘Exner has almost single handedly rescued a drowning beast and breathed life back into it’’ (Matthews, 2005, para. 3), or that it saved the tool from ‘‘the total disrepute into which it was rapidly sinking’’ (Campbell, 2005, para. 3). The CS has not, however, avoided significant debate and criticism of its own. Despite its popularity, the CS is currently ‘‘engulfed in a scientific controversy that is at least as heated and widespread as the Rorschach controversy of the 1950s and 1960s’’ (Lilienfeld et al., 2000, p. 32). Numerous articles concerning its scientific status have surfaced in recent years. Esteemed peer-reviewed journals have devoted special sections to debate on the adequacy of the CS’s psychometric properties. One specific area of controversy concerns Rorschach use for the ‘‘assessment of American minority groups and for non-Americans’’ (Garb, Wood, Nezworski, Grove, and Stejskal, 2001, p. 436). Various elements of this controversy will be presented to explore what is already known about Rorschach’s cross-cultural utility, as well as suggestions for future research and culturally sensitive practice using the Rorschach to assess clients from diverse backgrounds. The Rorschach has enjoyed a long history of cross-cultural application. From the outset, Rorschach himself described the inkblot procedure as a useful tool for the investigation of psychopathology as well as cultural variation in personality (Rorschach, 1921/1942). He believed the inkblot test’s unique potential for cross-cultural use rested in its composition from task stimuli of neutral, nonpictorial, visual forms requiring no item translation (Lindzey, 1954, cited in Allen and Dana, 2004). Proponents of the Rorschach have presented strong cases in support of this original view of the Rorschach as applicable across cultures. According to Viglione (1999), in the United States, ‘‘the Rorschach has demonstrated its usefulness with a variety of ethnic and subcultural groups’’ (p. 252). Ritzler (2001), for example, presents a relatively strong case in favor of Rorschach

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assessment within appropriate multicultural practice. The crux of his argument lies in his understanding of the Rorschach as an assessment tool with low cultural task demands. According to Ritzler, the Rorschach may be viewed as relatively culture free due in large part to notable stimulus ambiguity and standardization procedures employed. Similar to Hermann Rorschach’s original claim, Ritzler asserted that that the inkblots are ‘‘sufficiently ambiguous to eliminate most cultural bias’’ and that taking a Rorschach is a novel experience for nearly everyone, regardless of culture (p. 238). Moreover, normative data demonstrate that none of the inkblots’ popular responses has clear cultural specificity. With respect to standardization, the Rorschach is qualified as a culture-fair method, based on its standard procedures for administration, scoring, and interpretation. The step-by-step fashion tailored for each individual protocol, it is argued, means that all subjects are assessed with identical procedures, regardless of cultural identity. Thus, potential cultural bias on the part of the administering psychologist is minimized (Ritzler, 2001). Systematic research has provided quantitative support for arguments that the Rorschach is in fact culture fair. Presley, Smith, Hilsenroth, and Exner (2001) conducted a study aimed at identifying Rorschach differences between African Americans and White Americans and understanding these differences within a social and cultural framework. These researchers selected the responses of forty-four African American nonpatient participants from Exner’s normative data sample (1993). This group was matched closely with 44 White American nonpatient participants on gender, age, education, marital status, and socioeconomic status. The results of the study revealed a ‘‘striking similarity between the African American and White American samples on most of the Rorschach variables’’ (Presley et al., 2001, p. 504). The authors concluded that results suggested that the impact of race alone does not appear to be a significant determinant of nonclinical personality functioning as measured by the Rorschach. Having examined Rorschach norms across countries, the International Rorschach Society (1999) presented results of a comparison of twelve countries, revealing notable consistency across countries on all variables examined. (For more studies finding the Rorschach well suited for use with American minorities or non-Americans, see Butcher, Nezami, and Exner, 1998; Viglione, 1999; and Stricker and Gold, 1999.) On the opposite side of the Rorschach debate are several researchers who assert that the use of the Rorschach with minority groups is inherently problematic. Lilienfeld et al. (2000) present a largely negative critique of the validity and reliability of the most popular projective measures, including Exner’s Comprehensive System for the Rorschach (1993). They conclude that extant studies ‘‘suggest that the use of the CS with American minorities and non-Americans can be highly problematic’’ (Lilienfeld et al., p. 33) and therefore recommend against using the CS for routine cross-cultural applications.

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364 HANDBOOK OF MULTICULTURAL ASSESSMENT Garb et al. (2001) conducted a survey of eighteen studies, concluding that current CS norms are flawed and noting a ‘‘lack of appropriate normative data for many ethnic groups, for example, Black adults, Hispanic American adults and children, and Native American adults and children’’ (p. 436). Garb et al. note other authors’ findings of normative differences between White and Korean Americans (Moon and Cundick, 1983), native and nonnative Alaskans (Glass, Bieber, and Tkachuk, 1996), and others (Constantino et al., 1995; Day, Boyer, and Devos, 1989; Devos, 1989; Devos and Miner, 1989). Researchers such as Meyer (2001) and Allen and Dana (2004), however, have argued forcefully against the validity of Garb et al.’s conclusions, pointing out various sampling issues and analytical errors (Meyer, 2001). Interpretation errors are attributed to the authors having ‘‘misconstrued . . . the meaning of their findings through oversimplification, omission of relevant contents, and apparent failure to understand the methodologies, intent, and findings of the cross-cultural and multicultural assessment literature’’ (Allen and Dana, 2004, p. 191).

Cross-Cultural Rorschach Research Regardless of which side of the Rorschach debate they support, there appears to be unanimous sentiment among researchers that methodological changes in Rorschach research are necessary. Allen and Dana (2004) describe several core methodological issues in cross-cultural Rorschach research. Among others, these researchers highlight the importance of evaluating linguistic equivalence of Rorschach instructions. It is noted that the brevity and complex nature of Rorschach instructions ‘‘may require a particular style of abstraction that is itself culture specific’’ (Allen and Dana, 2004, p. 194). To date, however, researchers have not formally studied the linguistic equivalence of translated instructions or potential ethnic/regional differences in English use within and outside the United States. To remedy the situation, Allen and Dana urge researchers to evaluate translated instructions using systemic, comprehensive field testing. Investigators also note the need to investigate potential effects of acculturation status on Rorschach results. Acculturation is defined as adaptation to an immigrant’s new country through cultural assimilation (Gordon, 1964) or the ‘‘extent to which ethnic-cultural minorities participate in the cultural traditions, values, assumptions and practices of the dominant society’’ (Landrine and Klonoff, 1995, p. 124). As such, this variable ‘‘represents both an important source of heterogeneity within ethnic groups and a specific variable of interest underlying ethnic group membership’’ (Allen and Dana, 2004, p. 196). Early findings have indicated that acculturation produces modifications in perceptions (Ramirez, Castaneda, and Lherold, 1974). Noting that studies were needed to ‘‘clarify the differential roles of language and culture and

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acculturation on perceptions,’’ Moon and Cundick (1983) conducted a study to examine the relationship between Korean and American cultures and languages on Rorschach responses. Results demonstrate that cultural differences in Rorschach responses changed significantly as acculturation seemed to occur. Despite such findings, conventional assessment views against the establishment of ethnic subgroup norms have severely limited the development of norms relevant to acculturation status. Allen and Dana (2004) recommend that researchers reverse this trend, given that ‘‘the availability of acculturation norms for the four major ethnic groups in the United States could minimize pathologization of traditional individuals. . . . The development of acculturation status norms would also help assure the clinical utility of the CS internationally while advancing its multicultural utility in the United States’’ (p. 196). While acculturation status and linguistic equivalence are among the most popular area of concern for future Rorschach research, several other areas have been the subject of methodological scrutiny. Garb et al. (2001), for example, express concern over frequent fallacies with control groups, criterion contamination, and selective reporting of results. They note that Rorschach researchers frequently fail to adjust alpha levels when performing multiple statistic tests. According to Garb et al., resolution of the Rorschach debate requires that the ‘‘methodological rigor of individual studies be improved’’ (p. 441) and that positive results already documented be replicated. In addition, they urge researchers to establish a body of research on incremental validity and to conduct more meaningful meta-analyses.

Implications for Practice With all that is yet unknown about multicultural Rorschach use, how might practitioners use what is known to inform best practice? It is already evident that acculturation is a relevant and important factor in Rorschach response patterns. Because acculturation covers such a wide spectrum, an assessment psychologist must be able to determine the extent of acculturation in an individual client. Some acculturation assessments are intended for use with multiple ethnic groups, for example, the Stephenson Multigroup Acculturation Scale (Stephenson, 2000). The majority of measures, however, are designed for specific use with populations of particular origin. Measures currently exist for several of the more dominant cultures, including Hispanic Americans (Cortes, Rogler, and Malgady, 1994; Dana, 1996; Marin and Gamba, 1996), Native Americans (Collier, 2000; Garrett and Pichette, 2000), African Americans (Landrine and Klonoff, 1995; Snowden and Hines, 1999), and Asian Americans (Kim, Atkinson, and Yang, 1999). However, researchers have yet to develop acculturation assessments for many of the other cultures of origin in the United States.

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366 HANDBOOK OF MULTICULTURAL ASSESSMENT By employing some of the methods currently available for assessing acculturation, ‘‘the assessment psychologist can arrive at a useful estimate of the extent to which the client is culturally different. If acculturation is minimal much caution must be exercised in projective personality assessment’’ (Ritzler, 2001, p. 245). If the Rorschach is used with persons of low acculturation levels, practitioners should administer the technique and interpret results with this variable in mind. Although level of acculturation is critical, it must not be considered apart from the effects of language differences. As cited in Ritzler (2001), Dana (1993) and Tiemann and Ritzler (1999) have indicated that even quite acculturated clients respond to projective methods differently in their native language than they do in English. Studies such as those conducted by Rosenberg and Ritzler (1999) and Tiemann and Ritzler (1999) indicated that more valid results are obtained for less acculturated individuals when the test is administered in their native language, while results were somewhat less clear with highly acculturated subjects. Thus, while this may be less critical if the client scores higher on acculturation scales, practitioners are advised to administer the Rorschach in the client’s native or dominant language (Ritzler, 2001).

References Alland, A., Jr. (1983). Playing with form: Children draw in six cultures. New York: Columbia University Press. Allen, J., & Dana, R. H. (2004). Methodological issues in cross-cultural and multicultural Rorschach research. Journal of Personality Assessment, 82(2), 189–206. Andersson, I., & Andersson, S. B. (1997). Aesthetic representations among Himba people in Namibia. Unpublished manuscript, Linkoping University, Sweden. Arnheim, R. (1969). Visual thinking. Berkeley: University of California Press. Avila-Espada, A. (2000). Objective scoring for the TAT. In R. H. Dana (Ed.), Handbook of cross-cultural and multicultural personality assessment (pp. 465–480). Mahwah, NJ: Erlbaum. Bailey, B. E., & Green, J., III. (1977). Black Thematic Apperception Test stimulus material. Journal of Personality Assessment, 4, 25–30. Beck, S. (1944). Rorschach’s test I: Basic processes. Philadelphia: Grune and Stratton. Bellak, L., & Abrams, D. M. (1997). The T.A.T., the C.A.T. and the S.A.T. in clinical use (6th ed.). Needham Heights, MA: Allyn & Bacon. Bellak, L., & Bellak, S. S. (1949). Children’s Apperception Test. Larchmont, NY: CPS. Bellak, L., & Bellak, S. S. (1965). The Children’s Apperception Test. Larchmont, NY: CPS. Bruner, J. (1986). Actual minds, possible worlds. Cambridge, MA: Harvard University Press.

MULTICULTURAL ISSUES IN PROJECTIVE ASSESSMENT Buck, J. N. (1948). The H-T-P test. Journal of Clinical Psychology, 4, 151–159. Burns, R. C., & Kaufman, S. F. (1970). Kinetic Family Drawings (K-F-D). New York: Brunner & Mazel. Burns, R. C., & Kaufman, S. H. (1972). Actions, styles, and symbols in Kinetic Family Drawings (K-F-D): An interpretive manual. New York: Brunner/Mazel. Butcher, J. N., Nezami, E., & Exner, J. E. (1998). Psychological assessment of people in diverse cultures. In S. S. Kazarian & D. R. Evans (Eds.), Cultural clinical psychology (pp. 61–105). New York: Oxford University Press. Camara, W. J., Nathan, J. S., & Puente, A. E. (2000). Psychological test usage: Implications in professional psychology. Professional Psychology: Research and Practice, 31, 141–154. Campbell, T. W. (2005). Issues in forensic psychology: Rorschach technique. Retrieved July 5, 2005, from http://www.campsych.com/rorschach.htm. Catte, M., & Cox, M. V. (1999). Emotional indicators in children’s human figure drawings. European Child and Adolescent Psychiatry, 8, 86–91. Chappell, P. A., & Steitz, J. A. (1993). Young children’s human figure drawings and cognitive development. Perceptual and Motor Skills, 76, 611–617. Chuah, V. (1992). Kinetic Family Drawings of Chinese American children. Unpublished doctoral dissertation, Andrews University. Collier, C. (2000). Separating difference from disability: Assessing diverse learners. Ferndale, WA: Cross Cultural Developmental Education Services. Cortes, D. E., Rogler, L. H., & Malgady, R. G. (1994). Biculturality among Puerto Rican adults in the United States. American Journal of Community Psychology, 22, 707–721. Costantino, G., Flanagan, R., & Malgady, R. (1995). The history of the Rorschach: Overcoming bias in multicultural projective assessment. Rorschachiana: Yearbook of the International Rorschach Society, 20, 148–171. Costantino, G., Malgady, R. G., Casullo, M. M., & Castillo, A. (1991). Cross-cultural standardization of TEMAS in three Hispanic subcultures. Hispanic Journal of Behavioral Sciences, 13, 48–62. Costantino, G., Malgady, R. G., & Rogler, L. H. (1988). Tell-Me-A-Story (TEMAS). Beverly Hills, CA: Western Psychological Services. Court, E. (1989). Drawing on culture: The influence of culture on children’s drawing performance in rural Kenya. Journal of Art and Design Education, 8, 65–88. Cox, M. V. (1993). Children’s drawings of human figures. Hove, UK: Erlbaum. Cox, M. V., & Howarth, C. (1989). Human figure drawing of normal children and those with severe learning difficulties. British Journal of Developmental Psychology, 7, 333–339. Cox, M. V., & Mason, S. (1998). The young child’s pictorial representation of the human figure. International Journal of Early Years Education, 6, 31–38.

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368 HANDBOOK OF MULTICULTURAL ASSESSMENT Cox, M. V., & Parkin, C. (1986). Young children’s human figure drawing: Cross sectional and longitudinal studies. Educational Psychology, 6, 353–368. Cramer, P. (2004). Storytelling, narrative, and the Thematic Apperception Test. New York: Guilford Press. Crossley, N. (1996). Intersubjectivity: The fabric of social becoming. Thousand Oaks, CA: Sage. Cummings, J. A. (1986). Projective drawings. In H. Knoff (Ed.), The assessment of child and adolescent personality (pp. 199–244). New York: Guilford Press. Dana, R. (1993). Multicultural assessment perspectives for professional psychology. Needham Heights, MA: Allyn & Bacon. Dana, R. H. (1996). Assessment of acculturation in Hispanic populations. Hispanic Journal of Behavioral Sciences, 18(3), 317–328. Dana, R. H. (2000). An assessment intervention model for research and practice with multicultural populations. In R. H. Dana (Ed.), Handbook of cross-cultural and multicultural personality assessment (pp. 5–16). Mahwah, NJ: Erlbaum. Dana, R. H. (2005). Multicultural assessment: Principles, applications and examples. Mahwah, NJ: Erlbaum. Daoud, F. S. (1976). First drawn pictures: A cross-cultural investigation. Journal of Personality Assessment, 40, 376–377. Day, R., Boyer, L. B., & Devos, G. A. (1989). Progressive constriction in Apache youth. In G. A. Devos & L. B. Boyer (Eds.), Symbolic analysis cross-culturally: The Rorschach test (pp. 293–334). Berkeley: University of California Press. Dennis, W. (1957). Performance of Near Eastern children on the Draw-A-Man test. Child Development, 28, 427–430. Dennis, W. (1960). The human figure drawings of bedouins. Journal of Social Psychology, 52, 209–219. Dennis, W. (1966). Group values through children’s drawings. Hoboken, NJ: Wiley. de Valle, P., McEachern, A. G., & Sabina, M. Q. (1999). Using drawings and writings in a group counseling experience with Cuban rafter children, ‘‘Los Balseritos.’’ Guidance and Counseling, 14, 20–28. Devos, G. A. (1989). Personality continuities and cultural chance in Japanese Americans. In G. A. Devos & L. B. Boyer (Eds.), Symbolic analysis cross-culturally: The Rorschach test (pp. 93–136). Berkeley: University of California Press. Devos, G. A., & Miner, H. (1989). Oasis and Casbah: Acculturative stress. In G. A. Devos & L. B. Boyer (Eds.), Symbolic analysis cross-culturally: The Rorschach test (pp. 201–245). Berkeley: University of California Press. Dewaraja, R., Sato, H., & Ogawa, T. (2006). Anxiety in tsunami-affected children in Sri Lanka measured by Revised Children’s Manifest Anxiety Scale and Synthetic House-Tree-Person test. International Congress Series, 1287, 74–78. Esquivel, G. B., & Flanagan, R. (2007). Narrative methods of personality assessment in school psychology. Psychology in the Schools. 44, 271–280.

MULTICULTURAL ISSUES IN PROJECTIVE ASSESSMENT Exner, J. E. (1974). The Rorschach: A comprehensive system (Vol. 1). Hoboken, NJ: Wiley. Exner, J. E. (1993). The Rorschach: A comprehensive system: (Vol. 1), Basic foundations (3rd ed.). Hoboken, NJ: Wiley. Flanagan, R., & Esquivel, G. B. (2006). Empirical and clinical methods in the assessment of personality and psychopathology: An integrative approach for training. Psychology in the Schools, 43, 513–526. Franco, F., Karp, S. A., & Schottenbauer, M. A. (2005). The Spanish-version of the Draw-A-Person Questionnaire. Hispanic Journal of Behavioral Sciences, 27, 455–470. Frank, L. K. (1939). Projective methods for the study of personality. Journal of Psychology, 8, 389–413. Freeman, N. H. (1980). Strategies in representation in young children. Orlando, FL: Academic Press. Garb, H. N., Wood, J. M., Lillienfeld, S. O., & Nezworski, M. T. (2002). Effective use of projective techniques in clinical practice: Let the data help with selection and interpretation. Professional Psychology: Research and Practice, 33, 454–463. Garb, H. N., Wood, J. W., Nezworski, M. T., Grove, W. M., & Stejskal, W. J. (2001). Toward a resolution of the Rorschach controversy. Psychological Assessment, 13, 433–448. Garrett, M. T., & Pichette, E. F. (2000). Red as an apple: Native American acculturation and counseling with or without reservation. Journal of Counseling and Development, 78, 3–13. Glass, M. H., Bieber, S. L., & Tkachuk, M. J. (1996). Personality styles and dynamics of Alaska of native and nonnative incarcerated men. Journal of Personality Assessment, 66, 583–603. Golomb, C. (1992). The child’s creation of a pictorial world. Berkeley: University of California Press. Golomb, C. (2002). Art in context: A cultural and comparative perspective. Washington, DC: American Psychological Association. Gonzales, E. (1982). A cross-cultural comparison of the developmental items of five ethnic groups in the Southwest. Journal of Personality Assessment, 46, 26–31. Goodenough, F. L. (1926). Measurement of intelligence by drawings. Orlando, FL: Harcourt. Goodenough, F. L., & Harris, D. B. (1950). Studies in the psychology of children’s drawings, II: 1928–1949. Psychological Bulletin, 47, 396–433. Goodnow, J. J. (1977). Child drawing. Cambridge, MA: Harvard University Press. Gordon, M. M. (1964). Assimilation in American life: The role of race, religion, and national origins. New York: Oxford University Press. Graf, M. H. (1986). The use of Kinetic Family Drawing with Hispanic mothers in the school setting. School Psychology International, 7, 217–223.

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370 HANDBOOK OF MULTICULTURAL ASSESSMENT Groth-Marnat, G., & Roberts, L. (1998). Human figure drawings and house-tree-person drawings as indicators of self-esteem: A quantitative approach. Journal of Clinical Psychology, 54, 219–222. Handler, L., & Habenicht, D. (1994). The Kinetic Family Drawing technique: A review of the literature. Journal of Personality Assessment, 62, 440–464. Harris, D. B. (1963). Children’s drawings as measures of intellectual maturity. Orlando, FL: Harcourt. Havighurst, R. J., Gunther, M. K., & Pratt, I. E. (1946). Environment and the Draw-AMan test: The performance of Indian children. Journal of Abnormal and Social Psychology, 41, 50–63. Hilsenroth, M. J. (2004). Projective assessment of personality and psychopathology: An overview. In M. J. Hilsenroth & D. L. Segal (Eds.), Comprehensive handbook of psychological assessment (Vol. 2, pp. 356–371). Hoboken, NJ: Wiley. Hock, H. R. (1999). Forty studies that changed psychology: Explorations into the history of psychological reason. Upper Saddle River, NJ: Prentice Hall. Hojnoski, R. L., Morrison, R., Brown, M., & Matthews, W. J. (2006). Projective test use among school psychologists: A survey and critique. Journal of Psychoeducational Assessment, 24, 145–159. Hoshmand, L. T. (2000). Narrative psychology. In A. E. Kazdin (Ed.), Encyclopedia of psychology (Vol. 5, pp. 287–392). Washington DC: American Psychological Association. Howard, G. S. (1991). Cultural tales: A narrative approach to thinking, cross-cultural psychology and psychotherapy. American Psychologist, 46, 187–197. Hulse, W. C. (1951). The emotionally disturbed child draws his family. Quarterly Journal of Child Behavior, 3, 152–174. Karon, B. P. (2000). The clinical interpretation of the Thematic Apperception Test, Rorschach, and other clinical data: A reexamination of statistical versus clinical prediction. Professional Psychology: Research and Practice, 31, 230–233. Karp, S. A. (1999). Manual for the Draw-A-Person Questionnaire (2nd ed.). Brooklandville, MD: Objective/Projective Tests. Kellogg, R. (1969). Analyzing children’s art. Palo Alto, CA: National Press Books. Kim, B.S.K., Atkinson, D. R., & Yang, P. H. (1999). The Asian Values Scale (AVS): Development, factor analysis, validation, and reliability. Journal of Counseling Psychology, 46, 342–352. Klopfer, B., & Kelley, D. (1942). The Rorschach technique. Yonkers, NY: World Book. Klopfer, W. G., & Taulbee, E. S. (1976). Projective tests. Annual Review of Psychology, 27, 543–567. Kohn, S. W., Conti, D., & Esquivel, G. B. (2006). Personality and behavioral assessment: Considerations for culturally and linguistically diverse individuals. In G. B. Esquivel, E. C. Lopez, & S. G. Nahari (Eds.), Handbook of multicultural school psychology: Interdisciplinary perspectives. Mahwah, NJ: Erlbaum.

MULTICULTURAL ISSUES IN PROJECTIVE ASSESSMENT Koppitz, E. M. (1966). Emotional indicators on human figure drawings of children: A validation study. Journal of Clinical Psychology, 22, 321–324. Koppitz, E. (1968). Psychological evaluation of children’s human figure drawings. New York: Grune & Stratton. Landrine, H., & Klonoff, E. (1995). The African American Acculturation Scale II: Cross-validation and short form. Journal of Black Psychology, 21, 124–152. La Voy, S. K., Pedersen, W. C., Reitz, J. M., Brauch, A. A., Luxenberg, T. M., & Nofsinger, C. C. (2001). Children’s drawings: A cross-cultural analysis from Japan and United States. School Psychology International, 22, 53–63. Leichtman, M. (2004). Projective tests: The nature of the task. In M. J. Hilsenroth & D. L. Segal (Eds.), Comprehensive handbook of psychological assessment (Vol. 2, pp. 356–371). Hoboken, NJ: Wiley. Lilienfeld, S. O., Wood, J. M., & Garb, H. N. (2000). The scientific status of projective techniques. Psychological Science in the Public Interest, 1, 27–66. Lindzey, G. (1954). Projective techniques and cross-cultural research. New York: Appleton-Century-Crofts. Machover, K. (1949). Personality projection on the drawing of the human figure. Springfield, IL: Thomas. Magnum, M. E. (1976). Familial identification in Black, Anglo, and Chicano MR children using the K-F-D. Dissertation Abstracts International, 36(11-A), 7343. Mancuso, J. C. (1996). Constructionism, personal construct psychology, and narrative psychology. Theory and Psychology, 58, 469–473. Marin, G., & Gamba, R. J. (1996). A new measurement of acculturation for Hispanics: The Bidimensional Acculturation Scale for Hispanics (BAS). Hispanic Journal of Behavioral Sciences, 18(3), 297–316. Matthews, M. (2005). Rorschach inkblot test. Retrieved July 7, 2005, from http://www .rorschach.org. Matto, H. C. (2002). Investigating the validity of the Draw-A-Person: Screening procedures for emotional disturbance: A measurement validity study with high-risk youth. Psychological Assessment, 14, 221–225. Matto, H. C., & Naglieri, J. A. (2005). Race and ethnic differences and human figure drawings: Clinical utility of the DAP:SPED. Journal of Clinical Child and Adolescent Psychology, 34, 706–711. McAdams, D. P. (1993). The stories we live by: Personal myths and the making of the self . New York: Morrow. McAdams, D. P. (2001). The person: An integrated introduction to personality psychology. Orlando, FL: Harcourt. McAdams, D. P., & Bowman, P. T. (2001). Narrating life’s turning points: Redemption and contamination. In D. P. McAdams, R. Josselson, & A. Lieblich (Eds.), Turns in the road: Narrative studies of lives in transition (pp. 3–34). Washington DC: American Psychological Association.

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372 HANDBOOK OF MULTICULTURAL ASSESSMENT Meyer, G. J. (2001). Evidence to correct misperceptions about Rorschach norms. Clinical Psychology: Science and Practice, 8, 389–396. Meyer, G. J., & Archer, R. P. (2001). The hard science of Rorschach research: What do we know and where do we go? Psychological Assessment, 13, 486–502. Moon, T. I., & Cundick, B. P. (1983). Shifts and constancies in Rorschach responses as a function of culture and language. Journal of Personality Assessment, 47, 345–349. Murray, H. A. (1943). Thematic Apperception Test: Manual. Cambridge, MA: Harvard University Press. Naglieri, J. A., McNeish, T. J., & Bardos, A. N. (1991). Draw A Person: Screening procedure for emotional disturbance. Austin, TX: Pro-Ed. Naglieri, J. A., & Pfeiffer, S. I. (1992). Validity of Draw A Person: Screening procedure for emotional disturbance with a socially-emotionally disturbed sample. Journal of Consulting and Clinical Psychology, 4, 156–159. Nuttall, E., Chieh, L., & Nuttall, R. (1988). Views of the family by Chinese and U.S. children: A comparative study of Kinetic Family Drawings. Journal of School Psychology, 26, 191–194. Paget, G. W. (1932). Some drawings of men and woman made by children of certain non-European races. Journal of he Royal Anthropological Institute, 62, 127–144. Palmer, L., Farrar, A. R., Valle, M., Ghahary, N., Panella, M., & DeGraw, D. (2000). An investigation of the clinical use of the House-Tree-Person projective drawings in the psychological evaluation of child sexual abuse. Child Maltreatment, 5, 169–175. Piotrowski, Z. (1957). Perceptanalysis. New York: Macmillan. Presley, G., Smith, C., Hilsenroth, M., & Exner, J. (2001). Clinical utility of the Rorschach with African Americans. Journal of Personality Assessment, 77(3), 491–507. Ramirez, M., Castaneda, A., & Lherold, L. (1974). The relationship of acculturation to cognitive style. Journal of Cross Cultural Psychology, 6, 227–237. Rappaport, D., Gill, M., & Schafer, R. (1946). Diagnostic psychological testing (Vols. 1 and 2). Chicago: Yearbook Publishers. Riethmiller, R. J., & Handler, L. (1997). Problematic methods and unwarranted conclusions in DAP research: Suggestions for improved research procedures. Journal of Personality Assessment, 69, 459–475. Ritzler, B. A. (1993). Test review: TEMAS. Journal of Psychoeducational Assessment, 11, 381–389. Ritzler, B. A. (2001). Multicultural usage of the Rorschach. In L. A. Suzuki, P. J. Meller, & J. G. Ponterotto (Eds.), The handbook of multicultural assessment: Clinical, psychological, and educational applications (pp. 237–252). San Francisco: Jossey-Bass. Ritzler, B. A. (2004). Cultural applications of the Rorschach, apperception tests, and figure drawings. In M. J. Hilsenroth & D. L. Segal (Eds.), Comprehensive handbook of psychological assessment (Vol. 2, pp. 356–371). Hoboken, NJ: Wiley.

MULTICULTURAL ISSUES IN PROJECTIVE ASSESSMENT Rorschach, H. (1942). Psychodiagnostics: A diagnostic test based on perception (3rd ed., B. Kronenberg & P. Lemkau, Trans.). Berne, Switzerland: Hans Huber. (Original work published in 1921) Rosenberg, D., & Ritzler, B. (1999). Acculturation as a factor in the validity of cross-cultural Rorschach comprehensive assessment. Unpublished manuscript. Rosenwald, G. C., & Ochberg, R. L. (Eds.). (1992). Storied lives: The cultural politics of self understanding. New Haven, CT: Yale University Press. Schofield, J. W. (1978). An exploratory study of the Draw-A-Person as a measure of racial identity. Perceptual and Motor Skills, 46, 311–321. Smith, D., & Dumont, F. (1995). A cautionary study: Unwarranted interpretations of the Draw-A-Person test. Professional Psychology: Research and Practice, 26, 298–303. Snowden, L. R., & Hines, A. M. (1999). A scale to assess African American acculturation. Journal of Black Psychology, 25, 36–47. Stephenson, M. (2000). Development and validation of the Stephenson Multigroup Acculturation Scale (SMAS). Psychological Assessment, 12, 77–88. Stevenson, H. W., & Stigler, J. W. (1992). The learning gap. New York: Summit Books. Stricker, G., & Gold, J. R. (1999). The Rorschach: Toward a nomothetically based, ideograpically applicable configural model. Psychological Assessment, 11, 240–250. Sundberg, N., & Ballinger, T. (1968). Nepalese children’s cognitive development as revealed by drawings of man, woman, and self. Child Development, 39, 969–985. Swensen, C. H. (1968). Empirical evaluation of human figure drawings. Psychological Bulletin, 54, 431–466. Teglasi, H. (2001). Essentials of TAT and other story telling assessment. Hoboken, NJ: Wiley. Teichman, Y., & Zafrir, H. (2003). Images held by Jewish and Arab children in Israel of people representing their own and the other group. Journal of Cross-Cultural Psychology, 34, 658–676. Ter Laak, J., De Goede, M., Aleva, A., & Van Rijswijk, P. (2005). The Draw-A-Person Test: An indicator of children’s cognitive and socioemotional adaptation? Journal of Genetic Psychology, 166, 77–93. Tharinger, D. J., & Stark, K. (1990). A qualitative versus a quantitative approach to evaluating the Draw-A-Person and Kinetic Family Drawing: A study of mood- and anxiety-disorder children. Psychological Assessment, 2, 365–375. Thompson, C. E. (1949). The Thompson modification of the Thematic Apperception Test. Rorschach Research Exchange, 13, 469–478. Tiemann, J., & Ritzler, B. (1999). Analysis of language-based differences on Rorschach Comprehensive System and TAT protocols of fluent bilinguals. Unpublished doctoral dissertation, Long Island University. Toku, M. (2000). Cross-cultural analysis of artistic development: Drawing by Japanese and U.S. children. Visual Arts Research, 27, 46–59.

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374 HANDBOOK OF MULTICULTURAL ASSESSMENT Viglione, D. J. (1999). A review of recent research addressing the utility of the Rorschach. Psychological Assessment, 11, 251–265. Vygotsky, L. S. (1978). Mind in society. Cambridge, MA: MIT Press. Walton, J. R. (1983). Kinetic school drawings of referred school children. Paper presented at the National Association of School Psychologists, Detroit, MI. Wechsler, D. (1989). Wechsler Intelligence Test for Children-Revised manual. New York: Psychological Corporation. Wegmann, P., & Lusebrink, V. B. (2000). Kinetic Family Drawing scoring method for cross-cultural studies. Arts in Psychotherapy, 27, 179–190. Weiss, S. C. (1980). Culture Fair Intelligence Test and the Draw-A-Person scores from a rural Peruvian sample. Journal of Social Psychology, 111, 147–148. Wiggins, J. S. (2003). Paradigms of personality assessment. New York: Guilford Press. Williams, T. O., Fall, A., Eaves, R. C., & Woods-Groves, S. (2006). The reliability of scores for the Draw-A-Person intellectual ability test for children, adolescents, and adults. Journal of Psychoeducational Assessment, 24, 137–144. Wilson, B. (1985). The artistic Tower of Babel: Inextricable links between culture and graphic development. Visual Arts Research, 11, 90–104. Woike, B. A., & McAdams, D. P. (2001). TAT-based personality measures have considerable validity. American Psychological Society Observer, 14, 10. Wood, J. M., Nezworski, M. T., & Stejskal, W. J. (1996). The comprehensive system for the Rorschach: A critical examination. Psychological Science, 7, 3–10. Yama, M. F. (1990). The usefulness of human figure drawing as an index of overall adjustment. Journal of Personality Assessment, 54, 78–86. Zhang, T., Xu, S., Cai, Z., & Chen, Z. (1993). Research on the Thematic Apperception Test: Chinese revision and its norms. Acta Psychologica Sinica, 25, 314–323.

CHAPTER SEVENTEEN

On the Multicultural Utility of the 16PF and the CPI-434 in the United States Kristen M. Strack Marcella H. Dunaway Stefan E. Schulenberg

T

he 16PF (Fifth Edition, 16PF-5) and the CPI-434 are two commonly used measures of normal (nonpathological) personality. Both measures have undergone revisions, are used in a variety of capacities, and are the focus of numerous research studies. Although neither measure is without criticism, they are generally considered to be psychometrically sound (Aiken and Groth-Marnat, 2006; Gregory, 2007). The focus of this chapter is on the multicultural applications of these measures with racial and ethnic minorities in the United States. The previous edition of this book featured a chapter on the 16PF and the CPI by Kwan and Aldarondo (2001). We reviewed this work, started from the ground up, and then incorporated material published since the previous edition. This chapter begins with a discussion of the 16PF-5, followed by the CPI-434 and pertinent multicultural assessment issues. The chapter concludes with recommendations and directions for future research.

INTRODUCTION TO THE 16PF-5 The Fifth Edition of the Sixteen Personality Factor Questionnaire (16PF-5; Cattell, Cattell, and Cattell, 1993; Russell and Karol, 2002) is a 185-item instrument that can be used as a measure of personality with people between We are grateful to Laura Johnson and William P. Deal for thoughtful suggestions on a previous draft of this chapter.

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376 HANDBOOK OF MULTICULTURAL ASSESSMENT the ages of sixteen and eighty-two (Cattell and Schuerger, 2003; Russell and Karol, 2002). It provides ten scores (standard ten scale), with a mean of 5.5 and a standard deviation of 2. Scores above 7 are viewed as high scores, and scores below 4 are considered to be low (Conn and Reike, 1994; Russell and Karol, 2002). Each primary scale contains ten to fifteen items, and each item has a three-point response format (Cattell, 2004; Russell and Karol, 2002). The 16PF-5 requires a fifth-grade reading level, and it can be administered in group or individual settings and in computer or paper-and-pencil formats (Cattell and Schuerger, 2003; Russell and Karol, 2002; Schuerger, 2000). The 16PF was developed by Raymond B. Cattell. Using factor analysis, Cattell reduced numerous personality adjectives found in the English language to a set of categories, ultimately discovering sixteen factors that accounted for the most variance (Cattell, 2004). Since the first edition of the measure in 1949, it has been revised in 1956, 1962, 1968, and 1993 (Cattell and Schuerger, 2003). Similar measures are available for youths (Adolescent Personality Questionnaire, Children’s Personality Questionnaire), and the 16PF Select Questionnaire was developed for use in employment settings (Cattell, 2004; Schuerger, 2000). The 16PF-5 contains sixteen primary factor scales and five global factor (second-order) scales. Table 17.1 contains a description of the primary and global scales of the 16PF-5. The 16PF-5 also has three validity scales: the Impression Management scale (IM), which measures social desirability; the Acquiescence scale (ASQ), which measures the degree of agreement with a statement regardless of the content of the statement; and the Infrequency scale (INF), which detects random responding (Cattell and Schuerger, 2003; Craig, 1999; Russell and Karol, 2002). The 16PF-5 is used in both clinical and counseling settings (Cattell, 2004; Cattell and Schuerger, 2003). It has been recommended for use as a complement to the Minnesota Multiphasic Personality Inventory-2 (Meyer and Deitsch, 1996). Barton and Dreger (1986) used earlier versions of the 16PF and MMPI to predict marriage roles in couples seeking marital counseling. They found that the MMPI was a better predictor of marital roles than the 16PF, yet when both measures were used, prediction was enhanced. In studies pairing the 16PF with the Millon Clinical Multiaxial Inventory, the 16PF was found to be of added assistance in the diagnosis of personality disorders (DeLamatre and Schuerger, 1992; Terpylak and Schuerger, 1994). The 16PF has also been used in a variety of employment and career settings (Hartung, Borges, and Jones, 2005; Meronek and Tan, 2004; Schuerger, 1995; Wakcher, Cross, and Blackman, 2003).

Reliability of the 16PF-5 According to the 16PF-5 technical manual (Conn and Reike, 1994), the internal consistency of the instrument was examined with three samples: two from the general population and one group of college students (N = 4, 660). The

MULTICULTURAL UTILITY OF THE 16PF AND THE CPI-434 IN THE UNITED STATES

Table 17.1. 16PF-5 Scale Descriptions Primary Scales

Description (Designed to Measure)

Warmth (A)

Warmth in interpersonal relationships, and the desire to emotionally exchange with people

Reasoning (B)

Intelligence (brief measure)

Emotional Stability (C)

Emotional coping with everyday life and difficulties, emotional reactions, and emotional well-being

Dominance (E)

Assertiveness, dominance, and deference

Liveliness (F)

Eagerness and spontaneity in social situations

Rule-Consciousness (G)

The degree to which people follow and respect rules

Social Boldness (H)

Sociability versus timidity and inhibition

Sensitivity (I)

Sentimentality and sensitivity

Vigilance (L)

Watchfulness and degree of trust

Abstractedness (M)

Impracticality

Privateness (N)

Level of self-disclosure

Apprehension (O)

Anxiety and assuredness

Openness to Change (Q1)

Ability to be open to new ideas and new ways of behaving

Self-Reliance (Q2)

Preference for doing things alone or with others

Perfectionism (Q3)

Compulsivity and discipline

Tension (Q4)

Patience and energy

Global Scales

Description (Designed to Measure)

Extraversion (EX)

Preferences relating to social situations (extraversion versus introversion)

Anxiety (AX)

Level of worry and concern

Tough-Mindedness (TM)

Sensibleness and objectivity when dealing with others

Independence (IN)

Dominance, assertiveness, and influence over others

Self-Control (SC)

Restraint

Note: Derived from Cattell and Schuerger (2003), Conn and Reike (1994), Craig (1999), and Schuerger (2000).

377

378 HANDBOOK OF MULTICULTURAL ASSESSMENT internal consistency reliability for the primary scales ranged from the mid-.60s (Openness to Change) to the mid-.80s (Social Boldness), with a median reliability of .75 (Conn and Reike, 1994). Reliability data represent an improvement over previous editions (Aiken and Groth-Marnat, 2006; Conn and Reike, 1994). Test-retest reliability was examined over a two-week interval (N = 204) and a two-month interval (N = 159) with two samples of college students (Conn and Reike, 1994). For the primary scales of the 16PF-5, the two-week test-retest reliability ranged from the upper .60s (Reasoning) to the upper .80s (Social Boldness), with a median reliability of .80. The two-month test-retest reliability for the primary scales ranged from the mid-.50s (Vigilance) to the upper .70s (Social Boldness), with a median reliability of .69 (Conn and Reike, 1994). Test-retest reliabilities for the global scales over a two-week interval ranged from the mid-.80s (Independence and Anxiety) to the low .90s (Extraversion), with a median reliability of .87. The two-month test-retest reliability ranged from the low .70s (Anxiety) to the low .80s (Tough-Mindedness), with a median reliability of .80 (Conn and Reike, 1994).

Validity of the 16PF-5 The 16PF-5 is a prime example of a factor-analytically derived measure of personality, and studies that affirm the factor structure of the 16PF offer support for construct validity (Cattell and Schuerger, 2003). By way of examples, Cattell and Cattell (1995) reported the results of a factor-analytic study that confirmed the sixteen primary factors and six global factors (including intelligence), and Chernyshenko, Stark, and Chan (2001) confirmed that the instrument could be factored into sixteen first-order factors and five second-order factors. (See Hofer and Eber, 2002, for a review of studies relating to the second-order factor structure of the 16PF.) The 16PF-5 has also been compared to other personality measures, providing additional support for validity. Conn and Reike (1994) reported a study that compared the 16PF to four other measures of personality: Personality Research Form, California Psychological Inventory, NEO Personality Inventory-Revised, and the Myers-Briggs Type Indicator. The results showed a high degree of correspondence between the 16PF and these four personality measures. The predictive validity of the 16PF-5 has been examined in several studies (Hartung et al., 2005; Shaughnessy, Spray, Moore, and Siegel, 1995). For instance, Meronek and Tan (2004) found that the Independence scale was predictive of firefighters’ job satisfaction, and the Tough-Mindedness scale was predictive of supervisors’ judgments of job performance.

16PF-5 Normative Data When the 16PF-5 was first released, normative data were based on 1990 census data (Conn and Reike, 1994). The 1990 norms were criticized because of the

MULTICULTURAL UTILITY OF THE 16PF AND THE CPI-434 IN THE UNITED STATES

overrepresentation of individuals between the ages of fifteen and forty-four and the underrepresentation of individuals within the age ranges of fifty-five to sixty-four and sixty-five and over (Meyer and Deitsch, 1996). People with higher levels of education were overrepresented, whereas those with a high school diploma or less education were underrepresented (Meyer and Deitsch, 1996). When the 2000 U.S. census data were released, the norms for the 16PF-5 were updated accordingly (Aiken and Groth-Marnat, 2006; Cattell and Schuerger, 2003; Russell and Karol, 2002). The norms were stratified according to race, age, education, and gender. The norms for the 16PF included people endorsing White/Caucasian, African American, American Indian, Asian American, Hispanic American, and multiracial descent (Cattell and Schuerger, 2003). The updated norm sample closely matches the 2000 U.S. census figures with regard to gender and race (Russell and Karol, 2002).

Cultural Considerations of the 16PF-5 Development of the 16PF-5 focused on updating item content and norms (Cattell and Cattell, 1995; Conn and Reike, 1994; Russell and Karol, 2002). The instrument developers attempted to remove items that were dated; items that contained gender, racial/ethnic, or disability bias; and items that could not be easily translated into other languages or cultures (Aiken and Groth-Marnat, 2006; Cattell and Cattell, 1995; Russell and Karol, 2002). The 16PF has been translated into over thirty languages (Cattell, 2004) and has been studied with cross-cultural samples, including college students in Korea (Sohn, 2001) and South Africa (Abrahams and Mauer, 1999), military personnel in Italy (Lingiardi, Falanga, and D’Augelli, 2005), professional women in India (Afroz and Mittra, 2003), and employees in England (Lord, 1996). The 16PF also has an associated Web site (http://www.16pfworld.com), which offers professionals the opportunity to administer the measure in various languages (Cattell, 2004; Cattell and Schuerger, 2003). The Web site allows a respondent to take the latest edition of the measure in his or her language of choice. The results are then compared to norms for the particular language group, and a report in a specific language can be generated. Although this Web site is a positive step, assessors should exercise caution. Subtle differences may be introduced when measures are translated, and each new instrument’s method of translation and psychometric properties should be examined separately. Research using the 16PF-5 with racial and ethnic minorities in the United States appears more limited than cross-cultural research internationally, which seems surprising considering the popularity of the inventory (Cattell, 2004). Table 17.2 contains studies that were conducted with U.S. racial and ethnic minorities using older editions of the 16PF. Recent studies using the 16PF-5 have included racial and ethnic minorities (Low, Williamson, and Cottingham,

379

College students

College students

Male felons

Fourth

Fourth

Fourth

Fourth

Rutledge, Hancock, & Rutledge (1996)

Lee (1994)

Orozco (1993)

Seibel, Wallbrown, Reuter, & Barnett (1990)

Child care employees

Dementia caregivers

Fourth

Knight & McCallum (1998)

Study Samples

Edition

Authors

243 Caucasians, 85 African Americans, 10 Hispanics, and 9 Asian or Native Americans

328 Mexican Americans

Primarily African American. Exact numbers were not provided.

54 African Americans and 89 Caucasians

110 Caucasians and 44 African Americans

Ethnic Breakdown Findings

Examined motivational distortion in male felons. A significant relationship between the motivational distortion score and the score on several of the primary scales was found. The authors determined that the motivational distortion corrections in the 16PF-4 manual could be generalized to a sample of male felons.

Examined the relationship between level of acculturation and personality. The Mexican American college students yielded different scores in comparison to the college norm group (lower on B, M, and N scales). Acculturation level was related to four of the scales (E, F, H, and N).

More desirable employees differed from less desirable employees on seven scales of the 16PF.

Investigated thought rebounding—the increase of a thought after a period of suppression of the thought. Anxiety scale was predictive of thought rebounding (less anxiety predicted more thought rebound). Race/ethnicity predicted thought rebound (Caucasians more than African Americans).

Cardiovascular reactivity was compared to induced stress, depression and anxiety, and positive stress appraisals. Used the motivational distortion scale and found no significant differences based on race/ethnicity. Positive reappraisal was more common among African Americans than Caucasians.

Table 17.2. Multicultural Studies Involving the 16PF

Fourth

Fourth

Fourth

Fourth

Fourth

Third

Whitworth & Perry (1990)

Clark (1986)

Johnson et al. (1985)

DeBlassie & Franco (1983)

Golden (1970)

Meredith (1966)

College students

College students

College students

Families residing in Hawaii

College students

College students

154 Japanese Americans and 140 Caucasians

117 Japanese Americans and 100 Caucasians

51 Hispanic Americans

169 Caucasians, 52 Chinese Americans, and 125 Japanese Americans

91 African Americans and 109 Caucasians

140 Caucasians, 195 Mexican Americans (English version), and 211 Mexican Americans (Spanish version)

Japanese and Caucasian males differed on eleven scales, and Japanese and Caucasian females differed on eight scales.

Different second-order factor structures were found for Japanese Americans and Caucasians.

Investigated students’ ability to predict scores on the 16PF. The students were able to predict their scores on eight of the 16PF scales.

High degree of similarity across ethnic groups. Results suggested that age influenced test scores.

Investigated the attitudes, personality, and social backgrounds of Caucasian and African American college students based on majors. African American science majors were more tough-minded than African American nonscience majors. Some racial/ethnic differences were noted.

Significant differences were found between the groups. Caucasians and Mexican Americans taking the measure in Spanish differed on ten scales. Caucasians and Mexican Americans taking the measure in English differed on five scales. Mexican Americans taking the measure in English and Mexican Americans taking the measure in Spanish differed on seven scales.

382 HANDBOOK OF MULTICULTURAL ASSESSMENT 2004; Mack-Allen, 2005; Manuel, Borges, and Gerzina, 2005); however, the data are rarely examined from a multicultural perspective. Clearly, multicultural studies with the 16PF-5 with U.S. racial and ethnic minorities are lacking. Some earlier multicultural studies found differences on some scales between Caucasians and other racial and ethnic groups, such as Japanese Americans and Mexican Americans. Schuerger (1995, 2000) noted that assessors should consider an individual’s racial and ethnic background when making interpretations based on the results of the 16PF; however, dramatic differences should not be expected. It is our perspective that assessors who use the 16PF-5 should be familiar with the available literature in addition to being competent in multicultural assessment issues. Additional multicultural research is necessary with U.S. samples to better understand how the measure is affected by variables such as acculturation and racial and ethnic identity. Such variables are related to substantial within-group variability characteristic of racial/ethnic groups. Further clarification of these interrelationships will aid assessors in enhancing their interpretive accuracy when conducting multicultural assessments with the 16PF-5.

INTRODUCTION TO THE CPI-434 The California Psychological Inventory (CPI-434; Gough and Bradley, 1996), a 434-item measure of personality with a true-false format, requires a seventhgrade reading level and is intended for use with individuals aged twelve to seventy (Donnay and Elliott, 2005; Gough and Bradley, 1996; Groth-Marnat, 2003). Designed primarily through the criterion-keying approach to test construction, with raw scores translated into T-scores (Aiken and Groth-Marnat, 2006; Gough and Bradley, 1996; Gregory, 2007), it can be administered individually or in groups and in computer or paper-and-pencil formats (Groth-Marnat, 2003). The CPI-434 is designed to assess personality with descriptors used by ordinary people to classify and understand their own behavior and the behavior of others (Gough, 2000; Gough and Bradley, 1996). It achieves this goal by assessing an individual’s typical behavior, attitudes, and feelings in such a way as to create an accurate description of the individual being assessed (Donnay and Elliott, 2005; Groth-Marnat, 2003). The CPI-434 assesses personality using twenty folk concepts (folk scales) believed to be universally applicable in everyday interpersonal life (Gough and Bradley, 1996; Gough and Sandhu, 1964). The purpose of the CPI folk scales is twofold: as a predictor to determine an individual’s behavior in a given setting and as a means of identifying people who exhibit behavior described as significantly differentiating from that expected in a specified situation (Gough and Bradley, 1996). The folk scales can be grouped into classes intended to describe clusters of personality traits: Class

MULTICULTURAL UTILITY OF THE 16PF AND THE CPI-434 IN THE UNITED STATES

I scales (interpersonal aspects such as self-concept and social effectiveness), Class II scales (personal responsibility, values, and self-control), Class III scales (achievement-related behaviors and intellectual tendency), and Class IV scales (remaining factors within a person that contribute to the overall expression of personality) (Donnay and Elliott, 2005; McAllister, 1996). Table 17.3 contains a description of CPI-434 scales. Several scales facilitate the determination of profile validity. The Well-Being (Wb) scale aids in the detection of a fake bad profile, the Good Impression (Gi) scale measures positive impression management, and the Communality (Cm) scale measures random or grossly exaggerated responding (Gough and Bradley, 1996; Groth-Marnat, 2003). In addition to the twenty folk scales, scores are calculated for three vector scales, intended to describe the personality structure that underlies the entire inventory. The vector scales are Externality/Internality (v.1), NormDoubting/or -Favoring (v.2), and Ego-Integration (v.3) (Donnay and Elliott, 2005; Gough, 2000; Gough and Bradley, 1996). An individual’s personality can be categorized into different types (Alpha, Beta, Gamma, and Delta) depending on the pattern of scores for the vector scales (McAllister, 1996). According to McAllister (1996), Alphas tend to be task-oriented responsible leaders who generally follow rules. Betas tend to be internally focused and are dependable. Gammas are generally sociable and creative people who have good leadership abilities, and Deltas tend to be private, reserved individuals. Scores are also calculated on thirteen special-purpose scales. Examples of these scales are Managerial Potential, Work Orientation, Creative Temperament, Leadership Potential, Law Enforcement Orientation, Tough-Mindedness, and Anxiety (Donnay and Elliott, 2005; Gough and Bradley, 1996; McAllister, 1996).

Reliability of the CPI-434 Internal consistency reliabilities for the CPI-434 were calculated on three thousand males and three thousand females (Gough and Bradley, 1996). Coefficients for the folk scales range from the low .60s (Py) to the mid-.90s (Wb) for the total sample. For the vector scales, coefficients range from the upper .70s (v.2) to the upper .80s (v.3) for the total sample. Test-retest reliability data were calculated for high school students (N = 237) (one-year interval) and adults (females n = 91, males n = 44) (five-year interval for females and twenty-five-year interval for males). Students’ performance on the folk scales yielded test-retest reliability coefficients ranging from the low .50s (Cm) to the mid-.80s (F/M). Adult folk scale test-retest reliability coefficients range from the mid-.30s (Ac) to the mid-.70s (Sc) for females and the upper .30s (F/M) to the low .80s (Do) for males (Gough and Bradley, 1996).

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384 HANDBOOK OF MULTICULTURAL ASSESSMENT Table 17.3. CPI-434 Scale Descriptions Folk Scales by Class

Description (Designed to Measure)

Class I Scales Dominance (Do)

Leadership capacity and positive interpersonal dominance

Capacity for Status (Cs)

Personal traits related to success and achievement orientation

Sociability (Sy)

Propensity to be outgoing

Social Presence (Sp)

Self-assurance and confidence in social situations

Self-Acceptance (Sa)

Sense of personal worth and self-concept

Independence (In)

Tendency to be self-reliant and autonomous

Empathy (Em)

Ability to relate to others’ thoughts and personal experience

Class II Scales Responsibility (Re)

Ability to understand and comply with social rules and accept consequences for behavior

Socialization (So)

Integrity and ability to conform to societal rules

Self-Control (Sc)

Capacity for impulse control and goal-directed behavior

Good Impression (Gi)

Propensity to provide socially desirable answers

Communality (Cm)

Random and unusual patterns of responding

Well-Being (Wb)

Feelings of social and psychological well-being

Tolerance (To)

Tolerance and acceptance of others

Class III Scales Achievement via Conformance (Ac) Ability and need to achieve in structured situations Achievement via Independence (Ai) Ability and need to achieve in unstructured situations Intellectual Efficiency (Ie)

Personality correlates of intellectual ability (that is, competency)

Class IV Scales Psychological-Mindedness (Py)

Insight and interest into behavior and motivations of others

Flexibility (Fx)

Flexibility in thinking and behavioral plasticity

Femininity/Masculinity (F/M)

Patience and interpersonal sensitivity

Note: Derived from Donnay and Elliott (2005), Gough and Bradley (1996), Groth-Marnat (2003), and McAllister (1996).

Validity of the CPI-434 Much of the research on the CPI has focused on practical applications, with a significant portion of the research relating to predictive validity (Groth-Marnat, 2003). The CPI has historically been helpful in predicting achievement in high school, college, and medical school, as well as student teacher, police, and

MULTICULTURAL UTILITY OF THE 16PF AND THE CPI-434 IN THE UNITED STATES

military personnel effectiveness (Gregory, 2007). There is limited research on the CPI in clinical environments (Aiken and Groth-Marnat, 2006). Factor-analytic studies of the CPI-434 primarily support five factors (Donnay and Elliott, 2005; Groth-Marnat, 2003). Gough and Bradley (1996) discussed a solution encompassing the following factors: (1) ascendance, (2) dependability, (3) originality, (4) conventionality, and (5) sensitivity. McAllister (1996) found that the twenty folk scales cluster onto the following factors: (1) social effectiveness, self-confidence, and inventiveness, (2) personal well-being and overall outlook, (3) independent thought, (4) social conformity and adherence to rules, and (5) dependence/independence and sensitivity.

CPI-434 Normative Data The CPI was originally created and validated on large numbers of Caucasian male and female high school and university students (McAllister, 1996). The CPI-434 manual (Gough and Bradley, 1996) reports normative data for fifty-two samples of males (N = 3, 000) and 42 samples of females (N = 3, 000) from high school, college, and graduate or professional school, as well as various occupational samples and other groups (including psychiatric patients and juvenile offenders). The ethnic breakdown of the current normative sample is not provided in the manual, but McAllister (1996) noted that efforts were made to accurately represent the general population with regard to variables such as age, sex, and educational level.

CPI-434 Cross-Cultural Considerations Originally published in 1956, the CPI was designed to measure constructs present in most cultures (Groth-Marnat, 2003). A revised version (Form 462, or the CPI-R) was published in 1986, with the current third edition (Form 434) following in 1996. Throughout the editions of the CPI, items have been revised or eliminated to ensure more politically correct language and reduce dated language (Gough, 2000). The CPI, in its various versions, has been translated into over forty languages (Groth-Marnat, 2003). A considerable amount of cross-cultural research has been completed with a range of samples, including young adults in India (Gough and Sandhu, 1964), various Japanese samples (Mizushima and DeVos, 1967; Nishiyama, 1975), Israeli citizens (Levin and Karni, 1970, 1971), college graduates in Taiwan (Ying, 1990, 1991), and students in Romania (Pitariu, 1981) and Greece (Repapi, Gough, Lanning, and Stefanis, 1983). The use of the CPI with U.S. racial and ethnic minorities has also been reported in the literature (see Table 17.4). Some studies report relative equivalence of CPI scores across racial/ethnic groups, while others raise concerns. In several studies, Caucasians tended to have higher folk scale scores than

385

CPI-434

CPI-434

CPI

CPI

Holmes (2001)

Davis, Hoffman, & Nelson (1990)

Cross & Burger (1982)

Edition

Schaubhut, Donnay, Thompson, & Morris (2004)

Authors

Findings

There were differences among the three ethnic groups; however, the 190 African authors concluded that they were not practically meaningful (small effect Americans, 190 Caucasians, and 190 sizes) and that the CPI-434 performs fairly across all three ethnic groups. Latinos/Hispanics

Ethnic Breakdown

College students

Job applicants

354 African Americans and 394 Caucasians

70 Native Americans (38 males, 32 females) and 100 Caucasians (47 males, 53 females)

A number of questions (74 percent) were answered true more often by African Americans than by Caucasians. An average of 38 percent of the items from each scale resulted in significant differences between the groups. Significant racial differences were found for males but not for females; however, the pattern of responding was different for African American and Caucasian females.

Native Americans scored significantly lower than Caucasians on several scales. These differences appeared to be related to gender. The findings were interpreted to mean that Native American women may be less dominant and less controlling than Caucasian women. Caucasian men were found to hold more conventional values than Native American men. The authors asserted that the CPI may put Native American women at a disadvantage when it is used for job screening purposes and that such scores should be compared to cultural norms.

Community 400 Caucasians, 164 African Americans were found to score significantly lower than residents African Americans Caucasians on eleven of twenty scales.

Employed adults

Study Samples

Table 17.4. Multicultural Studies Involving the CPI

CPI

CPI

CPI

CPI

CPI

Jones (1978)

Cross, Barclay, & Burger (1978)

Blane & Yamamoto (1970)

Mason (1969)

Gill & Spilka (1962)

772 African American and Caucasian participants (no further breakdown was provided)

41 African American males, 56 African American females, 62 Caucasian males, 67 Caucasian females Significant differences were found among the groups on eight of eighteen folk scales. Caucasians had higher scores on Sp, Wb, To, Cm, Ai, Ie, and Fx. African Americans had higher scores on the Gi scale. Score differences appeared to be more prevalent for African American males than females.

Substantial differences were reported between African Americans and Caucasians. African Americans reported more dominant tendencies, concern with impulse control, self-criticisms, cynicism, conventional moral attitudes, psychological toughness, and conformity, with less adventurousness, less vulnerability, and less risk taking.

22 Native Americans, 9 Mexican Americans, 16 Caucasians

High school 60 Mexican American students students (30 classified as achievers, 30 classified as underachievers)

Junior high school students

No significant differences were found between achieving and underachieving students on the Ai scale. Significant group differences were detected for the Ac, Ie, and So scales. The authors argued that the CPI is a valid measure for a Mexican American student sample.

Caucasians had the overall highest scores on all folk scales, followed by Mexican Americans and Native Americans, respectively.

High school 289 Japanese Japanese Americans had higher F/M scores than Caucasians. students Americans, 80 Caucasians, 93 Japanese

College students

Junior college students

388 HANDBOOK OF MULTICULTURAL ASSESSMENT minority comparison groups. In particular, there appear to be significant discrepancies among African Americans and Native Americans when compared to Caucasians. Similar to conclusions regarding the 16PF-5, assessors should be familiar with the literature on the CPI in order to inform their interpretations; however, much of the published CPI research uses older versions (Kwan and Aldarondo, 2001). Additional research is needed to better document the psychometric properties of the CPI-434 with racial and ethnic minorities in the United States and more effectively delineate the potential influence of such important variables as acculturation and racial/ethnic identity. More attention needs to be given to within-group diversity and how measures such as the 16PF-5 and the CPI-434 may or may not be appropriate based on these cultural differences. For those interested in additional research on the CPI-434, the Comprehensive Bibliography of the CPI Assessment: 1948–2002 (CPP, 2003) is a useful place to begin. The source contains a thorough listing, including international and multicultural studies; however, given that the resource is alphabetized, it would be useful in future editions to also present studies in sections by subject matter (for example, multicultural studies and international studies).

MULTICULTURAL PERSONALITY ASSESSMENT: IMPLICATIONS FOR THE 16PF-5 AND THE CPI-434 Providers of mental health services are encountering greater numbers of racially and ethnically diverse clients (American Psychological Association, 1990; Flores and Obasi, 2003). It is imperative that assessors increase their cultural competencies, empirically investigate multicultural constructs, and use and develop assessment measures that are psychometrically sound with diverse populations (Flores and Obasi, 2003; Scogin and Crowther, 2005). The American Psychological Association (1990) published guidelines for mental health providers who work with individuals from different cultural, linguistic, and ethnic backgrounds. These guidelines include the importance of recognizing and accepting diversity, understanding the role a person’s culture or ethnicity plays in his or her background, and understanding the effects of socioeconomic status. Cultural competency (Sue and Sue, 2003) is pertinent to all involved in the mental health profession. Knowledge of an individual’s culture aids the provider in gaining a fuller picture of the individual, thereby improving assessment quality (Keitel, Kopala, and Adamson, 2001; Pope and Vasquez, 1998; Scogin and Crowther, 2005). Assessors using the 16PF-5 and CPI-434 need to consider certain factors at the outset, such as equivalence, acculturation, and ethnic/racial identity development. They should be aware of these and similar factors that may affect

MULTICULTURAL UTILITY OF THE 16PF AND THE CPI-434 IN THE UNITED STATES

an assessment. Prior to the discussion of several key areas, it is important to distinguish between etic and emic measures.

Etic Versus Emic Measures An emic instrument is a culture-specific measure that does not attempt to understand cultures outside the one of interest; an etic measure is a culture-universal instrument designed to compare constructs across cultures (Berry, 1969; Dana, 1993). Other terms have been introduced, such as imposed etic (Berry, 1969) and pseudo etic (Dana, 1998; Geisinger, 2003), referring to assumptions that constructs are etic even if no investigation of these constructs has been undertaken in different cultures. Although both the 16PF and the CPI were originally designed based on aspects of U.S. culture, language, for example (Kwan and Aldarondo, 2001), both measures appear to be moving in directions that take into account variations in culture (as evidenced by modifications to items), although international efforts are ahead of multicultural efforts in the United States. In general, both etic and emic measures should be used to arrive at an accurate personality description (Triandis and Suh, 2002) because bias may result with multicultural use of instruments normed on a single cultural group. This is not as easy as it may seem, given that emic measures are often research oriented, inapplicable to other cultural groups, expensive, and time-consuming, which results in only a few such measures being available (Dana, 1998; Roysircar-Sodowsky and Kuo, 2001).

Equivalence The concept of equivalence should be addressed when using psychological assessment measures with individuals from different cultural backgrounds. Different types of equivalence include linguistic equivalence, conceptual equivalence, functional equivalence, and metric equivalence (Dana, 1998; Geisinger, 2003; Okazaki and Sue, 1995). First, it is necessary to assess whether the instrument to be administered is in the individual’s preferred language (Flores and Obasi, 2003). Even if a person is competent with the English language, this does not necessarily mean that English is the preferred language. In addition, a person may be able to competently speak a language but have difficulty reading and writing in the language, or there may be problems understanding English idioms related to psychological and emotional states, introducing error into the assessment (American Educational Research Association, American Psychological Association, and National Council on Measurement in Education, 1999; Okazaki and Sue, 1995). Second, one should assess whether the construct being measured (aspects of personality) is the same across cultures (Dana, 1993; Flores and Obasi, 2003; Geisinger, 2003). A measure of a particular construct developed for Caucasians may not be exactly equivalent for an

389

390 HANDBOOK OF MULTICULTURAL ASSESSMENT Asian American sample, for example (Segal and Coolidge, 2004). Third, it is necessary to assess functional equivalence, that is, whether the instrument has the same purpose across cultures (Geisinger, 2003). Finally, metric equivalence refers to whether the psychometric properties of the measure are similar across cultures and whether scores in one culture are equivalent to scores in another (Geisinger, 2003). Such issues demand consideration with racial and ethnic minorities in the United States because they may have a dramatic impact on the validity of a psychological assessment.

Acculturation Acculturation occurs when groups of individuals from different cultural groups come into contact and change one another (Berry, 2002; Gonzalez, 2005). Both groups may change based on contact; however, change tends to occur in one group more than the other (Berry, 2002). In the United States, Caucasians are typically defined as the majority culture, with racial and ethnic minorities identified as the acculturating group. Berry’s acculturation model (2002) posits four possible strategies that may result with respect to cultural maintenance and the amount of contact with other cultures: assimilation, separation, integration, and marginalization (Berry, 2002). Assimilation is when a person does not maintain much of his or her own culture, but instead seeks frequent contact with the dominant culture. Separation occurs when an individual seeks to maintain his or her culture while simultaneously avoiding interaction with other cultures. Integration is when a person maintains his or her culture and also interacts with other cultures, and marginalization results when an individual has limited possibility or interest in maintaining his or her culture and limited interest or ability to interact with other cultures (Berry, 2002). Each strategy is a complex process influenced by a variety of factors, such as behavioral, social, or language skills; racism; or mental illness, for example. Given that acculturation may have a major impact on psychological functioning, resulting in stress and influencing well-being, it is an important variable to consider when conducting personality assessments (Berry, 2002; Okazaki and Sue, 1995, 2000; Scogin and Crowther, 2005; Velasquez, 1995). Individuals conducting assessments with members of minority groups should assess a person’s degree of acculturation prior to using personality measures such as the 16PF-5 and the CPI-434 (recall that the 16PF is considered to have counseling and clinical applications, while the CPI is a counseling measure, not a clinical measure). Areas that should be addressed when assessing acculturation include society of origin, society of settlement, moderating factors (demographic factors, socioeconomic status, social support, prejudice, discrimination), psychological variables (acculturative stress, well-being), language proficiency and preference, traditions, values, and the family’s level of acculturation and attitude regarding acculturation (Berry, 2002; Dana, 1993;

MULTICULTURAL UTILITY OF THE 16PF AND THE CPI-434 IN THE UNITED STATES

Huff and Kline, 1999; Okazaki and Sue, 1995). Acculturation instruments have been developed to aid in assessing the construct; however, they have various degrees of psychometric support and should be evaluated accordingly (see, for example, Gonzalez, 2005, and Kim and Abreu, 2001).

Racial and Ethnic Identity In addition to assessing acculturation, it is recommended that assessors document an individual’s racial and ethnic identity development, allowing one to better understand within-group differences and a person’s unique personality development (Dana, 1993, 2005; Kohatsu and Richardson, 1996). Cultural groups such as Asian Americans, Hispanic Americans, and Native Americans have considerable within-group heterogeneity, and within-group differences may be greater than between-group differences (Allen, 2002; Scogin and Crowther, 2005; Trimble, Helms, and Root, 2003). Racial identity and ethnic identity have been used somewhat interchangeably; however, they are thought to be separate, though related, concepts. Both terms refer to a sense of group identity that an individual experiences based on commonalities between the individual and the group (Kohatsu and Richardson, 1996). Racial identity refers to when a person’s identity is based on identifying with a large racial group, such as African American or Asian American, and ethnic identity refers to when the person’s group identity is based on identifying with an ethnic or religious cultural group, such as Filipino American, Cherokee, Cuban American, or Jewish American (Kohatsu and Richardson, 1996; Trimble et al., 2003). Assessors are encouraged to learn about a person’s racial and ethnic identity development through discussion. For instance, individuals may be asked about their culture, ethnicity, and race and how these constructs affect them (Trimble et al., 2003). With regard to measures of racial and ethnic identity, several have been developed; however, they have not been validated to the extent that they are routinely used in practice (Scogin and Crowther, 2005). Additional psychometric support will contribute to their utility.

Recommendations: Tying It All Together Individuals involved in the assessment of people from racial/ethnic minority groups should give special attention to the selection, administration, and interpretation of assessment data (Dana, 1993; Scogin and Crowther, 2005; Velasquez, 1995), and assessors should not rely on a single method in order to derive interpretations. Providers should gather information from multiple sources to aid in interpretation, such as interviews, records, and measures (Flores and Obasi, 2003; Groth-Marnat, 2003; Okazaki and Sue, 1995; Scogin and Crowther, 2005). Those conducting assessments should evaluate confirming evidence in the light of disconfirming evidence from various sources to

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392 HANDBOOK OF MULTICULTURAL ASSESSMENT enhance the accuracy of interpretations. Assessors should also be aware of their own biases and how they may influence the assessment (Flores and Obasi, 2003; Okazaki and Sue, 1995). Sue (1996) provided seven useful guidelines for the practitioner who has been assigned the task of assessing an individual from an ethnic minority group: 1. Choose measures that are linguistically and conceptually appropriate for the individual. 2. Determine whether appropriate standardization procedures and normative data exist. 3. Interpret with caution the results of any instrument that has not been appropriately normed or standardized on the group of interest. 4. Use initial results to formulate hypotheses for additional testing. 5. Use multiple measures to establish convergent validity. 6. Attempt to understand the cultural background of the individual being assessed to interpret results in the context of the person’s cultural identity. 7. Consult with others who are more familiar with the examinee’s cultural background to ensure appropriate interpretation of results. The importance of establishing rapport should not be overlooked, especially relating to multicultural assessments. Establishing rapport helps the respondent’s comfort level and provides time for the assessor to gather information that will aid in determining the suitability of measures and facilitating culturally appropriate interpretations (Allen, 1998; Scogin and Crowther, 2005; Velasquez, 1995). A person’s previous experience with assessment should be reviewed (Allen, 2002). Some people may have had negative experiences that may influence the current assessment (Allen, 2002; Scogin and Crowther, 2005; Velasquez, 1995), and individuals with limited experience may be unduly influenced by preexisting expectations. The assessment, including its purpose, how measures will be selected, and how the results will be communicated, should be discussed (Allen, 2002; Roysircar-Sodowsky and Kuo, 2001). It is also important to review the results with the respondent in order to collect feedback that may be helpful in ensuring assessment quality (Allen, 2002; Flores and Obasi, 2003). Assessors should strive for cultural competence, that is, gains in awareness, knowledge, and skills (Sue and Sue, 2003). Cultural competence is imperative because an individual’s cultural background affects the way that he or she thinks, behaves, feels, and interprets the world (Aponte and Johnson, 2000; Flores and Obasi, 2003). Several authors have discussed the importance of

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cultural competence in psychological assessment (Chavez and Gonzales-Singh, 1980; Scogin and Crowther, 2005; Velasquez, 1995), and it has been suggested that this process should start at the training level with integrated cultural issues and supervision throughout (Allen, 2002; Dana, 2005). There are various methods that clinical and counseling psychology graduate programs may employ to meet this goal, such as offering specialized cross-cultural psychology seminars, a specialty focus in cross-cultural counseling or clinical psychology, or infusing culture into each course. With specific regard to graduate-level assessment training in clinical and counseling psychology programs, one method to help foster a growing awareness of multicultural issues is to assign presentations based on multicultural assessment readings where students rotate through the course and facilitate discussion based on the material they present (for example, acculturation, ethnic/minority identity development, or within-group variability). To hone test development and evaluation and multicultural assessment skills, graduate students may be assigned to write and present a paper that is a thorough, multicultural psychometric evaluation of an intelligence measure (in the case of a cognitive assessment course) or a personality measure (in the case of a personality assessment course). Given the importance of understanding nonpathological personality functioning in addition to psychopathology and considering the continued relevance of the 16PF and the CPI to the training of those learning assessment (Watkins, 1991), these measures can readily be included in such training exercises.

FUTURE MULTICULTURAL RESEARCH WITH THE 16PF-5 AND THE CPI-434 Multiple avenues of research may be pursued with these measures. For instance, the normative data for the 16PF-5 and the CPI-434 with U.S. racial and ethnic minorities would benefit from expansion. These measures were established with predominantly Caucasian samples, and additional norms would be of assistance in enhancing multicultural interpretations. Given wide within-group variability, some have advocated the development of specific subgroup norms so that an individual could be compared with more specific regard for his or her cultural group (Chavez and Gonzales-Singh, 1980). For example, this would entail developing norms for subgroups within the Hispanic population (such as Latin Americans and Cuban Americans) or the Asian American population (such as Chinese Americans and Korean Americans). Although this issue is complex and would require substantial effort in time and funds to overcome methodological and sampling problems (for a more involved discussion, see Okazaki and Sue, 2000), it is worthy of consideration.

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394 HANDBOOK OF MULTICULTURAL ASSESSMENT With regard to translations of these measures, it is promising that editions are developed for U.S. racial and ethnic minorities, the Spanish-American version of the Fifth Edition of the 16PF being an example (Cattell, 2004). However, researchers and practitioners should evaluate their psychometric properties in their own right and not assume that the psychometric properties of the original will carry over to the translated version. Further studies with translated measures are needed. Also, given that behaviors defined as socially desirable may fluctuate cross-culturally (Flores and Obasi, 2003), additional multicultural studies are warranted to understand how such variables as response bias influence responses to the 16PF-5 and the CPI-434. Relating specifically to the 16PF-5, even though it is a measure of nonpathological personality functioning, it is sometimes used in clinical assessments to give a fuller picture of an individual’s personality (Cattell, 2004). Future research should focus on culturally competent assessment of racial and ethnic minorities using the 16PF-5 in clinical contexts, and researchers in both counseling and clinical settings should investigate psychometric properties, acculturation, and racial and ethnic identity development in various samples. Alternatively, because the CPI-434 is not a clinical measure, research on these variables in counseling settings will aid in delineating the interrelationships among these variables. A variety of empirical questions may be asked in relation to these measures. For example, would individuals who are marginalized have different profiles on the CPI-434 and the 16PF-5 in comparison to those individuals who are integrated? If there are differences, which scales would be most affected? Such studies on acculturation would add to the research base of these measures and provide additional data on multicultural constructs. Researchers should also take into account mediating variables such as socioeconomic status. Well-standardized and validated assessment measures may have greater utility with U.S. racial and ethnic minorities who have attained middle-class status (Okazaki and Sue, 1995; Scogin and Crowther, 2005), and this may be the case with the 16PF-5 and the CPI-434. Kwan and Aldarondo (2001) noted the need for additional studies involving the current editions of the 16PF and CPI given that many of the available studies employed older versions. Since their chapter was published, the call for additional research in this area has gone largely unanswered in the published literature. One problem is that more studies need to be conducted. A second problem is that studies being conducted may not be published. Although some studies using the 16PF and the CPI with U.S. racial and ethnic minorities were found in journals, others were located in Dissertation Abstracts (Holmes, 2001; Mack-Allen, 2005; Orozco, 1993; Sohn, 2001). This discovery leads to two pertinent recommendations. First, researchers should be reminded of the file drawer problem in psychology (Rotton, Foos, Van Meek, and Levitt, 1995), where

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many studies that are conducted do not go on to be published. Thus, assessors who use these instruments should search for unpublished studies such as dissertations to enrich their understanding of relevant research with U.S. racial and ethnic minorities. Second, authors of these studies should make efforts to publish findings in peer-reviewed journals in order to make relevant and important research more readily available. We hope that these recommendations for future research will result in dramatically expanding the multicultural psychometric foundations of the 16PF-5 and the CPI-434, enhancing their utility.

References Abrahams, F., & Mauer, K. F. (1999). Qualitative and statistical impacts of home language on responses to the items of the Sixteen Personality Factor Questionnaire (16PF) in South Africa. South African Journal of Psychology, 29, 76–86. Afroz, N., & Mittra, R. (2003). Do personality traits define self-actualization in professional women? Journal of the Indian Academy of Applied Psychology, 29, 61–66. Aiken, L. R., & Groth-Marnat, G. (2006). Psychological testing and assessment (12th ed.). Needham Heights, MA: Allyn and Bacon. Allen, J. (1998). Personality assessment with American Indians and Alaska Natives: Instrument considerations and service delivery style. Journal of Personality Assessment, 70, 17–42. Allen, J. (2002). Assessment training for practice in American Indian and Alaska Native settings. Journal of Personality Assessment, 79, 216–225. American Educational Research Association, American Psychological Association, & National Council on Measurement in Education (1999). Standards for educational and psychological testing. Washington, DC: Author. American Psychological Association (1990). APA Guidelines for providers of psychological services to ethnic, linguistic, and culturally diverse populations. Washington, DC: Author. Aponte, J. F., & Johnson, L. R. (2000). The impact of culture on the intervention and treatment of ethnic populations. In J. F. Aponte & J. Wohl (Eds.), Psychological intervention and cultural diversity (2nd ed., pp. 18–39). Needham Heights, MA: Allyn and Bacon. Barton, K., & Dreger, R. M. (1986). Prediction of marital roles from normal and pathological dimensions of personality: 16PF and MMPI. Psychological Reports, 59, 459–468. Berry, J. W. (1969). On cross-cultural comparability. International Journal of Psychology, 4, 119–128. Berry, J. W. (2002). Conceptual approaches to acculturation. In K. M. Chun, P. B. Organista, & G. Marin (Eds.), Acculturation: Advances in theory, measurements, and applied research (pp. 17–37). Washington, DC: American Psychological Association.

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396 HANDBOOK OF MULTICULTURAL ASSESSMENT Blane, H. T., & Yamamoto, K. (1970). Sexual role identity among Japanese and Japanese-American high school students. Journal of Cross-Cultural Psychology, 1, 345–354. Cattell, H. E. (2004). The Sixteen Personality Factor (16PF) Questionnaire. In M. J. Hilsenroth, D. L. Segal, & M. Hersen (Eds.), Comprehensive handbook of psychological assessment: Vol. 2, Personality assessment (pp. 39–49). Hoboken, NJ: Wiley. Cattell, H. E., & Schuerger, J. M. (2003). Essentials of 16PF assessment. Hoboken, NJ: Wiley. Cattell, R. B., Cattell, A. K., & Cattell, H. E. (1993). Sixteen Personality Factor Questionnaire. Champaign, IL: Institute for Personality and Ability Testing. Cattell, R. B., & Cattell, H. E. (1995). Personality structure and the new fifth edition of the 16PF. Educational and Psychological Measurement, 55, 926–937. Chavez, E. L., & Gonzales-Singh, E. (1980). Hispanic assessment: A case study. Professional Psychology: Research and Practice, 11, 163–168. Chernyshenko, O. S., Stark, S., & Chan, K. Y. (2001). Investigating the hierarchical factor structure of the fifth edition of the 16PF: An application of the Schmid-Leiman orthogonalization procedure. Educational and Psychological Measurement, 61, 290–302. Clark, M. L. (1986). Predictors of scientific majors for Black and White college students. Adolescence, 21, 205–213. Conn, S. R., & Reike, M. L. (1994). 16PF Fifth Edition: Technical manual. Champaign, IL: Institute for Personality and Ability Testing. CPP. (2003). Comprehensive bibliography of the CPI assessment: 1948–2002. Palo Alto, CA: Author. Craig, R. J. (1999). Interpreting personality tests: A clinical manual for the MMPI-2, MCMI-III, CPI-R, and 16PF. Hoboken, NJ: Wiley. Cross, D. T., Barclay, A., & Burger, G. K. (1978). Differential effects of ethnic membership, sex, and occupation on the California Psychological Inventory. Journal of Personality Assessment, 42, 597–603. Cross, D. T., & Burger, G. (1982). Ethnicity as a variable in responses to California Psychological Inventory items. Journal of Personality Assessment, 46, 153–158. Dana, R. H. (1993). Multicultural assessment perspectives for professional psychology. Needham Heights, MA: Allyn and Bacon. Dana, R. H. (1998). Multicultural assessment of personality and psychopathology in the United States: Still art, not yet science, and controversial. European Journal of Psychological Assessment, 14, 62–70. Dana, R. H. (2005). Multicultural assessment: Principles, applications, and examples. Mahwah, NJ: Erlbaum. Davis, G. L., Hoffman, R. G., & Nelson, K. S. (1990). Differences between Native Americans and Whites on the California Psychological Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 2, 238–242.

MULTICULTURAL UTILITY OF THE 16PF AND THE CPI-434 IN THE UNITED STATES DeBlassie, R. R., & Franco, J. N. (1983). The difference between personality inventory scores and self-ratings in a sample of Hispanic subjects. Journal of Non-White Concerns, 11, 43–46. DeLamatre, J. E., & Schuerger, J. M. (1992). Personality disorder concept scales and 16PF dimensions. Psychological Reports, 70, 839–849. Donnay, D.A.C., & Elliott, T. R. (2005). The California Psychological Inventory. In L. E. Beutler & G. Groth-Marnat (Eds.), Integrative assessment of adult personality (2nd ed., pp. 227–261). New York: Guilford Press. Flores, L. Y., & Obasi, E. M. (2003). Positive psychological assessment in an increasingly diverse world. In S. J. Lopez & C. R. Snyder (Eds.), Positive psychological assessment: A handbook of models and measures. Washington, DC: American Psychological Association. Geisinger, K. F. (2003). Testing and assessment in cross-cultural psychology. In J. R. Graham & J. A. Naglieri (Eds.), Handbook of psychology: Vol. 10, Assessment psychology (pp. 95–117). Hoboken, NJ: Wiley. Gill, L. J., & Spilka, B. (1962). Some nonintellectual correlates of academic achievement among Mexican-American secondary school students. Journal of Educational Psychology, 53, 144–149. Golden, J. C. (1970). Cross-cultural second order factor structures of the 16PF. Journal of Personality Assessment, 42, 167–170. Gonzalez, J. C. (2005). Measures of acculturation. In G. P. Koocher, J. C. Norcross, & S. S. Hill III (Eds.), Psychologists’ desk reference (2nd ed., pp. 77–80). New York: Oxford University Press. Gough, H. G. (2000). The California Psychological Inventory. In C. E. Watkins & V. L. Campbell (Eds.), Testing and assessment in counseling practice (2nd ed., pp. 45–71). Mahwah, NJ: Erlbaum. Gough, H. G., & Bradley, P. (1996). CPI manual (3rd ed.). Palo Alto, CA: Consulting Psychologists Press. Gough, H. G., & Sandhu, H. S. (1964). Validation of the CPI socialization scale in India. Journal of Abnormal and Social Psychology, 68, 544–547. Gregory, R. J. (2007). Psychological testing: History, principles, and applications (5th ed.). Needham Heights, MA: Allyn and Bacon. Groth-Marnat, G. (2003). Handbook of psychological assessment (4th ed.). Hoboken, NJ: Wiley. Hartung, P. J., Borges, N. J., & Jones, B. J. (2005). Using person matching to predict career specialty choice. Journal of Vocational Behavior, 67, 102–117. Hofer, S. M., & Eber, H. W. (2002). Second-order factor structure of the Cattell Sixteen Personality Factor Questionnaire. In B. De Raad & M. Perugini (Eds.), Big five assessment (pp. 397–409). Kirkland, WA: Hogrefe & Huber Publishers. Holmes, K. Y. (2001). Personality in adulthood: Age, ethnic group and gender differences. Dissertation Abstracts International, 62, 6010.

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398 HANDBOOK OF MULTICULTURAL ASSESSMENT Huff, R. M., & Kline, M. V. (1999). The cultural assessment framework. In R. M. Huff & M. V. Kline (Eds.), Promoting health in multicultural populations: A handbook for practitioners (pp. 481–499). Thousand Oaks, CA: Sage. Johnson, R. C., Ahern, F. M., Nagoshi, C. T., McClearn, G. E., Vandenberg, S. G., & Wilson, J. R. (1985). Age and group-specific cohort effects on personality test scores: A study of three Hawaiian populations. Journal of Cross-Cultural Psychology, 16, 467–481. Jones, E. E. (1978). Black-White personality differences: Another look. Journal of Personality Assessment, 42, 244–252. Keitel, M. A., Kopala, M., & Adamson, W. S. (2001). Ethical issues in multicultural assessment. In L. A. Suzuki, J. G. Ponterotto, & P. J. Meller (Eds.), Handbook of multicultural assessment: Clinical, psychological, and educational applications (2nd ed., pp. 29–48). San Francisco: Jossey-Bass. Kim, B. S., & Abreu, J. M. (2001). Acculturation measurement: Theory, current instruments, and future directions. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 394–424). Thousand Oaks, CA: Sage. Knight, B. G., & McCallum, T. J. (1998). Heart rate reactivity and depression in African-American and White dementia caregivers: Reporting bias or positive coping? Aging and Mental Health, 2, 212–221. Kohatsu, E. L., & Richardson, T. Q. (1996). Racial and ethnic identity measurement. In L. A. Suzuki, P. J. Meller, & J. G. Ponterotto (Eds.), Handbook of multicultural assessment (pp. 611–650). San Francisco: Jossey-Bass. Kwan, K.L.K., & Aldarondo, F. (2001). Use of 16PF and CPI with U.S. racial and ethnic minorities: Issues of cultural application and validity. In L. A. Suzuki, J. G. Ponterotto, & P. J. Meller (Eds.), Handbook of multicultural assessment: Clinical, psychological, and educational applications (2nd ed., pp. 253–278). San Francisco: Jossey-Bass. Lee, R. E. (1994). Personality characteristics of very desirable and undesirable childcare workers in a residential setting. Psychological Reports, 74, 579–584. Levin, J., & Karni, E. S. (1970). Demonstration of cross-cultural invariance of the California Psychological Inventory in America and Israel by the Guttman-Lingoes smallest space analysis. Journal of Cross-Cultural Psychology, 1, 253–260. Levin, J., & Karni, E. S. (1971). A comparative study of the CPI femininity scale: Validation in Israel. Journal of Cross-Cultural Psychology, 2, 387–391. Lingiardi, V., Falanga, S., & D’Augelli, A. R. (2005). The evaluation of homophobia in an Italian sample. Archives of Sexual Behavior, 34, 81–93. Lord, W. (1996). Use of the 16PF in the UK: Applications in the workplace. European Review of Applied Psychology, 46, 67–72. Low, J. M., Williamson, D., & Cottingham, J. (2004). Predictors of university student lawbreaking behaviors. Journal of College Student Development, 45, 535–548.

MULTICULTURAL UTILITY OF THE 16PF AND THE CPI-434 IN THE UNITED STATES Mack-Allen, J. (2005). Relationship between emotional intelligence and personality factors in a community-based sample. Dissertation Abstracts International, 66, 3456. Manuel, R. S., Borges, N., & Gerzina, H. A. (2005). Personality and clinical skills: Any correlation? Academic Medicine, 80, 530–533. Mason, E. P. (1969). Cross-validation study of personality characteristics of junior high students from American Indian, Mexican, and Caucasian ethnic backgrounds. Journal of Social Psychology, 77, 15–24. McAllister, L. (1996). CPI interpretation (3rd ed.). Mountain View, CA: Consulting Psychologists Press. Meredith, G. M. (1966). Amae and acculturation among Japanese-American college students in Hawaii. Journal of Social Psychology, 70, 171–180. Meronek, J. S., & Tan, J. A. (2004). Personality predictors of firefighter job performance and job satisfaction. Applied H.R.M. Research, 9, 39–40. Meyer, R. G., & Deitsch, S. E. (1996). The clinician’s handbook. Needham Heights, MA: Allyn and Bacon. Mizushima, K., & DeVos, G. (1967). An application of the California Psychological Inventory in a study of Japanese delinquency. Journal of Social Psychology, 71, 45–51. Nishiyama, T. (1975). Validation of the CPI femininity scale in Japan. Journal of Cross-Cultural Psychology, 6, 482–489. Okazaki, S., & Sue, S. (1995). Cultural considerations in psychological assessment of Asian-Americans. In J. N. Butcher (Ed.), Clinical personality assessment: Practical approaches (pp. 107–119). New York: Oxford University Press. Okazaki, S., & Sue, S. (2000). Implications of test revisions for assessment with Asian Americans. Psychological Assessment, 12, 272–280. Orozco, S. (1993). Acculturation levels of Mexican American college students and performance on personality assessment inventories. Dissertation Abstracts International, 54, 5950. Pitariu, H. (1981). Validation of the CPI femininity scale in Romania. Journal of Cross-Cultural Psychology, 12, 111–117. Pope, K. S., & Vasquez, M. J. (1998). Ethics in psychotherapy and counseling: A practical guide. San Francisco: Jossey-Bass. Repapi, M., Gough, H. G., Lanning, K., & Stefanis, C. (1983). Predicting academic achievement of Greek secondary school students from family background and California Psychological Inventory scores. Contemporary Educational Psychology, 8, 181–188. Rotton, J., Foos, P. W., Van Meek, L., & Levitt, M. (1995). Publication practices and the file drawer problem: A survey of published authors. Journal of Social Behavior and Personality, 10, 1–13. Roysircar-Sodowsky, G., & Kuo, P. Y. (2001). Determining cultural validity of personality assessment: Some guidelines. In D. B. Pope-Davis & H.L.K. Coleman (Eds.), The

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400 HANDBOOK OF MULTICULTURAL ASSESSMENT intersection of race, class, and gender in multicultural counseling (pp. 213–239). Thousand Oaks, CA: Sage. Russell, M., & Karol, D. (2002). The 16PF 5th Edition: Administrator’s manual. Champaign, IL: Institute for Personality and Ability Testing. Rutledge, P. C., Hancock, R. A., & Rutledge, J. H. (1996). Predictors of thought rebound. Behavior Research and Therapy, 34, 555–562. Schaubhut, N. A., Donnay, D.A.C., Thompson, R. C., & Morris, M. L. (2004, August). Gender and ethnic differences on CPI 434 scales. Poster session presented at the annual convention of the American Psychological Association, Washington, DC. Schuerger, J. M. (1995). Career assessment and the Sixteen Personality Factor Questionnaire. Journal of Career Assessment, 3, 157–175. Schuerger, J. M. (2000). The Sixteen Personality Factor Questionnaire. In C. E. Watkins & V. L. Campbell (Eds.), Testing and assessment in counseling practice (2nd ed., pp. 73–110). Mahwah, NJ: Erlbaum. Scogin, F., & Crowther, M. R. (2005). Integrative personality assessment with older adults and ethnic minority clients. In L. E. Beutler & G. Groth-Marnat (Eds.), Integrative assessment of adult personality (2nd ed., pp. 338–355). New York: Guilford Press. Segal, D. L., & Coolidge, F. L. (2004). Objective assessment of personality and psychopathology: An overview. In M. J. Hilsenroth & D. L. Segal (Eds.), Comprehensive handbook of psychological assessment: Vol. 2, Personality assessment (pp. 3–13). Hoboken, NJ: Wiley. Seibel, H. P., Wallbrown, F. H., Reuter, E. K., & Barnett, R. W. (1990). Further evidence concerning motivational distortion on the Sixteen Personality Factor primaries by male felons. Journal of Personality Assessment, 55, 367–375. Shaughnessy, M. F., Spray, K., Moore, J., & Siegel, C. (1995). Prediction of success in college calculus: Personality, scholastic aptitude test, and screening scores. Psychological Reports, 77, 1360–1362. Sohn, W. J. (2001). Using differential item functioning procedures for investigating the cross-cultural equivalence of personality tests. Dissertation Abstracts International, 62, 3844. Sue, D. W., & Sue, D. (2003). Counseling the culturally diverse: Theory and practice (4th ed.). Hoboken, NJ: Wiley. Sue, S. (1996). Measurement, testing, and ethnic bias: Can solutions be found? In G. R. Sodowsky & J. C. Impara (Eds.), Multicultural assessment in counseling and clinical psychology (pp. 7–36). Lincoln, NE: Buros Institute of Mental Measurements. Terpylak, O., & Schuerger, J. M. (1994). Broad factor scales of the 16 PF Fifth Edition and Millon Personality Disorder Scales: A replication. Psychological Reports, 74, 124–126. Triandis, H. C., & Suh, E. M. (2002). Cultural influences on personality. Annual Review of Psychology, 53, 133–160.

MULTICULTURAL UTILITY OF THE 16PF AND THE CPI-434 IN THE UNITED STATES Trimble, J. E., Helms, J. E., & Root, M.P.P. (2003). Social and psychological perspectives in ethnic and racial identity. In G. Bernal, J. Trimble, & F. Leong (Eds.), Handbook of racial and ethnic minority psychology: Part III, Social and developmental process (pp. 239–275). Thousand Oaks, CA: Sage. Velasquez, R. J. (1995). Personality assessment of Hispanic clients. In J. N. Butcher (Ed.), Clinical personality assessment: Practical approaches (pp. 120–139). New York: Oxford University Press. Wakcher, S., Cross, K., & Blackman, M. C. (2003). Personality comparison of airline pilot incumbents, applicants, and the general population norms on the 16PF. Psychological Reports, 92, 773–780. Watkins, C. E. (1991). What have surveys taught us about the teaching and practice of psychological assessment? Journal of Personality Assessment, 56, 426–437. Whitworth, R. H., & Perry, S. M. (1990). Comparison of Anglo- and Mexican Americans on the 16PF administered in Spanish or English. Journal of Clinical Psychology, 46, 857–863. Ying, Y. (1990). Use of the CPI structural scales in Taiwan college graduates. International Journal of Social Psychology, 36, 49–57. Ying, Y. (1991). Validation of the California Psychological Inventory femininity scale in Taiwan college graduates. Journal of Multicultural Counseling and Development, 19, 166–172.

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Multicultural Applications of the Myers-Briggs Type Indicator Mary H. McCaulley Raymond A. Moody

T

he Myers-Briggs Type Indicator (MBTI) is a self-report questionnaire in the category of cognitive personality tests. It is concerned with individual differences in perception and judgment. Its history is unique among personality measures in that it was created in the 1940s and 1950s by two brilliant women who were not psychologists, had no graduate degrees, and were not in academia. Their purpose was to make it possible to validate and make practical use of that part of C. G. Jung’s theory described in his Psychological Types (Jung, 1921/1971), a theory that was not respected at the time and is still debated and misunderstood. The MBTI uses less familiar nonparametric statistics developed to fit the needs of the theory. Because this book is written for clinicians, researchers, and educators, we begin with Jung’s assumptions about the development of his types from infancy to maturity and the influence of families and cultures in fostering or interfering with normal development. We follow that with a brief description of how Isabel Briggs Myers constructed the MBTI to be faithful to Jung’s theory of psychological type, then describe reliability, validity, and applications of

Mary McCaulley died on August 26, 2003, at the age of eighty-three. Mary was cofounder of the Center for Applications of Psychological Type (CAPT) with Isabel Myers and was CAPT’s first president. She also was instrumental in building professional and academic credibility for Myers’s instrument: the Myers-Briggs Type Indicator. The beginning of this historic relationship between the two women is chronicled in CAPT’s Web site, www.capt.org.

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the MBTI in education, careers, and organizations. The chapter ends with comments on issues in translating the MBTI and its use in different cultures.

JUNG’S THEORY OF PSYCHOLOGICAL TYPES Jung made it clear that his typology was not an armchair theory but had been validated in his clinical work hundreds of times. Jung’s reasons for developing this part of his larger body of work included reducing the chaotic multiplicity of points of view into some kind of order; trying to understand his differences with Freud and Adler; describing the various aspects of consciousness; and finally, helping practicing psychologists who, armed with an exact knowledge of their own differentiated and inferior functions, can avoid many serious blunders in dealing with patients. Jung’s theory challenges two assumptions of much of personality theory today. First, Jung assumed that type preferences are not learned but inborn. Substantial evidence accumulated in recent years supports the notion that Jung was correct (Bouchard and Hur, 1998; Bouchard and McGue, 1990; Jang, Livesley, and Vernon, 1996; Krueger, Markon, and Bouchard, 2003; Riemann, Angleitner, and Strelau, 1997) Second, traits are not basic in themselves but develop from the exercise of dichotomous inborn preferences. The dichotomies in Jung’s typology are between the extraverted and introverted attitudes toward the environment; the ‘‘irrational’’ sensing or intuitive perceiving functions for taking in information; and the ‘‘rational’’ thinking or feeling judging functions for drawing conclusions about what has been perceived. The attitudes and functions are viewed as preferences. We use all of them, but we have our natural favorites and seek to develop the skills that go with them. The assumption of type dynamics, that these preferences develop over time and interact in unique ways, is the key for understanding the characteristics of each of Jung’s types. An infant is born with four basic mental functions or processes: sensing, intuition, thinking, and feeling. One will become the most conscious—the favorite or dominant function. A second will be the auxiliary to balance the dominant. The third or tertiary, and the fourth or inferior, functions will lag behind in development. Jung describes the dominant function in strong words: ‘‘[It] possesses the energy with which it is endowed by nature,’’ ‘‘the most favored and most developed function,’’ ‘‘vital to provide the conscious process of adaptation with clear and unambiguous aims,’’ ‘‘absolutely reliable,’’ and ‘‘under control of the will’’ (pp. 405–407). Jung described eight types, pairing the attitude and the dominant function: extraverted sensing type, extraverted intuitive type, extraverted feeling type, and extraverted thinking type, and the comparable four types preferring

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404 HANDBOOK OF MULTICULTURAL ASSESSMENT introversion. Isabel Myers described sixteen types in the MBTI by including both the dominant and the auxiliary functions. For example, Jung’s extraverted sensing type became the extraverted sensing type with thinking as auxiliary and the extraverted sensing type with feeling as auxiliary. In Psychological Types Jung acknowledged the importance of culture in strong words: Individuation . . . is a process of differentiation, having as its goal the development of the individual personality. Individuation is a natural necessity inasmuch as its prevention by a leveling down to collective standards is injurious to the vital activity of the individual. . . . Any serious check to individuality . . . is an artificial stunting. . . . [A] social group consisting of stunted individuals cannot be a healthy and viable institution; only a society that can preserve the internal cohesion and collective values, while at the same time granting the individual the greatest freedom, has any prospect of enduring vitality[p. 448]. . . . If a plant is to unfold its specific nature to the full, it must first be able to grow in the soil in which it is planted [p. 449]. . . . I do not think it is improbable . . . that a reversal of type often proves exceedingly harmful to the physiological well-being of the organism, usually causing acute exhaustion [p. 333].

Personality, psychological type, always develops within a cultural context. Type tells us what we want to do. Culture tells us how to do it according to the constraints and values of the surrounding culture. Common phrases in cultures may reflect pressure for conformity, as in the Australian, ‘‘Don’t be a tall poppy,’’ or the Japanese, ‘‘A nail that sticks up gets hammered down.’’ Without a culturally sanctioned outlet, having a preference for extraversion in these cultures may pose a problem for individual development. We have seen examples of falsification, often stemming from families that devalue the dominant function of their child. For example, an adult client with a preference for intuition remembers being told, ‘‘Stop those crazy thoughts. You don’t have any common sense. We worry how you will make it in the world. What will become of you?’’ In counseling, the client discovered that her intuitions were on target, and she began to trust them. At termination, she told the counselor, ‘‘I feel as if I have a gift I have been afraid of all these years. I feel so much more integrated with myself.’’ Given Jung’s strong words on falsification of type, counselors reporting MBTI results to clients are careful to take time to discover if the MBTI type is indeed the best-fit type for the client. Information about cultural differences is growing as the MBTI is translated all over the globe. Data so far show that all sixteen types appear in all cultures but not in equal numbers. As cultural psychologists move away from their position that all of personality is taught by the culture and as personality psychologists take into account that inborn type preferences may be supported or falsified by the culture, our understanding of human behavior is greatly enriched.

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DEVELOPMENT OF THE MYERS-BRIGGS TYPE INDICATOR Katharine Cook Briggs had created her own typology before Jung’s Psychological Types was translated into English in 1923 (Myers and Myers, 1980). She found her typology was consistent with Jung’s, though his was fleshed out more, and she began studying his book intensively. She shared her excitement with her daughter Isabel, and the two became ‘‘type watchers’’ for twenty years. During World War II, Isabel Briggs Myers saw many people taking jobs to be patriotic but hating their work. She believed that Jung’s typology could be a valuable tool for choosing a career. If the work called on a person’s preferred perception and judgment, it would stay interesting and motivating, and the person would stay in the job. A major application of the MBTI today is in career counseling. In retrospect, it was difficult to believe that a self-report instrument, using questions about everyday life, could possibly identify conscious and unconscious type preferences—and the dominant, auxiliary, tertiary, and inferior functions. Undaunted, Isabel Myers embarked on a journey that lasted to the end of her life. Steeped in Jung’s theory, she knew her questions could not ask directly about Jung’s theoretical constructs. Her items posed choices between ordinary behaviors that are straws in the wind for the underlying conscious and unconscious mental processes of Jung’s typology. The questions are in forced-choice, categorical format because, according to Jung’s theory of bipolarity, the choices had to be between equally valuable preferences. Myers knew her straws in the wind would not be the same in all cultures. A challenge for translators today is to rewrite and test new questions whenever the original items are not suitable in that culture. She tested hundreds of questions on family and friends, and her children, Peter and Ann, tested them on friends at school. Following Jung, Myers assigned each preference a name and a letter: • The attitudes Extraversion (E) or Introversion (I) • The perceiving functions Sensing (S) or Intuition (N) • The judging functions Thinking (T) or Feeling (F) • Two preferences implied but not described by Jung: Judging (J) or Perceiving (P) The J-P scale was an important contribution by Isabel Myers. It describes whether a person favors a perceiving process (S or N) or a judging process (T or F) in the extraverted attitude. Thus, the J-P dichotomy also describes behaviors of interest in their own right. Equally important, J-P is used to identify the dominant, auxiliary, tertiary, and inferior functions in each of the sixteen types. (For further explanation, see Myers, McCaulley, Quenk, and Hammer, 1998.)

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406 HANDBOOK OF MULTICULTURAL ASSESSMENT When she created the indicator, Isabel Myers sought precision at the midpoint of dichotomous scales. For example, for an S-N item, she asked herself, ‘‘How consistently does this person prefer sensing over intuition?’’ The assumption was that the development of sensing or intuition follows a qualitatively separate path in each case. Energy toward developing sensing leads to traits and behaviors such as practicality, realism, and enjoyment of the here and now. Energy toward developing intuition leads to traits and behaviors such as imagination, intellectuality, and future vision. Note that dichotomous MBTI scales are different from many scales in psychology where one trait is assumed to be a continuum and is measured on a normal curve, with a more positive aspect of a trait having a higher score and the more negative aspects having a lower score. In Jung and Myers’s view, both sides of the dichotomies are positive.

TYPE DESCRIPTIONS An important last step in constructing the MBTI was the type description. Isabel Myers wrote theory-based descriptions for each of the sixteen types. Each description shows the type at its best, with good development of the dominant and auxiliary functions. These descriptions end with brief comments about blind spots, or problems if the auxiliary is not well developed. The positive type descriptions (likened to horoscopes by those who do not understand the complexity and richness of Jung’s theory) are a major source of the popularity of the MBTI. The many popular books about the MBTI contain descriptions also based on type dynamics.

THE MBTI BECOMES KNOWN TO THE WORLD Throughout the 1940s, working alone in her living room, with financial help from her husband and her father, Isabel Myers continued to test and revise the MBTI. In the 1950s, with the endorsement of the Association of American Medical Colleges, she collected and analyzed data on a sample of 5,355 medical students from forty-five medical schools. She found predicted type differences in Medical College Aptitude Test scores and later in medical specialty choices. Consistent with Jung’s theory, sensing types, who prefer hands-on tasks with the immediate situation, chose orthopedic surgery, obstetrics, and anesthesiology. Intuitive types, who enjoy working with abstract ideas, theory, and symbols, more often chose psychiatry, neurology, and internal medicine. In 1956 Harold Wiggers, dean of the Albany (New York) Medical College, told Henry Chauncey, president of Educational Testing Service (ETS), about

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the ‘‘Briggs-Myers Type Indicator.’’ After an agreement in 1957 between Isabel Myers and ETS, she created Form E and the new standard MBTI Form F and wrote a manual. In 1962 ETS published the new forms and the new manual. The MBTI was in the ETS Office of Special Tests, sold only for research, and not listed in any ETS catalogue (Saunders, 1991). A few visitors to ETS heard about the MBTI and began to use it. In 1968, Takeshi Ohsawa translated the MBTI into Japanese under an agreement with Isabel Myers. In 1969, as a clinical psychologist at the University of Florida, Mary McCaulley, discovered the MBTI by chance and began working with Isabel Myers. They created an unofficial Typology Laboratory at the university and with student help completed the first MBTI computer-scoring program in 1971. The head of the Division of Housing arranged for the University of Florida class of entering students in 1972 to take the Indicator. Work-study students keypunched and verified 2,514 Form F answer sheets. With the help of data supplied by the student affairs office, the Typology Lab prepared a report on type differences in academic aptitude scores and initial choice of fields of study. Word about the MBTI spread on the campus. Faculty and graduate students began other MBTI research. In 1975, the MBTI took three major steps forward. First, an MBTI conference was held at the University of Florida. More than two hundred people came from all parts of the United States and Canada. Second, Myers and McCaulley closed the Typology Laboratory and founded the Center for Applications of Psychological Type (CAPT) to continue and advance Isabel Myers’s work.1 Initially CAPT was a field office of the American Medical Student Foundation. In 1979 it became an independent nonprofit organization. CAPT is still actively engaged in research and publication of type-related materials. Third, Consulting Psychologists Press (CPP) became the publisher of the MBTI. When CPP listed the MBTI in its 1976 catalogue, the MBTI was no longer restricted to research and was at last available for practical use. Under the watchful eye of Isabel Myers, CAPT created Form G in 1977, instituted MBTI training for psychologists, and followed up on the specialty choices of the medical students Isabel Myers had tested in the 1950s. Nineteen percent had changed their primary specialty. A significant number, particularly I-P types, had moved to a field that was a better fit for the type they reported initially. In 1979, CAPT created the Association for Psychological Type, a membership organization for persons interested in the MBTI. APT is now international, with active affiliates in Asia, Africa, Europe, Latin America, and North America. Isabel Briggs Myers died on May 5, 1980, but the MBTI continued to develop through the next two decades. Shortly after his mother’s death, Peter Briggs Myers asked David Saunders, a psychologist who had worked with his mother at ETS, to create an MBTI form with every item she had ever used in any

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408 HANDBOOK OF MULTICULTURAL ASSESSMENT form of the Indicator. After extensive research, Saunders developed two new forms. In 1987 CPP published his 290-item Form J and a scoring report, the Type Differentiation Indicator, and in 1989 a shorter Form K, with 131 items, which generated an Expanded Analysis Report. In 1985 McCaulley completed the revision of the MBTI manual (Myers and McCaulley, 1985). Ten years later, CPP published MBTI Applications: A Decade of Research on the Myers-Briggs Type Indicator (Hammer, 1996). In the mid-1990s, a research team at Consulting Psychologists Press conducted a major revision of the MBTI. Their research effort led to publication of Form M (the new standard version of the MBTI) and a new manual (Myers et al., 1998). Rather than adding up the votes for each preference, Form M is scored using item response theory, taking into account more complex statistical properties of each item and providing greater accuracy. The Form M manual compares research from Form F and Form G to Form M. Earlier MBTI manuals had many tables analyzing MBTI data for E-I, S-N, T-F, and J-P. The Form M manual took seriously the fact that ‘‘type is the unit of measurement for the MBTI’’ and added many tables showing characteristics of the sixteen types. Its chapters cover MBTI applications in career counseling, counseling and psychotherapy, education, and organizations. Chapter Fourteen of that 1998 manual, on multicultural settings, is of special interest to readers of this book. The authors, Linda K. Kirby and Nancy J. Barger, describe practical and technical issues of using the MBTI and provide extensive data on MBTI type distributions in other cultures. The MBTI, almost unknown in 1976, is now the most widely used personality inventory in the world, with more than 2 million administrations per year. An increasing body of MBTI research outside the United States is confirming forty years of research by Isabel Briggs Myers and more than thirty years of research by many others.

MBTI CONSTRUCTION AND PSYCHOMETRICS Jung believed the mental processes that are the foundation of his typology are inherent in all members of the human race. Two bodies of knowledge support Jung’s assumption. The first is that around the globe, people of all cultures recognize differences between extraverts and introverts, sensing and intuitive types, thinking and feeling types, and judging and perceiving types. The second is that Costa and McCrae (1992), seeking to develop a comprehensive description of personality using a totally different, purely empirical methodology based on decades of research in factor analysis (Digman, 1990), ‘‘discovered’’ Jung’s theory-based type preferences. Their NEO-PI Extraversion identifies the E pole of MBTI E-I; Openness to Experience identifies the

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intuitive pole of the MBTI S-N; Agreeableness identifies the Feeling pole of MBTI T-F; and Conscientiousness identifies the judging pole of MBTI J-P. These researchers characterized the correlations between these four NEO-PI scales and their corresponding MBTI dichotomies as ‘‘virtual unity’’ (McCrae and Costa, 1989). The fifth NEO-PI factor, Neuroticism (anxiety), has no similar scale in the MBTI because Isabel Myers focused her research on the ‘‘constructive use of differences’’ and described each type at its best. However, from the beginning, she was concerned with type development and included unscored research questions to study it. (To her, good type development meant perceiving the world accurately and making good decisions.) In his factor analyses of MBTI Form J, Saunders found seven factors that include Myers’s research questions. He called them ‘‘Comfort Scales.’’ These scales, along with subscales for E-I, S-N, T-F, and J-P, are part of the Type Differentiation Indicator, available from Consulting Psychologists Press Scoring Service to professionals qualified to purchase Level C tests. Several forms of the MBTI are available. Form M is the standard form that assesses the four dichotomies, Step I. Form Q is a revised version of Form J. Myers recognized that each of the four dichotomies is made up of a number of component parts. Form Q adds five subscale dichotomies or facets for each of the major dichotomies, Step II (Quenk, Hammer, and Majors, 2001). This form describes some of the qualitative differences that appear within each type. A third form that focuses on type skill development, based on Myers’s sample of more than fifty thousand meticulously analyzed cases, is currently undergoing verification, Step III.

PSYCHOMETRIC PROPERTIES The Myers-Briggs Type Indicator has unique psychometric properties. Statistics reported for reliability and validity reflect the intent of the instrument to measure a theory of dichotomies rather than one of continuous traits.

Reliability From the beginning of her work, Isabel Myers clustered items in E-I, S-N, T-F, and J-P into subscales. As part of her analysis of reliability of the scales, she created an X half and a Y half for each preference. For example, on the E-I scale, instead of assigning E-I items to X or Y as they occurred on the answer sheet, she assigned equal numbers of items in each cluster to the X and Y halves. Reliability coefficients were computed by correlating these ‘‘logical split-half scales.’’ The 1985 and 1998 manuals report high internal consistency

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410 HANDBOOK OF MULTICULTURAL ASSESSMENT reliabilities of Form G and Form M over a variety of samples for split-half correlations of X and Y scores. The 1998 manual also reports reliabilities for ‘‘consecutive split half scales.’’ Internal consistency reliabilities for sample sizes from 37 to 2,859 are over .90, whether the analysis uses logical split-half, consecutive split-half, or coefficient alpha. In her 1962 manual, Myers raised a question that persists today: ‘‘How much of any given result is the reliability of the Indicator and how much is the reliability of the person taking it? The potent but as yet unmeasurable variable of type development—i.e., the extent to which the person actually has developed the functions and the attitude he prefers—enters every equation as an unknown quantity’’ (Myers, 1962, p. 19). Internal consistency of answering the Indicator is predicted to be higher for persons at higher levels of type development, on the assumption that people who know themselves better answer more consistently. Data for the 1985 manual confirmed the early work in the 1962 manual. Reliabilities were lower for grade school students and those in programs for low achievers. Reliabilities were higher for older students and adults and for samples having college education. Myers also found that reliabilities are sometimes lower for the T-F scale. Her explanation was that good judgment, whether by thinking or feeling, is the most difficult part of type development. Others have suggested that in a period of changing values and social behaviors, the cultural guidelines for T-F decisions are less clear and T-F items may be answered less consistently. Most samples in the 1985 manual have T-F reliabilities about the same as the other scales, but if any scale shows lower reliability, it is most likely to be T-F. The 1998 manual reports internal consistency data for Form M based on both split-half and coefficient alpha analyses. Samples include student groups, occupations, and age groups. Most coefficients are in the low 90s; a few on the T-F scale are in the high 80s. Form M coefficients for two ‘‘ethnic group’’ adult samples and four college student samples range from .80 to .96 (Myers et al., 1998). The Step II manual (Quenk et al., 2001) reports internal consistency data for Form Q. Coefficient alphas for the twenty facet scales range from .52 for college students to .87 for adults. The medians were .77 and .75, respectively. Consistent with theory, the younger people still in the early part of type development were less consistent than the adults.

Test-Retest Reliability MBTI test-retest reliabilities for E-I, S-N, T-F, and J-P continuous scores are higher over shorter periods of time and when the initial preferences are clear. The more interesting question is, How many people come out the same whole

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type on retest, the joint probability, taking all four dichotomies simultaneously? Levels of agreement are well over 50 percent, much greater than the chance expectation of 6.25 percent. Those who report a change in type are most likely to agree on three of the four preferences of their original type. Changes occur more often on scales where the original choice was less clear. Reliabilities for Form M reported in the 1998 manual tend to be somewhat higher than earlier reliabilities for Form G. For the twenty facets of Form Q, the median thirty-day test-retest scores for college students and adults described above were .65 and .77, respectively, with the younger people being less consistent, as expected. In the categorical test-retest frequencies, 65 percent of the college students and 73 percent of the adults remained in the same category on the second administration.

Validity The MBTI was designed specifically to make it possible to use Jung’s insights about psychological types. Construct validity determines whether research results are consistent with predictions from type theory. Correlations of E-I, S-N, T-F, and J-P with other measures should be significant when the measure reflects a type preference and nonsignificant when it does not. The most significant validity correlations are between MBTI E-I and scales of extraversion or introversion on other instruments. Extraversion-introversion scales of other instruments do not, and should not, correlate with MBTI S-N, T-F, and J-P. The 1985, 1998, and 2001 manuals have tables of correlations of the four MBTI preferences with other psychological tests, some of which have scales similar to those of the MBTI (for instance, the Millon Index of Personality Styles, the NEO-PI, and the Jungian Type Survey) and some of which are more general (the Adjective Check List, the Strong Interest Inventory, and the California Psychological Inventory). The tables in the manuals show the MBTI letter for significant correlations in a separate column, enabling readers to scan the table for construct validity. Recent research goes beyond the four preferences to report evidence for construct validity of type dynamics by analysis of whole type. The 1998 manual presents evidence of construct validity for the sixteen types using data from type distributions, self-reports, independent observer ratings, and new work on topographic mapping of brain activity. For Form Q, some analyses demonstrate the unique contribution of the Step II facet scales in a variety of settings, providing more information for predicting relationships, in some studies, nearly doubling the amount of variance explained.

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APPLICATIONS OF TYPE There are many application areas for the Myers-Briggs Type Indicator. They include career counseling; counseling and psychotherapy; education; organizational environment, change, and retention; leadership and executive coaching; conflict management; and stress management. In this section we focus on three: education, career counseling, and organizations.

Applications of the MBTI in Education Although many school counselors use the MBTI with students to increase self-understanding and plan for careers, the main value of the MBTI for education comes from insights into the learning styles of different types of students. Teacher training affords rich understanding of curriculum and instruction—the content to be taught and tools for teaching. The MBTI helps the teacher focus on how students use their minds. Consider first the four dichotomies: • Extraverts need opportunities to talk about what they are learning, and Introverts need time for quiet reflection. • Sensing types want practical reasons for learning the material. They look for concrete examples up front, prefer to learn by rote, and are happy with repetitive practice that consolidates learning. Intuitive types want the big picture and where today’s assignment fits in. They want to understand relationships among the specific parts. Once intuitives see the big picture, they quickly get bored with the details. • Thinking types (natural skeptics) look for logical connections between cause and effect. Feeling types want to know how the topic being studied is relevant to people and their world. Thinking types are in the majority among males and Feeling types among females. • Judging types are usually eager to get the task done and may declare victory before they have collected all the information they need. Perceiving types are more curious. They aim to miss nothing and may seek out more information until the last-minute flurry and may not make the deadline. Considerable research has established that type plays a role in academic aptitude and achievement. Most aptitude measures are written tests. Academic learning tends to emphasize working with concepts and ideas, using words, symbols, and abstractions, particularly at advanced education levels. The MBTI tools for this work are introversion and intuition. Data on type preferences and

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academic aptitude scores show a slight advantage for introverts and a clear advantage for intuitive types. When types are compared for aptitude and grades, the perceiving types have an edge in aptitude, perhaps because their openness and curiosity bring more information across their path. Judging types have an edge in grades, perhaps because their goal-directed, orderly lives include meeting academic commitments. The differences, though, are not large. All sixteen types fall within a range of less than one standard deviation above and below the mean (Myers et al., 1998). In the general population, extraverts and introverts are about equally divided. Introverts are somewhat more likely to seek higher education. The percentage of sensing types is estimated at 65 to 75 percent of the population. Higher education, with its focus on abstract theories, is more attractive to intuitive types, where they are found in greater numbers, especially in the humanities and arts. This does not mean that intuitives are more intelligent than sensing types. Myers and Myers (1980) observed that ‘‘intuitives tend to define intelligence as ‘quickness of understanding’ and sensing types tend to define intelligence as ‘soundness of understanding’’’ (p. 59). Clearly both kinds of understanding are important. Sensing types are more likely to prefer the closure of J, and intuitive types are more likely to prefer the openness of P. In most population samples, therefore, the solid and dependable S-J types outnumber the N-P independent spirits. There are other trends to watch for in viewing the education system through the lens of type. In the lower grades, S-J types are the majority among students and teachers. S-P types, who want to learn by doing and with many hands-on activities, find classroom structure confining. They are more likely to be underestimated by teachers. S-P students are more likely to drop out of school and less likely to seek higher education. S-P students rarely have a kindred-spirit S-P teacher. N-P students are the independent spirits. They are found in classes for gifted and in independent study programs. Teachers in these programs are frequently intuitives also. The quiet I-N types rank high in academics and look forward to college and graduate school, where they find more kindred spirits among the students and the faculty. Of 2,514 incoming University of Florida freshman in 1972, 25 percent were I-N types. Of the 75 later elected to Phi Beta Kappa, 48 percent were I-N types. Attending to all of these differences makes teaching much more complicated but also offers enhance achievement and satisfaction and lower the dropout rate. With knowledge of type, a teacher can identify student needs and select

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414 HANDBOOK OF MULTICULTURAL ASSESSMENT materials and activities appropriate to produce learning. As awareness of type differences has spread, new resources are becoming available for teaching writing (DiTiberio and Jensen, 1994; Jensen and DiTiberio, 1989; Thompson, 1996) and learning a second language (Ehrman, 1996). Excellent guidance is also available to help teachers understand learning styles and their own teaching styles (Bargar, Bargar, and Cano, 1994; DiTiberio, 1998; Fairhurst and Fairhurst, 1995; Lawrence, 1993, 1997; Mamchur, 1996; VanSant and Payne, 1995). Kise (2006a, 2006b) provides teacher educators with extensive guidance for coaching teachers and practical solutions for classroom management. An interesting cultural difference in academic aptitude scores recently appeared in an ongoing large-scale study of the SAT and MBTI in the multicultural schools of Worcester, Massachusetts. The two best predictors of high SAT scores were taking advanced courses and preferring intuition on the MBTI. There were clear differences in the type distributions of ethnic groups among the Worcester students. However, the ‘‘academic’’ I-N students in all ethnic groups were the most likely to take Advanced Placement courses (Keith McCormick, personal communication, 1999). As the MBTI became know internationally, users began to observe schools in various countries to see what could be learned from schools with different teaching strategies. Chapman (1994) provides a fascinating account of the part played by the MBTI in changing the Aleknagik School, an Eskimo school in rural Alaska. The school was called ‘‘the political nightmare of the district’’; all the teachers had resigned. A new principal came in and arranged to have an MBTI workshop for all the new staff and the entire student body. The results showed the students to be 90 percent introverts, 50 percent sensing types (all of whom were S-P), 70 percent thinking types, and 90 percent perceiving types. Type terminology became a standard component of student-student as well as student-teacher interactions. The new staff created a collegial, cooperative culture. A new program was developed, attuned to S-P learners and traditional Eskimo values and traditions. The curriculum favored action-oriented doing and brought in village elders to do part of the teaching. Through using the MBTI, the entire school became a family of learners: teachers, students, parents, and grandparents. From the ‘‘nightmare of the district,’’ it became a school with one of the highest test scores in the district, almost no absenteeism and tardiness, and high student and parent enthusiasm. Many of the S-P graduates elected to go on to college. In the second year, the roof of the school collapsed. The next day, teachers and parents taught school in their living rooms. Students learned bandaging, splinting, and other emergency techniques, and they read about heroes and wrote about village heroes. In mathematics, they took measurements of the building. In social studies, they talked about the legislature and school funding,

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and they wrote letters to their representatives. A year of teaching in their living rooms made the village itself a classroom. Students interviewed elders and started a village history, making people as well as books their resources. In the words of Chapman (1994), ‘‘The walls between curricular areas and age and grade groups fell along with the school roof’’ (p. 6). After just four years, the Aleknagik Project was spreading to other schools. The extraordinary success that teachers, students, and community achieved by incorporating type into teaching and native culture into the school’s curriculum attests to the merit of practical application of a positive and comprehensive approach in responding to natural learning styles and cultural values.

Applications of the MBTI in Career Counseling Career counseling was one of the first areas of applied research on type. The MBTI, often combined with career interest inventories, is widely used in schools, colleges, and business organizations. It is a framework of selfunderstanding from which to look at the world of work: ‘‘What are the gifts of my type?’’ ‘‘What will hold my interest?’’ ‘‘What kind of work setting will be satisfying?’’ ‘‘What strategies would work for me to modify the work environment to suit my type?’’ Kummerow (1998) contends that type can predict the kind of work environment that is most likely to support an individual and allow the person to do his or her best work. A career survey of a national sample (n = 3,036) supports her position. Recall that there are sixteen types, eight of them sensing types and eight of them intuitive types. In this study, seven of the eight intuitive types put ‘‘variety of tasks’’ at the top of their list of work situations they liked. Only two of the eight sensing types (ESTP and ESFP) made this choice. Eighty percent or more of the eight extraverted types rated ‘‘working in a team’’ as something they liked. None of the eight introverted groups rated teamwork so high. Once a counselor and client know both the kinds of participation a job entails and the client’s type preferences, the client has a much better picture of what may or may not appeal and can make an informed choice. Many clients seek career counseling to find the ‘‘one specific job’’ that is ‘‘right’’ for them. This approach, however, is limiting because job selection involves much more than type. Other factors include family circumstances; geographical location; job market conditions; education; skills; cultural, ethnic, and gender identification; and personal interests and values (Kummerow, 1998). The Atlas of Type Tables (Macdaid, McCaulley, and Kainz, 1986) shows type distributions for more than two hundred occupations and is a basic resource for career counselors. All types are found in all occupations but not in equal numbers. Type tables for occupations support the construct validity of the MBTI. Counseling careers, for example, attract enthusiastic and insightful N-F types and have relatively

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416 HANDBOOK OF MULTICULTURAL ASSESSMENT few practical and matter-of-fact S-T types. Accounting attracts many S-T types but few N-F types. Obviously certain jobs are easier or more interesting for some types than for others. Occasionally, however, clients consciously choose a job atypical for their type in order to stretch their talents and develop new skills. Kummerow (1998) points out that people in the same occupation do not develop a particular personality as a result of their work. It is more likely that people are attracted to and stay interested in an occupation because the choice lets them use their psychological gifts—their natural preferences. ‘‘It’s not that you’re an ISTJ because you’ve been an accountant for twenty years,’’ a counselor might say. ‘‘It’s more likely that you chose accounting twenty years ago because accounting appeals to ISTJs.’’ Data also show niche groups within some occupations. For example, Scherdin (1994) found the type distribution of sixteen hundred librarians to favor I, N, and T; Kummerow (1998) collected qualitative job descriptions from librarians and found type differences in specialties within library work. These niches were consistent with type theory. In summary, the MBTI offers five tools for career assessment and counseling: 1. Understanding one’s type enhances appreciation of one’s gifts and suggests a pathway to lifelong development. 2. Type tables offer the content for match or mismatch of one’s interests and careers. 3. The decision-making model is a strategy to trust one’s strengths and watch out for blind spots. 4. Counselors use an understanding of type differences to plan the best way for each type to cover the steps necessary for good career planning. 5. Counselors learn to speak the language of the client’s type and develop the strategies to improve the client-counselor process itself (McCaulley and Martin, 1995; Quenk, 2000).

Applications of the MBTI in Organizations During the past quarter century, consultants for business and governmental organizations have discovered and rapidly expanded applications of the MBTI in working with individuals, teams, and leaders. The aims of these programs include developing self-understanding; increasing appreciation for colleagues; improving communication; dealing with conflicts; enhancing teamwork; problem solving and decision making; planning, implementing, and managing organizational change; recognizing and managing stress; and executive coaching.

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The MBTI and type concepts are useful in counseling in organizations. Psychologists who work with organizations as consultants, counselors, or coaches find that the MBTI is a powerful tool and transplants well to other countries. For example, Barger and Kirby (1995) show how to help employees thrive in a world of change. Organizations themselves—large corporations or divisions within them, small work teams, volunteer and church groups, even families—have a composite type (witness the ‘‘corporate culture’’) that influences how they operate (Bridges, 2000). Understanding this composite, along with its type dynamics and developmental aspects, helps identify core values and motivations that impinge on and interact with those of its individual participants. For members of the culture, type concepts can enhance ‘‘clarity and comfort with their own work styles while constructively identifying possible blind spots and areas of vulnerability’’ (Kirby, Barger, and Pearman, 1998, p. 326). A major type pattern that occurs in managers in all levels, and in all countries, is that over half of samples of these leaders fall into the four ‘‘tough-minded’’ T-J types (Fleenor, 1997; Kirby and Barger, 1998; Kirby et al., 1998). Worldwide, the consensus seems to be that business leadership requires objective, analytical thinking (T) and organizational ability and decisiveness (J). The focus of the T-J leader is primarily on logical, objective rationale and cost-benefit analysis (T) within carefully structured plans and time frames (J). Effective leaders, however, must be able to call on all the preferences and use them as the situation may require (Pearman, 1998). Thus, leaders must also be able to tap into the mission and values of the organization (F); adapt flexibly and incorporate midcourse changes as new information arrives and organizational needs change (P); give weight to situational pressures of the environment (E); provide a clear conceptual understanding of the problem (I); take into account the specifics of who, what, when, how, and how much (S); and include a future vision to enhance the organization’s effectiveness (N). When leaders and other members of organizations are aware of the specialties of different types, they come to recognize conflicts as coming out of valid and valuable but different perspectives that each type contributes to solving problems. T-J types in leadership coaching are learning to take more seriously the ‘‘soft stuff.’’

TYPE ACROSS CULTURES Type cuts across ethnicity and culture. However, there may be important differences in how types are distributed within various ethnic and cultural groups.

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418 HANDBOOK OF MULTICULTURAL ASSESSMENT Applications of the MBTI extend broadly around the world. Internationally, the major interest has been in business consulting. No truly stratified random sample exists for any group, so it is not yet possible to make definitive comparisons of type distributions in ethnic or national cultures. Nonetheless, tentative conclusions can be advanced, along with some of their consequences. (For a comprehensive review, see Kirby and Barger’s chapter in Myers et al., 1998.) In all cultures examined so far, all types exist, though with varying distribution. People in most cultures find the items of the MBTI easy to understand and the results ‘‘sensible and useful’’ (Kirby and Barger, 1998, p. 370). For example, Whites in South Africa (Zietsmann, 1996), Blacks in South Africa (de Beer, 1997), and mainland Chinese (Freeman, Beuke, and Shanping, 2006) accept the MBTI. It has been surprising to find people worldwide confirming that the descriptions of type, originally written by Isabel Myers and arising from middle-class America, fit them quite accurately (Kirby and Barger, 1998). Kirby, Kendall, and Barger (2007), with years of experience delivering type workshops around the world, provide up-to-date guidance for practitioners in a variety of cultures. Translating the MBTI is more complex than translating text in a newspaper or a novel. The translator must understand Jung’s theory of psychological types. When Isabel Myers wrote questions for the Indicator, she started with twenty years of study of Jung and had a deep understanding of his typology. MBTI questions are pointers to underlying unconscious processes. Translators of the MBTI face two major challenges: choosing words with the correct nuance of meaning and modifying or substituting questions when the Myers question does not fit the culture (for example, Saturday is not the same kind of day in all cultures). In the 1970s, a few unofficial translations were done—into Spanish by a college student and into Arabic by an army corporal. It was only in the 1990s that quality translations in any number were approved by the publisher, Consulting Psychologists Press. These include translations into Bahasa Malay, Chinese, Danish, Dutch, French (European), French (Canadian), German, Italian, Korean, Norwegian, Portuguese, Spanish (Castellano), Spanish (United States), and Swedish. Translations available only for research include Afrikaans, Albanian, Arabic, Bosnian, Bulgarian, Croatian, Czechoslovakian, Finnish, Flemish, Greek, Hungarian, Icelandic, Indonesian, Latvian, Macedonian, Polish, Romanian, Russian, Serbian, Slovenian, Thai, Turkish, Vietnamese, and Zulu. Although most translators find the MBTI questions understandable for citizens in their countries, cautions have arisen about administering the MBTI in collectivist cultures where the emphasis is on the group rather than the individual. John Bathurst (1996) in New Zealand reported that the Maori have great difficulty with MBTI questions. They live in individualistic New

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Zealand but remain in their collectivist culture. They are more comfortable answering MBTI items according to their Maori lives rather than their individual preferences. Horikoshi (1998) asked Japanese Americans to complete the MBTI twice, once as the type their culture expected them to be and again as the type they thought they really were. Of the 113 participants, 99 (88 percent) answered S-J for the culture but only 45 (40 percent) reported S-J for themselves. The United States has many citizens from other countries whose lives bridge two cultures. Labarta (1983) noticed that in counseling sessions with clients whose native language was Spanish, the clients discussed more substantive issues when she conducted the session in Spanish rather than in English. In her dissertation, her bilingual subjects were asked to answer the MBTI twice—once in their Spanish environment and once in their American environment. They chose extraversion significantly more often in the Spanish frame of reference.

CONCLUSION With more than 2 million administrations per year around the world, the MBTI has provided extensive and compelling evidence that Jung’s theory of personality type is universal. Despite its middle-class American origin, people of diverse cultures have found its results meaningful and useful in education, counseling, career development, and organizations. Kirby and Barger (1998) conclude their discussion of multicultural issues and the MBTI in the fourteenth chapter of the MBTI manual in these words: This chapter has emphasized differences when the MBTI is used in multicultural settings and cautions about its use with people culturally different from those with whom it was developed. It is also important to recognize the positive experience of practitioners using the MBTI outside the United States: • Both psychological type and the MBTI have been used effectively in dozens of cultures, some very different from the U.S. middle-class culture. • Research and practitioner experience in using the MBTI multiculturally is overwhelmingly positive—clients recognize the patterns identified by psychological type, give examples of their use of preferences from their own experience, and find type’s identification of normal differences very helpful in increasing their understanding of themselves and others. • The perspective and ethics associated with psychological type and the MBTI, summarized by Myers as ‘‘the constructive use of differences,’’ make type and the MBTI particularly useful in cross-cultural work and multicultural settings, where respect for human diversity is of paramount importance’’ [Kirby and Barger, 1998, p. 384].

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Note 1. The MBTI bibliography and library are maintained by the Center for Applications of Psychological Type (CAPT) at 2815 N.W. 13th Street, Suite 401, Gainesville, FL 32609. The bibliography is available free online: go to http://www.capt.org/ and click Bibliography Search. As of June 2007, the MBTI bibliography contained more than 10,000 references. CAPT’s research librarian (352–375–0160 or [email protected]) provides guidance to anyone interested in doing type research. Visitors are welcome to use the library during normal CAPT business hours.

Distributors Asia-Pacific: Asiatic Psychologist Press, Carlton South, Victoria, Australia, www.asianicpsych.com.au Canada: Psychometrics Canada Ltd., Edmonton, Alberta, www.psychometrics.com Europe: OPP, Oxford, United Kingdom, www.opp.eu.uk India: Asiatic Psychologists Press India Pvt Ltd, Besant Nagarm, Chennai Japan: Kaneko Shobo, Tokyo, www.kanekoshobo.co.jp Korea: Korean Psychological Testing Institute, Seoul, www.kpti.com New Zealand: New Zealand Council for Educational Research, Wellington, www.nzcer.org.nz South Africa: Jopie Van Rooyen & Partners, Johannesburg, www.jvrafrica .co.za South America: Instrumentos de Desenvolvimento Humano (IDH) S˜ao Paulo, www.idhal.com.br United States: CPP, Mountain View, California, www.cpp.com

Professional Associations Africa: South Africa Association for Psychological Type Australia: Australian Association for Psychological Type Canada: APT Canada Europe: European Association for Psychological Type France: Association franc¸aise des types psychologiques Germany: German Association for Applied Typology Japan: Association for Psychological Type Latin America: Association for Psychological Type Korea: Korean Association for Psychological Type

MULTICULTURAL APPLICATIONS OF THE MYERS-BRIGGS TYPE INDICATOR

New Zealand: New Zealand Association for Psychological Type United Kingdom: British Association for Psychological Type United States: Association for Psychological Type International

References Bargar, J. R., Bargar, R. R., & Cano, J. M. (1994). Discovering learning performance and learning differences in the classroom. Columbus: Ohio Agricultural Education Curriculum Materials Service. Ohio State University. Barger, N. J., & Kirby, L. K. (1995). The challenge of change in organizations. Helping employees thrive in the new frontier. Mountain View, CA: Davies-Black. Bathurst, J. (1996). Developing a framework for investigating cultural differences using personality measures. In R. A. Moody (Ed.), Proceedings: Psychological type and culture—East and west: Second Multicultural Research Symposium (pp. 1–6). Gainesville, FL: Center for Applications of Psychological Type. Bouchard, T. J., Jr., & Hur, Y.-M. (1998). Genetic and environmental influences on the continuous scales of the Myers-Briggs Type Indicator: An analysis based on twins reared apart. Journal of Personality, 66 (2), 135–149. Bouchard, T. J., Jr., & McGue, M. (1990). Genetic and rearing environmental influences on adult personality: An analysis of adopted twins reared apart. Journal of Personality, 58 (1), 263–292. Bridges, W. (2000). The character of organizations: Using personality type in organization development. Palo Alto, CA: Davies-Black. Chapman, M. (1994). The Aleknagik Project: A success story of cooperative school restructuring based on traditional Eskimo learning patterns and Myers-Briggs type theory (an overview). In Proceedings: Orchestrating Educational Change in the 90s—The Role of Psychological Type (pp. 1–10). Gainesville, FL: Center for Applications of Psychological Type. Costa, P. T., & McCrae, R. R. (1992). Professional manual for the revised NEO Personality Inventory. Odessa, FL: Psychological Assessment Resources. de Beer, J. (1997). South African Myers-Briggs type distribution: A comparative study. Unpublished doctoral dissertation, Rand Afrikaans University. Digman, J. M. (1990). Personality structure: Emergence of the five-factor model. In M. R. Rosenzweig & L. W. Porter (Eds.), Annual review of psychology (Vol. 41, pp. 417–440). Palo Alto, CA: Annual Reviews. DiTiberio, J. K. (1998). Uses of type in education. In I. B. Myers, M. H. McCaulley, N. L. Quenk, & A. L. Hammer (Eds.), MBTI manual: A guide to the development and use of the Myers-Briggs Type Indicator (3rd ed., pp. 253–284). Palo Alto, CA: Consulting Psychologists Press. DiTiberio, J. K., & Jensen, G. H. (1994). Writing and personality: Finding your voice, your style, your way. Palo Alto, CA: Davies-Black.

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422 HANDBOOK OF MULTICULTURAL ASSESSMENT Ehrman, M. E. (1996). Understanding second language learning difficulties. Thousand Oaks, CA: Sage. Fairhurst, A. M., & Fairhurst, L. L. (1995). Effective teaching, effective learning: Making the personality connection in your classroom. Palo Alto, CA: Davies-Black. Fleenor, J. W. (1997). The relationship between the MBTI and measures of personality and performance in management groups. In L. K. Kirby & C. Fitzgerald (Eds.), Developing leaders: Research and applications in psychological type and leadership development (pp. 115–138). Palo Alto, CA: Davies-Black. Freeman, D., Beuke, C., & Shanping, W. (2006). Reliability and validity of the Myers-Briggs Type Indicator Form M when translated into traditional and simplified Chinese characters. Paper presented at the Psychological Type and Culture—East and West, Honolulu, HI. Hammer, A. L. (Ed.). (1996). MBTI applications. A decade of research on the Myers-Briggs Type Indicator. Palo Alto, CA: Consulting Psychologists Press. Horikoshi, W. C. (1998). Cross-cultural conflict of Asians in the U.S.: Application of MBTI in a multicultural environment. In R. A. Moody (Ed.), Proceedings: Psychological Type and Culture— East and West: A Multicultural Research Symposium (pp. 29–43). Gainesville, FL: Center for Applications of Psychological Type. Jang, K. L., Livesley, W. J., & Vernon, P. A. (1996). Heritability of the Big Five dimensions and their facets: A twin study. Journal of Personality, 64, 577–591. Jensen, G. H., & DiTiberio, J. K. (1989). Personality and the teaching of composition. Norwood, NJ: Ablex. Jung, C. G. (1921/1971). Psychological types (H. G. Baynes & R.F.C. Hull, Trans., Vol. 6). Princeton, NJ: Princeton University. Kirby, L. K., & Barger, N. J. (1998). Uses of type in multicultural settings. In I. B. Myers, M. H. McCaulley, N. L. Quenk, & A. L. Hammer (Eds.), Manual: A guide to the development and use of the Myers-Briggs Type Indicator (3rd ed., pp. 367–384). Palo Alto, CA: Consulting Psychologists Press. Kirby, L. K., Barger, N. J., & Pearman, R. R. (1998). Uses of type in organizations. In I. B. Myers, M. H. McCaulley, N. L. Quenk, & A. L. Hammer (Eds.), Manual: A guide to the development and use of the Myers-Briggs Type Indicator (3rd ed., pp. 325–365). Mountain View, CA: Consulting Psychologists Press. Kirby, L. K., Kendall, E., & Barger, N. J. (2007). Type and culture: Using the MBTI instrument in international applications. Mountain View, CA: CPP. Kise, J.A.G. (2006a). Differentiated coaching: A framework for helping teachers change. Thousand Oaks, CA: Corwin Press. Kise, J.A.G. (2006b). Differentiation through personality types: A framework for instruction, assessment, and classroom management. Thousand Oaks, CA: Corwin Press. Krueger, R. F., Markon, K. E., & Bouchard, T. J., Jr. (2003). The extended genotype: The heritability of personality accounts for the heritability of recalled family environments in twins reared apart. Journal of Personality, 71 (5), 809–833.

MULTICULTURAL APPLICATIONS OF THE MYERS-BRIGGS TYPE INDICATOR Kummerow, J. M. (1998). Uses of type in career counseling. In I. B. Myers, M. H. McCaulley, N. L. Quenk, & A. L. Hammer (Eds.), Manual: A guide to the development and use of the Myers-Briggs Type Indicator (3rd ed.). Mountain View, CA: Consulting Psychologists Press. Labarta, M. M. (1983). The effects of cultural referent and acculturation on the four dimensions of psychological type. Dissertation Abstracts International, 44 (6), 1965B. Lawrence, G. (1993). People types and tiger stripes (3rd ed.). Gainesville, FL: Center of Applications of Psychological Type. Lawrence, G. (1997). Looking at type and learning styles. Gainesville, FL: Center for Applications of Psychological Type. Macdaid, G. P., McCaulley, M. Y., & Kainz, R. I. (1986). Myers-Briggs Type Indicator atlas of type tables. Gainesville, FL: Center for Application of Psychological Type. Mamchur, C. M. (1996). A teacher’s guide to cognitive type theory and learning style. Alexandria, VA: Association for Supervision and Curriculum Development. McCaulley, M. H., & Martin, C. (1995). Career assessment and the Myers-Briggs Type Indicator. Journal of Career Assessment, 3 (2), 219–239. McCrae, R. R., & Costa, P. T. (1989). Reinterpreting the Myers-Briggs Type Indicator from the perspective of the five-factor model of personality. Journal of Personality, 57 (1), 17–40. Myers, I. B. (1962). Manual: The Myers-Briggs Type Indicator. Princeton, NJ: Educational Testing Service. Myers, I. B., & McCaulley, M. H. (1985). Manual: A guide to the development and use of the Myers-Briggs Type Indicator. Palo Alto, CA: Consulting Psychologists Press. Myers, I. B., McCaulley, M. H., Quenk, N. L., & Hammer, A. L. (1998). Manual: A guide to the development and use of the Myers-Briggs Type Indicator (3rd ed.). Palo Alto, CA: Consulting Psychologists Press. Myers, I. B., & Myers, P. B. (1980). Gifts differing. Palo Alto, CA: Consulting Psychologists Press. Pearman, R. R. (1998). Hard wired leadership: Unleashing the power of personality to become a new millennium leader. Palo Alto, CA: Davies-Black. Quenk, N. L. (2000). Essentials of Myers-Briggs Type Indicator assessment. Hoboken, NJ: Wiley. Quenk, N. L., Hammer, A. L., & Majors, M. S. (2001). MBTI Step II Manual: Exploring the next level of type with the Myers-Briggs Type Indicator Form Q. Palo Alto, CA: Consulting Psychologists Press. Riemann, R., Angleitner, A., & Strelau, J. (1997). Genetic and environmental influences on personality: A study of twins reared together using the self- and peer report NEO-FFI scales. Journal of Personality, 65, 449–475. Saunders, F. W. (1991). Katharine and Isabel: Mother’s light, daughter’s journey. Palo Alto, CA: Consulting Psychologists Press.

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424 HANDBOOK OF MULTICULTURAL ASSESSMENT Scherdin, M. J. (1994). Vive la difference: Exploring librarian personality types using the MBTI. In M. J. Scherdin (Ed.), Discovering librarians: Profiles of a profession. Chicago: Association of College and Research Libraries, American Library Association. Thompson, T. C. (Ed.). (1996). Most excellent differences: Essays on using type theory in the composition classroom. Gainesville, FL: Center for Applications of Psychological Type. VanSant, S., & Payne, D. (1995). Psychological type in schools: Applications for educators. Gainesville, FL: Center for Applications of Psychological Type. Zietsmann, G. (1996). The validation of the MBTI on a South African sample: A summary of the results. In Proceedings of the Fourth International Type Users Conference (pp. 186–190). Johannesburg: Jopie Van Rooyen.

CHAPTER NINETEEN

MMPI-2 and MCMI-III Performances of Non-White People in the United States What We (Don’t) Know and Where We Go from Here Kwong-Liem Karl Kwan Michael Lynch Maestas

T

he Minnesota Multiphasic Personality Inventory (MMPI-2) and the Millon Clinical Multiaxial Inventory-III (MCMI-III) continue to be the most widely used psychodiagnostic instruments in the United States. Both instruments have been translated into other languages, and the adaptability of translated versions with populations outside the United States has been reported (Butcher, 1996; Craig and Olson, 2005). Yet empirical studies with non-White populations (African Americans, American Indians, Asian Americans, and Latino/as) in the United States remain scarce and lag behind the projection that non-White groups will constitute 50 percent of the U.S. population by 2050 (Raajpoot, 2000). Despite being the fastest-growing non-White groups that are projected to constitute 33 percent of the U.S. population by 2050 (Maestas, 2000), Asian Americans and Latino/as were underrepresented in the standardization samples of both instruments. Consequently, Draguns (1996) cautioned that ‘‘the norms [of MMPI-2 and MCMI-III] obtained may not be valid [for non-White groups] in the future’’ (p. 68). Hall and Phung (2001) have noted that the MMPI-2 and MCMI-III are not designed to be sensitive to racial differences. Some researchers have contended that the lack of research has not precluded the use of these instruments with non-White individuals in the United States (Choca, 2004; Handel and Ben-Porath, 2000). Whereas the diagnostic validity of the instruments has been indicated in studies with non-White clinical treatment samples in the United States (Arbisi, Ben-Porath, and McNulty, 2002) and samples (using translated

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426 HANDBOOK OF MULTICULTURAL ASSESSMENT versions) outside the United States (Butcher, 1996; Craig and Olson, 2005), researchers and clinicians remain empirically cautious when scale scores of nontreatment groups can be associated with cultural variables such as language proficiency, sociopolitical experiences, and sociodemographic variables (Hall and Phung, 2001) other than psychopathology. Since Hall and Phung’s review (2001) of the cultural application of the MMPI and MCMI published in the previous edition of the Handbook of Multicultural Assessment (Suzuki, Ponterotto, and Meller, 2001), the MCMI-III has been updated (for example, with the Grossman Facet scales; Millon, Millon, Davis, and Grossman, 2006), and the MMPI-2 has restructured clinical scales (Tellegen et al., 2003) and released a new Fake Bad Scale (FBS). The applicability of the additional scales to non-White populations, however, has not been assessed. In this chapter, we provide an update and a review of studies that have examined the cultural application of the MMPI-2 and MCMI-III with non-White populations. Research and practice implications will be delineated.

MMPI-2 PERFORMANCES OF NON-WHITE GROUPS IN THE UNITED STATES The MMPI was originally developed as an assessment tool to provide psychodiagnosis to patients. Items were selected with an intended purpose of differentiating criterion groups (for example, between clinical patients and nonclinical individuals and among patients with different psychiatric disorders). The original MMPI consisted of ten clinical scales and four validity scales. In the light of the inadequacy of the clinical scales to provide valid psychodiagnosis and the risk of attributing excess meaning to the respective clinical labels, scale numbers were subsequently used to replace the scale label: Scale 1 (Hypochondriasis), Scale 2 (Depression), Scale 3 (Hysteria), Scale 4 (Psychopathic Deviate), Scale 5 (Masculinity-Femininity), Scale 6 (Paranoia), Scale 7 (Psychasthenia), Scale 8 (Schizophrenia), Scale 9 (Mania), and Scale 0 (Introversion-Extraversion). The four validity scales—Cannot Say (?) score, Lie (L) scale, Infrequency (F) scale, Defensiveness (K) scale—were developed to detect deviant test-taking attitudes to distort and falsify responses. MMPI items were administered to convenient samples from the University of Minnesota Hospitals: medical and psychiatric patients, relatives and visitors of patients, high school graduates attending precollege conferences, and Work Progress Administrator workers. These samples became the criterion and normative groups. The MMPI was later restandardized as MMPI-2 using a sample that was more representative of the population in the United States than the original sample. In addition, the item pool was updated by rewriting items with antiquated language, deleting items with objectionable content,

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and generating items that would enhance the content dimensions. Despite the restandardization, it was determined that efforts be made to maintain the continuity between the MMPI and MMPI-2 (Graham, 2006). The MMPI has been found to be a widely used instrument in a number of surveys conducted in the 1980s and 1990s (see Graham, 2006). There has been continuing interest in examining the MMPI/MMPI-2 patterns of non-White populations (Dahlstrom, Lachar, and Dahlstrom, 1986; Greene, 1987) in the United States and the adaptability for use with international samples outside the United States (Butcher and Pancheri, 1976; Butcher, 1996). Hall and Phung (2001) provided a review of the MMPI/MMPI-2 of U.S. racial and ethnic groups. Yet only limited published empirical studies can be identified since their review. To provide continuity, studies in and published since Hall and Phung’s review are summarized in this chapter. With the MMPI-2 being the most current and ethically sanctioned version to be used (American Psychological Association, 2002, Code 9.08), especially for clinical purposes, the review will focus only on empirical studies using the MMPI-2. (Reviews of the MMPI studies of racial and ethnic minority groups can be found in Greene, 1987, and Graham, 2006.)

MMPI-2 Studies of African Americans There were 314 (126 male and 188 female) African Americans in the restandardization sample (Butcher, Dahlstrom, Graham, Tellegen, and Kaemmer, 1989). The proportions of African American men (11.1 percent of men) and women (12.9 percent of women) in the normative group were both higher than that reported in the 1990 U.S. Census (9.7 percent for men, 10.7 percent for women). Compared to the Caucasians in the normative sample, African Americans scored higher on most scales, with the largest difference on Scale 4 (Psychopathic Deviate) for women (Butcher et al., 1989). Timbrook and Graham (1994) compared African Americans with a matched group of Caucasian Americans in the MMPI-2 normative group. African American men scored significantly higher on scale 8, and African American women scored significantly higher on scales 4, 5, and 9. A number of studies compared clinical samples of African Americans and Caucasian Americans. Using clients (123 African Americans, 561 Caucasian Americans) in a mental health center, McNulty, Graham, Ben-Porath, and Stein (1997) found that African American men (N = 42) scored significantly higher on the L scale and the Fears (FRS) content scale than Caucasian men (N = 225). African American women (N = 81) scored significantly higher on scale 9 and the Low Self-Esteem (LSE) content scale than Caucasian women (N = 336). The relationship between MMPI-2 scores and therapist ratings of conceptually related characteristics was not found to be significantly different between the two racial groups.

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428 HANDBOOK OF MULTICULTURAL ASSESSMENT Stukenberg, Brady, and Klinetob (2000) examined MMPI-2 profiles and differential endorsement of scales by demographic characteristics. MMPI-2 profiles and code types of 309 White and 179 African Americans with various diagnoses (for example, major depression, bipolar disorders, psychosis, adjustment disorder) in an acute care inpatient psychiatric unit were compared. Stukenberg et al. noted the need to establish reference points or base rates for testing minority patients in clinical settings. When gender groups were combined, the White sample scored significantly higher on scales 2 and 3, and the African American sample scored significantly higher on scale 9; however, none of the differences was clinically significant. In descending order, the most frequently endorsed two-point codes between the White and African American patients were 68/86 (White) – 68/86 (African American), 78/87 – no elevations, no elevations – 46/64, 46/64 – 78/87, 27/72 – 28/82, 28/82 – 48/84, and 48/84 – 89/98. Significant differences were found in the distribution of the most frequently endorsed two-point codes by race. Arbisi et al. (2002) examined if a number of MMPI-2-related diagnoses of 259 African American (159 male, 70 female) and 1,558 (1,233 male, 325 female) psychiatric patients could be significantly predicted by an MMPI-2 scale-alone model and/or a full model including MMPI-2 scales, race, and interactions between MMPI-2 scales and race. Results showed the presence of prediction bias in thirty-two of sixty-four comparisons in the men and twelve of the sixty-five comparisons in the women. The authors noted that when bias was present, it was in the direction of underprediction of psychopathology in African Americans. The MMPI-2 was used as one of the assessment instruments in a number of studies that compared African American and Caucasian American veterans with posttraumatic stress disorder (PTSD). Frueh, Smith, and Libet (1996) compared the MMPI-2 scores of 118 White and 88 Black veteran patients with PTSD. African Americans showed higher elevations on the F-K Index, scale 6, and scale 8. Yet in a subsequent study that attempted to replicate the finding with another sample of 54 Black and 84 White veteran patients, Frueh, Gold, de Arellano, and Brady (1997) did not find significant differences in MMPI-2 scales, indexes, or external ratings of psychopathology or diagnosis. African American veterans with combat-related PTSD were found to endorse more items on scale 6 (Frueh et al., 2002; 53 African and 30 Caucasian Americans) and the Bizarre Mentation (BIZ) content scale (Monnier, Elhai, Frueh, Sauvageot, and Magruder, 2002; 71 Caucasian and 40 African Americans). Yet few significant differences were found between the two racial groups in other symptoms as assessed by other instruments. Craig and Olson (2004) explored the ability of the MMPI-2 content scales of Negative Treatment Indicator (TRT) and Cynicism in predicting methadone treatment outcomes for a group of African American patients who were

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consecutively admitted in a treatment program within one year. Neither content scale was found to be significantly related to treatment outcomes. Whatley, Allen, and Dana (2003) investigated the relationship between Black racial identity and several MMPI scales (F, 4, 8, and 9) that produced (Black-White) group differences in previous studies. In addition, scale 6 was included because healthy cultural paranoia measured by the scale was considered potentially conceptually relevant. Using the Racial Identity Attitude Scale-Black (RIAS-B; Helms and Parham, 1996), it was found that Immersion-Emersion was a significant predictor of scale 4 and scale 9, and Internalization was a significant predictor of scale 6.

MMPI-2 Studies of Asian Americans There were nineteen Asian Americans (six men and thirteen women) representing 0.5 percent of men and 0.9 percent of women in the restandardization sample. The proportion was lower than that (2.6 percent for both groups) in the U.S. population as reported in the 1990 Census. Stevens, Kwan, and Graybill (1993) compared MMPI-2 scores of Chinese international students and a Caucasian sample matched on age, academic major, and year in school. Chinese men scored significantly higher on scale 0; Chinese women scored significantly on scale L. Both Sue, Keefe, Enomoto, Durvasula, and Chao (1996) and Tsai and Pike (2000) examined the effects of acculturation on MMPI-2 profiles. Among a sample of university students, Sue et al. (1996) found that low-acculturated Asian Americans scored significantly higher than high-acculturated Asian Americans; high-acculturated Asian Americans scored significantly higher than a matched group of Caucasian Americans. In general, Asian Americans scored significantly higher on scales 1, 2, 4, 6, 7, 8, and 0 than Caucasian Americans. Using an acculturation measure, Tsai and Pike (2000) divided ninety Asian Americans into low-acculturated, bicultural, and high-acculturated groups and compared their MMPI-2 scores with a matched Caucasian sample. It was found that the low-acculturated group scored significantly higher on scales L, F, 1, 2, 5, 6, 7, 8, and 0 than another comparison group. No significant differences were found between the high-acculturated Asian American and Caucasian American samples. Dong and Church (2003) used a Vietnamese translated version of the MMPI-2 to assess the psychological adjustment of Vietnamese refugees in the United States. Compared to other scales in the profile, both men and women showed slight elevations on scales F and 8. Although the overall profile was slightly higher than that of the normative sample, scales scores were within the normal range.

MMPI-2 Studies of American Indians There were thirty-eight men and thirty-nine women representing 3.3 percent of the men and 2.7 percent of the women in the MMPI-2 restandardization sample. The proportions of both groups were higher than that in the U.S. population

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430 HANDBOOK OF MULTICULTURAL ASSESSMENT as reported in the 1990 Census (0.6 percent of the U.S. population for both groups). Compared to their Caucasian counterparts in the restandardization sample, American Indian men scored more than five T scores on scales F and 4 and American Indian women on scales F, 1, 4, 5, and 8. Robin, Greene, Albaugh, Caldwell, and Goldman (2003) compared the MMPI-2 scores between two American Indian tribes (239 Plains and 490 Southwestern) and the MMPI-2 normative sample. Although no significant differences between the two tribes were found on clinical, content, or supplementary scales, the combined American Indian sample scored significantly higher on five validity and clinical scales, six content scales, and two supplementary scales than a matched group from the normative sample. Greene, Robin, Albaugh, Caldwell, and Goldman (2003) investigated the empirical correlates of these MMPI-2 scales with clinical and behavioral symptoms adapted from the Schedule for Affective Disorders and Schizophrenia (SADS). Meaningful correlations were found between some MMPI-2 scales and adapted items from SADS. For example, ‘‘broke rules at home or school’’ was correlated with scale 4 for men and scale 9 for women and the Antisocial Practices (ASP) content scale for men and Family Problems (FAM) content scales for women; ‘‘difficulties with family due to drinking’’ was significantly related to the Addiction Admission supplementary scale (AAS) for both men and women. Pace et al. (2006) examined the MMPI-2 scores between two American Indian tribes: eighty-four Eastern Woodland Oklahoma and eighty-seven Southwest Plains Oklahoma. Significant and meaningful difference between the two tribes was found only on the F scale. When the two tribes were combined, participants in the low education group scored significantly higher on the L scale than those in high education group. No significant differences were found on the clinical scales. Participants in the low acculturation subgroup were found to score significantly higher on the F scale and scale 8 than did the high acculturation subgroup, and the high acculturation group scored significantly higher on the K scale than the low acculturation group. Using archival data, Garrett, Paris, and Gastorf (2006) compared MMPI-2 profiles between Native American and non–Native American police officer applicants. The racial composition of the non–Native American applicant sample was not reported. Significant differences were found in scales F, 3, 6, 7, and MAC-R. Although the Native American sample reported higher scores, the mean differences were small, and the general profile fell within normal range.

MMPI-2 Studies of Latino/as There were thirty-five Latinos and thirty-eight Latinas in the MMPI-2, representing 3.1 percent of the men and 2.6 percent of the women in the MMPI-2 restandardization sample when there were 7.7 percent Latino and 6.9 percent Latina in the U.S. population as reported in the 1990 Census. Compared to

MMPI-2 AND MCMI-III PERFORMANCES OF NON-WHITE PEOPLE

Caucasian men in the sample, Latinos scored slightly higher on most scales, with none of the differences exceeding five T scores. Latinas scored higher on all scales except L, K, and 0 but lower on scales L and K than Caucasian women in the normative sample. The difference exceeded five T scores on scales F, 1, 4, 7, 8, and 9. Among college student samples, Whitworth and McBlaine (1993) found that Hispanic students scored higher on the L scale and lower on scales K, 3, and 4 than Caucasian students, and Whitworth and Unterbrink (1994) found that Hispanic students scored higher on scales L, K, 8, 9, as well as thirteen content scales. In both studies, differences that exceeded five T scores were found only on the Family Problems (FAM) and Cynicism (CYN) content scales (Whitworth and Unterbrink). In a meta-analytic study that examined results of thirteen studies that compared Latino and male Caucasian MMPI/MMPI-2 scores, Hall, Bansal, and L´opez (1999) found that the largest effect of ethnicity was on the L scale, where Latinos scored higher, and scale 5, where they scored lower. The effect size on both scales, however, was small and not substantive.

MCMI-III PERFORMANCES OF NON-WHITE POPULATIONS IN THE UNITED STATES The Millon Clinical Multiaxial Inventory, Third Edition (MCMI-III) is one of the most widely used objective personality assessment instruments (Choca, 2004). It consists of 175 items developed for use with emotionally disturbed individuals and psychiatric populations. The instrument was initially published in 1972 as the Millon-Illinois Self-Report Inventory (MI-SRI); through subsequent revisions, the measure came to be known as the Million Clinical Multiaxial Inventory (MCMI) in 1977 (Millon, 1997). The nomenclature of the scales is comparable to Axis I and Axis II diagnostic categories of the Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM-IV-TR; American Psychiatric Association, 2000). The MCMI is the product of extensive theoretical development and a three-stage sequence of validation. Through the years, the instrument has continued to evolve in the light of advancement in theories of personality, psychopathology, and data gathered from clinical practice (Millon et al., 2006). For the MCMI-III, these efforts culminated in the refinement and inclusion of the Grossman Facet scales that clarify scale elevations by identifying specific personality processes and domains contributing to observed elevations, the replacement of 95 items, and the addition of two new scales (Depressive scale and Post-Traumatic Stress Disorder scale) (Millon et al., 2006). Other aspects of the MCMI-III remain intact. Four modifying indexes (Disclosure, Desirability, Debasement, and Validity) provide data of profile validity.

431

432 HANDBOOK OF MULTICULTURAL ASSESSMENT An important hallmark of the MCMI-III is the prototypical approach to measure both enduring personality patterns and pathology (Axis II) and moderate and severe clinical syndromes (Axis I). Eleven scales assess clinical personality patterns (Schizoid, Avoidant, Depressive, Dependent, Histrionic, Narcissistic, Antisocial, Aggressive, Compulsive, Passive-Aggressive, and Self-Defeating), three scales evaluate more severe personality pathology (Schizotypal, Borderline, and Paranoid), and seven scales assess moderately severe clinical syndromes (Anxiety, Somatoform, Bipolar: Manic, Dysthymia, Alcohol Dependence, Drug Dependence, and Post-Traumatic Stress Disorder). Severe Axis I clinical syndromes are assessed by the Thought Disorder, Major Depression, and Delusional Disorder scales. For each of the scales, a base rate (BR) score for the respective scale construct was statistically established. This standard score is derived from the estimated prevalence of particular characteristics, traits, or patterns in the psychiatric population. Unlike other normative raw score transformations, the BR scores communicate the presence of a trait at a level of 75 and the presence of a disorder at a level of 85 for the respective fourteen personality scales (Millon et al., 2006). Furthermore, for the ten clinical syndromes scales, a BR score of 75 indicates the presence of a syndrome, and a score of 85 indicates the prominence of a syndrome (Millon et al., 1996). Millon (1997) cautioned that clinical judgment is crucial in the interpretive process because the degree to which a trait is problematic ‘‘is not a direct function of the quantity of the trait, but instead is a function of its interaction with other characteristics of the organism . . . , and the interaction between the organism and [its] context’’ (p. 66).

MCMI-III Normative and Cross-validation Samples The MCMI-III was developed from June 1992 to February 1993 using the 325 items on the MCMI-II Research Form (Millon et al., 2006), which were administered to 1,079 adults patients by clinicians in twenty-six U.S. states and Canada who routinely employed the MCMI in the treatment process (Millon et al., 2006). Eighty-one patients’ data were found unusable. The remaining participants were divided into an MCMI-III scale development group (n = 600) and a cross-validation group (n = 398). The applicability of MCMI-III with non-White groups in the United States is limited by the characteristics of the normative sample. Both MCMI-III scale development and cross-validation groups consisted of African American, American Indian, Asian American, and Latino/a patients (Tables 19.1 and 19.2). Except for American Indians, the other non-White groups were underrepresented in the normative sample when compared to 1990 and 2000 U.S. Census data. Although norms for specific non-White groups were delineated, they were based on small samples.

Percent

8.7

N

52

Normative Sample

12.1

1990 12.3

2000

U.S. Census (in percent)

African Americans

6

N 1.0

Percent

Normative Sample

1.0

1990 0.9

2000

U.S. Census (in percent)

American Indians

2

N 0.3

Percent

Normative Sample

2.9

1990

3.6

2000

U.S. Census (in percent)

Asian Americans

Table 19.1. NSMCMI-III Development Sample

17

N

2.8

Percent

Normative Sample

9.0

1990

12.5

2000

U.S. Census (in percent)

Latino/as

8.7

52

12.1

1990

8.3

33

12.1

1990

Percent

N 12.3

2000

U.S. Census (in percent)

Cross-Validation Sample

12.3

2000

U.S. Census (in percent)

African Americans

Percent

N

Normative Sample

African Americans

6

N

1.0

1990

1.5

Percent 1.0

1990 0.9

2000

U.S. Census (in percent)

0.9

2000

U.S. Census (in percent)

American Indians

1.0

Percent

Cross-Validation Sample

6

N

Normative Sample

American Indians

0

N

2.9

1990

0.0

Percent

2.9

1990

3.6

2000

U.S. Census (in percent)

3.6

2000

U.S. Census (in percent)

Asian Americans

0.3

Percent

Cross-Validation Sample

2

N

Normative Sample

Asian Americans

Table 19.2. NSMCMI-III Cross-Validation Sample

8

N

9.0

1990

2.0

Percent

9.0

1990

12.5

2000

U.S. Census (in percent)

12.5

2000

U.S. Census (in percent)

Latino/as

2.8

Percent

Cross-Validation Sample

17

N

Normative Sample

Latino/as

MMPI-2 AND MCMI-III PERFORMANCES OF NON-WHITE PEOPLE

Clinicians therefore need to exercise prudence when applying the test to non-White people. Choca (2004) cautioned professionals to draw on additional sources of information to support MCMI test data. However, since the review in the second edition of The Handbook of Multicultural Assessment: Clinical, Psychological, and Educational Applications (Suzuki et al., 2001), research studies with non-White groups continue to be appallingly dismal. In fact, despite the continued popular use of the MCMI-III by mental health professionals, overall research of the MCMI has shown a significant decrease since the early 1990s (Piotrowski, 1997; Craig and Olson, 2005). In the light of the paucity of research with non-White groups, published MCMI, MCMI-II, and MCMI-III studies conducted since 1992 as well as not discussed in the second edition of this Handbook (Suzuki et al., 2001) will be included in this review.

MCMI Studies of African Americans Calsyn, Saxon, and Daisy (1991) examined the effectiveness of the MCMI Drug Abuse Scale (T) in identifying known drug users who sought treatment in a Veterans Administration Medical Center. Clinical correlates of participants known to use drugs who scored higher than a base rate of 74 on the T scale were also investigated. The sample consisted of seventy-four Caucasian, thirty-three African American, and three Latino male veterans. Scale T identified 26 percent of the sample as having a prominent drug abuse syndrome. More than half (51 percent) of the sample scored below the clinical significance base rate (85). African Americans, narcissistic and antisocial subtypes, and those with severe psychopathology were more likely to have elevations on the T scale. The authors cautioned using scale T in identifying drug abusers. Hamberger and Hastings (1992) investigated racial differences among sixty-five African American and sixty-four Caucasian men who were undergoing mandated domestic violence treatment in an outpatient setting. The MCMI was administered as part of the treatment program. After controlling for the effects of age, education, and employment status, African Americans were found to score higher than Caucasians on the Paranoid, Hypomanic, and Psychotic Delusion subscales. Diagnostic accuracy, empirical correlates of the scales, and factor structure differences between ethnic groups were not explored. Munley, Vacha-Haase, Busby, and Paul (1998) compared the MCMI-II scores of 65 African American and 164 Caucasian male inpatients. These patients were categorized into four discharge diagnostic groupings (schizophrenic disorders; major affective disorders; other nonpsychotic neurotic, anxiety, personality disorders, posttraumatic stress disorder, or adjustment disorder; and substance abuse). No differences were found between African American and Caucasian patients who had a comorbid diagnosis of alcohol abuse or dependence. The two racial groups differed significantly on the comorbid diagnosis of drug abuse

435

436 HANDBOOK OF MULTICULTURAL ASSESSMENT or dependence, as it occurred more frequently in the African American sample. African American patients scored significantly higher than their Caucasian counterparts on the Histrionic, Narcissistic, Paranoid, Drug Dependence, and Delusional Disorder scales. When the two racial groups (46 African American and 46 Caucasian men) were matched on Axis I diagnoses at discharge and substance abuse comorbidity, the observed differences became nonsignificant.

MCMI Studies of American Indians Glass, Bieber, and Tkachuk (1996) explored profile differences on the MCMI-II and the effect of acculturation status on observed differences between fortyeight Alaska Native and 23 Caucasian incarcerated men. The Alaska Natives were observed to score higher on the Debasement, Compulsive, Avoidant, Schizoid, Alcohol Dependence, and Thought Disorder scales than non-Natives. Using an Acculturation Scale (King and Keane, 1992) developed for American Indians and Alaska Natives, Natives who indicated a bicultural status were more likely to exhibit borderline personality traits than those whose scores indicated an assimilated status. The authors determined that differences appeared to be more related to group membership (Alaska Native versus non-Native) than to acculturative status.

MCMI Studies of Asian Americans Gunsalus and Kelly (2000) studied the effect of culture on the MCMI-III Dependent and Compulsive scales. The sample consisted of 147 Korean students enrolled in a Korean university and 132 American college students (126 Caucasians, 1 African American, 3 Asian American, and 2 Latino/a). The Korean participants majored in English or English education. Results indicated that Korean students scored higher on the Dependent scale but no differences were found on the Compulsive scale. In addition, significant differences were found between Korean and American students on the Schizoid, Avoidant, Depressive, Histrionic, Aggressive, and Self-defeating scales. Except for the Histrionic scale on which Korean students scored lower, these students scored higher than their American counterparts on the other scales.

MCMI Studies of Latino/as Sugihara and Warner (1999) examined the personality characteristics of Latino batterers and Latino nonbatterers using the MCMI-III. The sixty batterers in the sample attended required monthly meetings for batterers. The volunteer comparison group consisted of forty-five Latino nonbatterers from the same community as the batterers. Both English and Spanish versions of the MCMI-III were administered. Batterers were found to score higher than nonbatterers on all MCMI-III scales except the Narcissistic, Antisocial, and Aggressive scales. Nonbatterers scored higher on the Histrionic and Compulsive scales.

MMPI-2 AND MCMI-III PERFORMANCES OF NON-WHITE PEOPLE

USE OF MMPI-2 AND MCMI-III WITH NON-WHITE POPULATIONS IN THE UNITED STATES There seems to be continuing, albeit limited, interest in examining the MMPI-2 and MCMI-III performances of non-White populations in the United States. MMPI-2 studies of non-White groups can be characterized by two types: comparisons with White samples and relationships with moderator variables (Table 19.3). Across non-White groups, most of the studies compared non-White MMPI-2 scores against that of a White sample. The majority of studies with African Americans were conducted with patients with clinical diagnoses. Only a handful of studies investigated the relationships between moderator variables

Table 19.3. Summary of MMPI-2 Studies with Non-White Groups in the United States Racial and Ethnic Groups African Americans

White Comparison Studies Treatment Sample Freuh, Smith, & Libet (1996)

Nonclinical Sample

Moderator Variable Studies and Studied

Timbrook & Graham (1994)

Whatley, Allen, & Dana (2003): Black Racial Identity

Freuh, Gold, de Arellano, & Brady (1997) McNulty, Graham, Ben-Porath, & Stein (1997) Stukenberg, Brady, & Klinetob (2000) Arbisi, Ben-Porath, & McNulty (2002) Frueh, Hammer, Bernat, Turner, Keane, Arana, (2002) Monnier, Elhai, Frueh, Sauvageot, & Magruder (2002) Craig & Olson (2004) (continued overleaf )

437

438 HANDBOOK OF MULTICULTURAL ASSESSMENT Table 19.3. (continued) Racial and Ethnic Groups American Indians

White Comparison Studies Treatment Sample

Nonclinical Sample

Moderator Variable Studies and Studied

Robin, Greene, Albaugh, Caldwell, & Goldman (2003) Greene, Robin, Albaugh, Caldwell, & Goldman (2003) Pace, Robbins, Choney, Hill, Lacey, & Blair (2006) Garrett, Paris, & Gastorf (2006)

Asian Americans/ Asians in the United States

Steven, Kwan, & Graybill (1993)

Sue, Keefe, Enomoto, Durvasula, & Chao (1996): Acculturation

Sue, Keefe, Enomoto, Durvasula, & Chao (1996)

Tsai & Pike (2000): Acculturation

Tsai & Pike (2000) Dong & Church (2003) Latino/as

Dong & Church (2003): Acculturation

Whitworth & McBlaine (1993) Whitworth & Unterink (1994)

and MMPI-2 scores. For Asian Americans, acculturation was the primary moderator studied (Dong and Church, 2003; Sue et al., 1996; Tsai and Pike, 2000). For African Americans, the conceptual relationship between racial identity statuses (such as guilt, anger, and distrust triggered by realization of societal racism characteristic of the preencounter racial identity status) and certain MMPI-2 scale scores (such as anger as assessed by scale 4, interpersonal sensitivity and defensiveness as assessed by scale 6) was explored. Only two studies (Dong and Church, 2003; Stevens et al., 1993) investigated a specific ethnic group.

Nonbatterers (Sugihara & Warner, 1999)

Latino/as

Batterers (Sugihara & Warner, 1999)

College students (Gunsalus & Kelly, 2000) Latinos

Combined Asian, Black, Latino/a, White Americans

Men and Women Men

White

Men

White

Men

Psychiatric inpatients (Munley, Vacha-Haase, Busby, & Paul, 1998)

Inmates (Glass, Bieber, & Tkachuk, 1996)

White

Men

Batterers (Hamberger & Hastings, 1992)

White

Comparison Groups

Men

Nonclinical Sample

Sample Gender

Substance abusers (Calsyn, Saxon, & Daisy, 1991)

Treatment Sample

Sample Characteristics

Koreans

American Indians

African Americans

Groups

Non-White

Table 19.4. Summary of MCMI Studies of U.S. Non-White Groups

Schizoid, Avoidant, Depressive, Dependent, Negativistic, Self-defeating, Schizotypal, Paranoid, Anxiety, Somatoform, Bipolar Manic, Dysthymia, Alcohol Dependence, Posttraumatic Stress Disorder, Thought Disorder, Major Depression, and Delusional Disorder (MCMI-III)

Dependent, Schizoid, Avoidant, Depressive, Aggressive, and Self-defeating (MCMI-III)

Debasement, Compulsive, Avoidant, Schizoid, Alcohol Dependence, and Thought Disorder (MCMI-II)

Histrionic, Narcissistic, Paranoid, Drug Dependence, and Delusional Disorder (MCMI-II)

Paranoid, Hypomanic, and Psychotic Delusion (MCMI)

Drug Abuse (MCMI)

Scales More Elevated Than the Comparison Group’s

440 HANDBOOK OF MULTICULTURAL ASSESSMENT Compared to the MMPI-2, there were much fewer empirical studies of the MCMI performances of non-White populations. Studies previously reviewed (Hall and Phung, 2001) had focused on only African American patients in clinical settings. Table 19.4 shows that research studies have expanded to include American Indians, Asians/Asian Americans, and Latinos. Of the six identified studies, five compared the respective non-White sample with a White group, five studies included only men, and five studies were conducted with samples with mental health problems (for example, African Americans in domestic violence treatment, Latino batterers, incarcerated Alaska Natives). One study (Glass et al., 1996) explored the relationship between a moderator (acculturation) and MCMI results, and only two studies used the MCMI-III (Gunsalus and Kelly, 2000; Sugihara and Warner, 1999). African American samples in various clinical settings were found to have higher elevations on the MCMI’s psychotic delusion scale (Hamburger and Hasting, 1992) and the MCMI-II’s delusional disorder scale (Munley et al., 1998), as well as on the paranoid scale (Hamburger and Hasting, 1992; Munley et al., 1998) than the respective White comparison samples. Similar results were reported in Hall and Phung’s review. It is apparent that the majority of MMPI-2 and MCMI studies examined whether racial group membership accounted for test score differences between non-White and White samples. Hall and Phung (2001) commented that ‘‘most ethnic difference research on the MMPI and MCMI has been conducted in something of a conceptual and sociopolitical vacuum’’ (p. 312). Most racial comparison studies were conducted without posing any a priori rationales of why racial groups differ (or do not differ). When small or no significant differences were found, results were often taken to support the notion that the assessment instruments showed no bias against the non-White populations, that is, race is not a source of test bias. As such, there seems to be a null hypothesis bias behind some racial comparison studies — that race does not matter. Yet the contention that race has no systematic effects on psychological test performances is problematic in both theory and practice. Hall and Phung (2001) noted that when qualitatively different groups (for example, White versus non-White groups) produced equal scores, the psychological measure can still be biased because it fails to show sensitivity to group differences. Test bias is also indicated if scale scores are systematically associated with factors that are not reflected by the tests’ conceptual or diagnostic intent. In other words, results can be accounted for by reasons other than what the test purports to measure. Psychometric information regarding group differences therefore is not sufficient for evaluating conceptual equivalence when psychological tests developed for and normed with a particular cultural group are applied to another racial and cultural group. When interpreting results that indicate no statistically significant or clinically meaningful differences between racial groups, especially on the MMPI-2,

MMPI-2 AND MCMI-III PERFORMANCES OF NON-WHITE PEOPLE

we observe that a number of these studies were conducted with clinical samples with known psychopathology. Given that the MMPI and MCMI were originally developed for psychodiagnostic purpose, the lack of significant differences between non-White and White psychiatric inpatients (Arbisi et al., 2002; Munley et al., 1998) may indicate the utility of the instruments in assessing some psychopathological constructs that exist across cultures. In fact, international adaptation of some assessment instruments, such as the Chinese MMPI-2, has been found to differentiate psychiatric patients and nonclinical samples. In a review of the application of the Chinese MMPI/MMPI-2 in Chinese societies, Kwan (1999) observed that some MMPI code types were able to characterize Chinese and U.S. patients who shared similar psychopathological symptoms, such as the 876 pattern for schizophrenic patients, the 89/98 pattern for manic patients, the 27/72 pattern for depressed patients, the F123 pattern for migraine patients, and the 49/94 patterns for prisoners and delinquents. As such, existing results indicate the utility of the instruments as post hoc measures to confirm diagnoses of patients in various treatment settings. The validity of these instruments to predict (rather than to confirm) the diagnostic accuracy for non-White people seeking treatment (those who have not already been diagnosed) as well as the personality functioning of those in nontreatment settings (such as accessible research samples) remain empirical questions. Studies with nonclinical samples in the United States have found that non-White people tended to score higher than the normative group. In the light of the psychodiagnostic intent of the MMPI-2 and MCMI-III, a number of studies have focused on identifying cultural and minority experiences other than psychopathology that may contribute to legitimate scale elevations. For example, African Americans in the Immersion-Emersion racial identity status (Helms, 1995) adopt and embrace an Afrocentric worldview and seek to combat White racism. The anger and distrust toward the oppressor group characteristic of the Immersion-Emersion status has been found to be a predictor of scale 4 and scale 9 of the MMPI-2 (Whatley et al., 2003). Similarly, less acculturated Asian Americans have been found to produce more elevated MMPI-2 profiles, which may indicate stress associated with cultural adaptation (Sue et al., 1996). Yet the more acculturated Asian Americans have also been found to produce higher elevations than White Americans (Sue et al., 1996). Whether cultureor adjustment-related factors contributed to such difference requires ongoing empirical investigation. Instead of minimizing group differences, identifying factors that contribute to expected racial group differences is a more valid and clinically meaningful approach to address the question, as well as to control the effects of test bias and utility. This is especially crucial when the instruments are applied to non-White nontreatment groups. As such, refraining from overpathologizing while recognizing that psychopathology exists provides

441

442 HANDBOOK OF MULTICULTURAL ASSESSMENT a prudent conceptual anchor for ethical application of psychological testing with non-White populations. Research studies with the multicultural use of the MMPI-2 and MCMI raise similar questions that clinicians conducting multicultural testing also ask: How does one understand the meaning of racial group differences in test scores? Do the generally elevated scores reported by non-White groups indicate the existence of psychopathology as the tests purport, or are they indicative of cultural reasons other than psychopathology? What are the relevant moderator variables, psychocultural (acculturation level) and sociocultural (education level), other than psychopathology, that account for (elevated) scores? In what ways do moderator variables systematically contribute to scale score (elevations)? These questions speak to the diagnostic validity of the instruments about which there is a paucity of empirical evidence available, especially for multicultural populations. Diagnostic validity is fundamental to the process of psychological assessment, especially with U.S. non-White individuals given empirical evidence that expressly warrants the cautious use of these instruments with these groups. Thus, the specter of overpathologizing is ever present and requires scrutiny. In practice, clinicians need to bear in mind that the MMPI-2 and MCMI-III were developed from and for clinical populations. Findings regarding the meaning of elevated scores for nontreatment non-White populations have been inconclusive. At the same time, some systematic relationships between test scores and psychocultural (for example, acculturation) and sociocultural (for example, education) variables have been empirically indicated. Acculturation has been noted as exerting various types of relationships (for instance, negative, positive, curvilinear; Rogler, Cort´es, and Malgady, 1991) on adjustment and test scores. Therefore, clinicians need to develop competence in identifying, assessing, and determining the relevance and contributions of these cultural variables toward a personalized and contextual approach of test interpretation. Dana (2005) cautions clinicians attributing scale elevations to psychopathology without examining the potential confounding effects of scale items. Language proficiency in particular is a potential confound that may lead to test bias. When the English version of the psychological tests is administered, especially to the increasing foreign-born demographics of Asian Americans and Latino/as, test takers’ language proficiency needs to be ascertained. Although translated versions of some instruments have been standardized with samples outside the United States, clinicians need to keep in mind that overseas findings do not imply cultural validity of the English version to non-White immigrants or descendents of immigrants in the United States. In other words, the fact that the Chinese MMPI-2 has been standardized with samples in Chinese societies does not imply the cultural validity of the English MMPI-2 with Chinese Americans or with Chinese immigrants in the United States. In sum, clinicians need

MMPI-2 AND MCMI-III PERFORMANCES OF NON-WHITE PEOPLE

to examine meanings of scale elevations through a lens of cultural awareness so as to maintain an objective and informed perspective and rationale for interpretation (Dana, 2005; L´opez, 2000). Without knowledge of the empirical relationships between cultural variables and test scores as documented in research, the exploration, data integration, and test interpretation process will be misguided, incomplete, and likely inaccurate.

References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author. American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57(12), 1060–1073. Arbisi, P. A., Ben-Porath, Y. S., & McNulty, J. (2002). A comparison of MMPI-2 validity in African American and Caucasian psychiatric inpatients. Psychological Assessment, 14, 3–15. Butcher, J. N. (1996). International adaptation of the MMPI-2: Research and practice applications. Minneapolis: University of Minnesota Press. Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). Minnesota Multiphasic Personality Inventory-2 (MMPI-2): Manual of administration and scoring. Minneapolis: University of Minnesota Press. Butcher, J. N., & Pancheri, P. (1976). A handbook of cross-national MMPI research. Minneapolis: University of Minnesota Press. Calsyn, D. A., Saxon, A. J., & Daisy, F. (1991). Validity of the MCMI Drug Abuse Scale varies as a function of drug choice, race, and Axis II subtypes. American Journal of Drug and Alcohol Abuse, 17(2), 153–159. Choca, J. P. (2004). Interpretive guide to the Millon Clinical Multiaxial Inventory (3rd ed.). Washington, DC: American Psychological Association. Craig, R. J., & Olson, R. E. (2004). Predicting methadone maintenance treatment outcomes using the Addiction Severity Index and the MMPI-2 content scales (Negative Treatment Indicators and Cynicism Scales). American Journal of Drug and Alcohol Abuse, 30, 823–839. Craig, R. J., & Olson, R. E. (2005). On the decline of MCMI-based research. In R. J. Craig (Ed.), New directions in interpreting the Millon Clinical Multiaxial Inventory-III (MCMI-III) (pp. 284–289). Hoboken, NJ: Wiley. Dahlstrom, W. G., Lachar, D., & Dahlstrom, L. E. (1986). MMPI patterns of American minorities. Minneapolis: University of Minnesota Press. Dana, R. H. (2005). Multicultural assessment: Principles, applications, and examples. Mahwah, NJ: Erlbaum. Dong, Y’Lang, & Church, A. T. (2003). Cross-cultural equivalence and validity of the Vietnamese MMPI-2: Assessing psychological adjustment of Vietnamese refugees. Psychological Assessment, 15, 370–377.

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444 HANDBOOK OF MULTICULTURAL ASSESSMENT Draguns, J. G. (1996). Multicultural and cross-cultural assessment: Dilemmas and decisions. In G. R. Sodowsky & J. C. Impara (Eds.), Multicultural assessment in counseling and clinical psychology (pp. 37–84). Lincoln, NE: Buros Institute of Mental Measurements. Frueh, B. C., Gold, P. B., de Arellano, M. A., & Brady, K. L. (1997). A racial comparison of combat veterans evaluated for PTSD. Journal of Personality Assessment, 68, 692–702. Frueh, B. C., Hammer, M. B., Bernat, J. A., Turner, S. M., Keane, T. M., & Arana, G. W. (2002). Racial differences in psychotic symptoms among combat veterans with PTSD. Depression and Anxiety, 16, 157–161. Frueh, B. C., Smith, D. W., & Libet, J. M. (1996). Racial differences on psychological measures in combat veterans seeking treatment for PTSD. Journal of Personality Assessment, 66, 41–53. Garrett, B. A., Paris, K. A., & Gastorf, J. W. (2006, August). Comparing MMPI-2 profiles of Native American and non-Native American police officers. Paper presented at the 114th Annual Convention of the American Psychological Association, New Orleans, LA. Glass, M. H., Bieber, S. L., & Tkachuk, M. J. (1996). Personality styles and dynamics of Alaska native and nonnative incarcerated men. Journal of Personality Assessment, 66(3), 583–603. Graham, J. R. (2006). MMPI-2: Assessing personality and psychopathology (4th ed.). New York: Oxford University Press. Greene, R. L. (1987). Ethnicity and MMPI performance: A review. Journal of Consulting and Clinical Psychology, 55, 497–512. Greene, R. L., Robin, R. W., Albaugh, B., Caldwell, A., & Goldman, D. (2003). Use of the MMPI-2 in American Indians: II. Empirical correlates. Psychological Assessment, 15, 360–369. Gunsalus, A. C., & Kelly, K. R. (2001). Korean cultural influences on the Millon Clinical Multiaxial Inventory III. Journal of Mental Health Counseling, 23(2), 151–161. Hall, G.C.N., Bansal, A., & L´opez, I. R. (1999). Ethnicity and psychopathology: A meta-analytic review of 31 years of comparative MMPI/MMPI-2 research. Psychological Assessment, 11, 186–197. Hall, G.C.N., & Phung, A. H. (2001). Minnesota Multiphasic Personality Inventory and Millon Clinical Multiaxial Inventory. In L. A. Suzuki, J. G. Ponterotto, & P. J. Meller (Eds.), Handbook of multicultural assessment: Clinical, psychological, and educational applications (2nd ed., pp. 307–330). San Francisco: Jossey-Bass. Hamberger, L. K., & Hastings, J. E. (1992). Racial differences on the MCMI in an outpatient clinical sample. Journal of Personality Assessment, 58(1), 90–95. Handel, R. W., & Ben-Porath, Y. S. (2000). Multicultural assessment with the MMPI-2: Issues for research and practice. In R. H. Dana (Ed.), Handbook of cross-cultural and multicultural personality assessment (pp. 229–245). Mahwah, NJ: Erlbaum.

MMPI-2 AND MCMI-III PERFORMANCES OF NON-WHITE PEOPLE Helms, J. E. (1995). An update of Helms’s White and People of Color Racial identity models. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (pp. 285–311). Thousand Oaks, CA: Sage. Helms, J. E., & Parham, T. A. (1996). The Racial Identity Attitude Scale. In R. L. Jones (Ed.), Handbook of tests and measures for Black populations (pp. 167–172). Oakland, CA: Cobb & Henry. King, J., & Keane E. (1992). Acculturation scale for American Indian adolescents. Denver: Voices of Indian Teens Project, National Center for American Indian/Alaska Native Mental Health Research, University of Colorado Health Sciences Center. Kwan, K.-L.K. (1999). MMPI and MMPI-2 performance of the Chinese: Crosscultural applicability. Professional Psychology: Research and Practice, 30(3), 260–268. L´opez, S. R. (2000). Teaching culturally informed psychological assessment. In R. H. Dana (Ed.), Handbook of cross-cultural and multicultural personality assessment (pp. 669–687). Mahwah, NJ: Erlbaum. Maestas, M. V. (2000). Acculturation and ethnic identity measures for Latinos and Asian Americans: Analyses of methodology and psychometrics. Dissertation Abstracts International, 61(7-A), 2562. McNulty, J. L., Graham, J. R., Ben-Porath, Y. S., & Stein, L.A.R. (1997). Comparative validity of MMPI-2 scores of African American and Caucasian mental health center clients. Psychological Assessment, 9, 464–470. Millon, T. (Ed.). (1997). The Millon inventories: Clinical and personality assessment. New York: Guilford Press. Millon, T., Millon, C., Davis, R., & Grossman, S. (2006). Millon Clinical Multiaxial Inventory–III manual (3rd ed.). Minneapolis, MN: National Computer Systems Pearson. Monnier, J., Elhai, J. D., Frueh, B. C., Sauvageot, J. A., & Magruder, K. M. (2002). Replication and expansion of findings related to racial differences in veterans with combat-related PTSD. Depression and Anxiety, 16, 64–70. Munley, P. H., Vacha-Haase, T., Busby, R. M., & Paul, B. D. (1998). The MCMI-II and race. Journal of Personality Assessment, 70(1), 183–189. Pace, T. M., Robbins, R. R., Choney, S. K., Hill, J. S., Lacey, K., & Blair, G. (2006). A cultural-contextual perspective on the validity of the MMPI-2 with American Indians. Cultural Diversity and Ethnic Minority Psychology, 12, 320–333. Piotrowski, C. (1997). Use of the Millon Clinical Multiaxial Inventory in clinical practice. Perceptual and Motor Skills, 84, 1185–1186. Raajpoot, U. A. (2000). Multicultural demographic developments: Current and future trends. In I. Cuellar & F. A. Paniagua (Eds.), Handbook of multicultural mental health (pp. 79–94). Orlando, FL: Academic Press.

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446 HANDBOOK OF MULTICULTURAL ASSESSMENT Robin, R. W., Greene, R. L., Albaugh, B., Caldwell, A., & Goldman, D. (2003). Use of the MMPI-2 in American Indians: I. Comparability of the MMPI-2 between two tribes and with the MMPI-2 normative groups. Psychological Assessment, 15, 351–359. Rogler, L. H., Cort´es, D. E., & Malgady, R. G. (1991). Acculturation and mental health status among Hispanics. American Psychologist, 46(6), 585–587. Stevens, M. J., Kwan, K.-L. K., & Graybill, D. F. (1993). Comparison of MMPI-2 scores of Foreign Chinese and Caucasian-American students. Journal of Clinical Psychology, 49, 23–27. Stukenberg, K., Brady, C., & Klinetob, N. (2000). Psychiatric inpatients and the MMPI-2: Providing benchmarks. Journal of Clinical Psychology, 56, 747–756. Sue, S., Keefe, K., Enomoto, K., Durvasula, R. S., & Chao, R. (1996). Asian American and White college students’ performance on the MMPI-2. In J. B. Butcher (Ed.), International adaptations of the MMPI-2 (pp. 206–218). Minneapolis: University of Minnesota Press. Sugihara, Y., & Warner, J. A. (1999). Mexican-American male batterers on the MCMI-III. Psychological Reports, 85(1), 163–169. Suzuki, L. A., Ponterroto, J. G., & Meller, P. J. (Eds.). (2001). Handbook of multicultural assessment: Clinical, psychological, and educational applications (2nd ed.). San Francisco: Jossey-Bass. Tellegen, A., Ben-Porath, Y. S., McNulty, J. L., Arbisi, P. A., Graham, J. R., & Kaemmer, B. (2003). The MMPI-2 restructured clinical (RC) scales: Development, validation, and interpretation. Minneapolis: University of Minnesota Press. Timbrook, R. E., & Graham, J. R. (1994). Ethnic differences on the MMPI-2? Psychological Assessment, 6, 212–217. Tsai, D. C., & Pike, P. L. (2000). Effects of acculturation on the MMPI-2 scores of Asian American students. Journal of Personality Assessment, 74, 216–230. Whatley, P. R., Allen, J., & Dana, R. H. (2003). Racial identity and the MMPI in African American male college students. Cultural Diversity and Ethnic Minority Psychology, 9, 345–353. Whitworth, R. H., & McBlaine, D. D. (1993). Comparison of the MMPI and MMPI-2 Administered to Anglo- and Hispanic-American university students. Journal of Personality Assessment, 61(1), 19–27. Whitworth, R. H., & Unterbrink, C. (1994). Comparison of MMPI-2 clinical and content scales administered to Hispanic and Anglo-Americans. Hispanic Journal of Behavioral Sciences 16(3), 255–264.

SECTION TWO

ASSESSMENT OF COGNITIVE ABILITIES

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he seven chapters in this section focus on the assessment of cognitive abilities. Topics are related to understanding cultural differences in meaning and use of particular instruments and procedures in assessing cognitive abilities. Chapter Twenty, by Robert J. Sternberg and Elena L. Grigorenko, addresses conceptual issues important to the understanding of ability testing in a multicultural context. The authors cite various models that address the relationship of abilities, tests, and cultures. They also discuss transportability issues, Western views of intelligence, and other cultural conceptions of ability. Chapter Twenty-One examines the educational assessment of Englishlanguage learners. Graciela N. Borsato and Amado M. Padilla cite the problems that have arisen when important decisions are based on such questionable assessment practices as inadequate language proficiency assessment and untrained interpreters. They describe the process of evaluating English-language proficiency and how this relates to the assessment of academic achievement. Chapter Twenty-Two, by Lisa Suzuki, Lorelei Prevost, and Ellen L. Short, highlights multicultural issues that have an impact on the assessment of intelligence and aptitude. Attention is given to traditional measures of intelligence as well as alternate forms, such as social intelligence, emotional intelligence, multiple intelligences, and biological indicators of intelligence. Specific reference is made to norming samples of the most recently reviewed tests in Buros’s Mental Measurements Yearbook.

448 HANDBOOK OF MULTICULTURAL ASSESSMENT Information regarding academic achievement testing for culturally diverse groups is presented in Chapter Twenty-Three, by Craig L. Frisby. The role of general mental ability, and the relationships of learning, ability, and achievement in relation to IQ are addressed. Analysis of data from the National Assessment of Educational Progress is provided with respect to reading, math, and science. Arthur MacNeill Horton Jr. provides information in Chapter Twenty-Four regarding multicultural issues as they relate to neuropsychological assessment tests. He discusses the history of clinical neuropsychology and various neuropsychological measures and describes the use of these tests with different racial and ethnic minority groups. Chapter Twenty-Five, by Paul J. Meller and Phyllis S. Ohr, highlights the assessment of developing skills in infants and preschoolers. The authors describe the growing zeitgeist in education including the No Child Left Behind Act, reauthorization of the Individuals with Disabilities Education Act, changing parameters of early childhood assessment, and rapid changes in the demographic composition of the United States. Attention is given to the Family-Oriented, Culturally Sensitive Infant/Toddler Assessment and Intervention program (FOCUS). Amanda L. Baden and Grace Wong examine assessment practices at the other end of the age spectrum. In Chapter Twenty-Six, they address multicultural assessment practices and their application to the elderly. Attention to culturally biased assessment and elements of culturally sensitive and comprehensive testing practices are identified. The authors also discuss traditional measures and special considerations for the elderly.

CHAPTER TWENTY

Ability Testing Across Cultures Robert J. Sternberg Elena L. Grigorenko

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any investigators of human abilities take for granted Western views of what human abilities are. They may disagree as to which Western view they accept, but they nevertheless accept one such view. But many people in the world have views of abilities that do not correspond well to conventional Western views (Berry, 1974; Das, 1994).

MODELS OF THE RELATIONSHIP AMONG ABILITIES, TESTS, AND CULTURES Many research programs demonstrate the potential hazards of single-culture research. For example, Greenfield (1997) found that it means a different thing to take a test among Mayan children than it does among most children in the United States. The Mayan expectation is that collaboration is permissible and that it is rather unnatural not to collaborate. Such a finding is consistent with the work of Markus and Kitayama (1991), suggesting different cultural Preparation of this chapter was supported under the Javits Act Program (Grant No. R206R00001) as administered by the Institute of Educational Sciences, U.S. Department of Education. Grantees undertaking such projects are encouraged to express freely their professional judgment. This chapter therefore does not necessarily represent the position or policies of the Office of Educational Research and Improvement or the U.S. Department of Education, and no official endorsement should be inferred.

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450 HANDBOOK OF MULTICULTURAL ASSESSMENT constructions of the self in individualistic versus collectivistic cultures. Indeed, Nisbett (2003) has found that some cultures, especially Asian ones, tend to be more dialectical in their thinking, whereas other cultures, such as European and North American ones, tend to be more linear. And individuals in different cultures may construct concepts in quite different ways, rendering results of concept formation or identification studies in a single culture suspect (Atran, 1999; Coley, Medin, Proffitt, Lynch, and Atran, 1999; Medin and Atran, 1999). Thus, groups may think about what appears superficially to be the same phenomenon—whether a concept or the taking of a test—differently. What appear to be differences in general intelligence may in fact be differences in cultural properties (Helms-Lorenz, Van de Vijver, and Poortinga, 2003). Helms-Lorenz et al. (2003) have argued that measured differences in intellectual performance may result from differences in cultural complexity, but complexity of a culture is extremely hard to define, and what appears to be simple or complex from the point of view of one culture may appear differently from the point of view of another. Sternberg (2004) has proposed four models of the relationships among abilities, tests, and cultures. The models presented here differ in two key respects: whether there are cross-cultural differences in the nature of the mental processes and representations involved in adaptation that constitute intelligence and whether there are differences in the instruments needed to measure intelligence (beyond simple translation or adaptation), as a result of cultural differences in the content required for adaptation. In model I, the nature of intelligence is the same across cultures, as are the tests used to measure intelligence. The theoretical positions of Jensen (1998), Rowe (2005), Rushton (1995), and Rushton and Jensen (2005) represent model I types of positions. The argument is that the nature of intelligence is precisely the same cross-culturally and that this nature can be assessed identically (using appropriate translations of text, where necessary) without regard to culture. For example, Jensen (1998) believes that general intelligence, or g, is the same across time and place. What varies across time and place are its levels. Model II represents a difference in the nature of intelligence but no difference in the instruments used to measure it. The measures used to assess intelligence are the same across cultures, but the outcomes obtained from using those measures are structurally different as a function of the culture being investigated. This approach is close to that taken by Nisbett (2003), who found that the same tests given in different cultures suggested that across cultures, people think about problems in different ways. In model III, the dimensions of intelligence are the same, but the instruments of measurement are not. On this view, measurement processes for a given attribute must be emic, that is, derived from within the context of the culture being studied rather than from outside it. This is not to say that

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the same instruments cannot be used across cultures, but when they are, the psychological meanings to be assigned to the scores will differ from one culture to another. This is the position taken in this chapter and in our earlier work (Sternberg, 1990). In model IV, both the instruments and the ensuing dimensions of intelligence are different as a function of the culture under investigation. This position embraces the radical cultural-relativist position (Berry, 1974) that intelligence can be understood and measured only as an indigenous construct within a given cultural context. It also embraces the position of Sarason and Doris (1979), who view intelligence largely as a cultural invention. In other words, nothing about intelligence is necessarily common across cultures.

THE TRANSPORTABILITY OF ABILITY TESTS The Standard Positions The importance of studying indigenous concepts of abilities from around the world has been recognized by those who believe that cognitive ability tests are transportable from one culture to another and by those who do not. Those researchers who support the first position argue for universalism (Lonner and Adamapolous, 1997) and, usually, cross-cultural quantification. Because they are interested in discovering both what is universal and what is variable across cultures (Berry, Poortinga, Segall, and Dasen, 1992; van de Vyjver and Leung, 1997), these scientists view conventional Western tests as anchors with known psychometric properties that, when translated as necessary, can provide basic data for cross-cultural comparative purposes (Poortinga, 1989). The underlying assumption here is that universal sets of the ‘‘best’’ ability tests can work anywhere, as long as they are adequately translated and administered by a ‘‘native’’ tester. In this tradition, studying indigenous folk conceptions of abilities means understanding how a particular culture differs from the gold standard of universal abilities captured by the most respected ability tests. The assumption underlying this research, then, is of the universality of abilities despite some degree of cultural specificity in folk conceptions of intelligence. Adherents to the second position—that ability tests are not transportable from one culture to another—have argued that the concept of intelligence and, hence, tests of intelligence and cognitive abilities are in large part cultural inventions (Berry, 1974; Sternberg, 1996a, 1996b; Stigler, Shweder, and Herdt, 1990). When unfolded, this argument implies that conventional ability tests (1) presuppose a particular cultural framework, which is not universally shared (Greenfield, 1997); (2) potentially create closed educational systems that select children and then reward them for abilities tested by conventional tests at the

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452 HANDBOOK OF MULTICULTURAL ASSESSMENT same time that they largely ignore other abilities (Sternberg, 1997); (3) provide information on developed skills rather than on the ability to develop such skills (Grigorenko and Sternberg, 1998; Sternberg, 1998; Sternberg and Grigorenko, 2004); and (5) are not easily or not at all transportable to different cultures (Cole, 1996; Cole, Gay, Glick, & Sharp, 1971; Greenfield, 1997; Laboratory of Comparative Human Cognition, 1982). Indeed, the abilities needed to adapt to the demands of one culture may be different from the abilities needed to adapt to another (Biesheuvel, 1943; Biesheuvel and Milcenzon, 1953; Gladwin, 1970; Kearins, 1981). According to investigators in this tradition, studying indigenous concepts of abilities is an attempt to recognize and appreciate the natural variability of cultural folk conceptions of abilities. The assumption underlying the research here, then, is the specificity of both intelligence and folk concepts of it. Regardless of which tradition we are speaking of, the richness of approaches that psychologists and anthropologists use to describe the complexity of indigenous ideas about intelligence is quite remarkable (Sternberg and Kaufman, 1998). These approaches have been developed by both cultural outsiders (Berry and Bennett, 1992) and insiders (Mukamurama, 1985). The approaches to assessment include interviews with parents (Dasen, 1984) and analyses of Piagetian conservation analyses (Greenfield, 1966). Cultural and cross-cultural researchers use methodologies of participatory observations (Fortes, 1938) and firsthand experience of the settings in which abilities are shown (Colby, Jessor, and Shweder, 1996); they use linguistic (Kagame, 1976) and cognitive (Cole et al., 1971) approaches; and they analyze their data with traditional (Super, 1983) and original, specially developed (Wober, 1974) statistical techniques. Many of the conventional models of human abilities posit a relatively fixed set of entities that are the same from one culture to another. According to these models, abilities are more or less stable individual-differences entities that have a fixed structure and set of relationships in the mind. Ability tests measure the quality of this structure and set of relationships.

Abilities as Developing Expertise: A Third View on Transportability An alternative view that is advanced here is that of abilities as developing expertise (Sternberg, 1998, 1999). According to this view, conventional mental ability tests measure only a limited aspect of the range of human abilities because they measure only a limited aspect of developing expertise at a particular fixed point in time. Developing expertise is defined here as the ongoing process of the acquisition and consolidation of a set of skills needed for a high level of mastery in one or more domains of life performance. All skilled performances go through a

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process of acquisition by which expertise develops over time with one or more rates of learning to an asymptote (which represents a stable, although not necessarily a maximal, level of expertise). The performances that are valued in one culture may differ from those valued in another culture. Hence the kinds of expertise that might be viewed as worthy of being tested may vary as well. Gladwin (1970) has documented the case of the Puluwat, who are able to navigate ships from one island to another without any obvious cues. If most of the readers of this chapter were to take a test relevant for performance in their society, chances are they would do quite poorly. The difference in what is important where is not limited to the Puluwat ˜ (1994) has reported related findings based on a series of studies culture. Nunes she conducted in Brazil (see also Carraher, Carraher, and Schliemann, 1985; Ceci and Roazzi, 1994). Street children’s adaptive intelligence is tested to the limit by their ability to form and successfully run a street business. If they fail to run such a business successfully, they risk starvation or death at the hands ˜ and her collaborators of death squads should they resort to stealing. Nunes have found that the same children who are doing the mathematics needed for running a successful street business cannot do well with the same types of mathematics problems presented in an abstract, paper-and-pencil format. From a conventional abilities standpoint, this result is puzzling. From a developing expertise standpoint, it is not. Street children grow up in an environment that fosters the development of practical but not academic mathematical skills. We know that even conventional academic kinds of expertise often fail to show transfer (Gick and Holyoak, 1980). It is scarcely surprising, then, that there would be little transfer here. The street children have developed the kinds of practical arithmetical expertise they need for survival and even success, but they will get no credit for these skills when they take a conventional abilities test. It also seems likely that if the scales were reversed and privileged children who do well on conventional ability tests or in school were forced out on the street, many of them would not survive long. Indeed, in the ghettoes of urban America, many children and adults who, for one reason or another end up on the street, in fact barely survive or do not make it at all. Differences in cultural adaptation apply not only in developing cultures. The skills required to survive in war-torn Kosovo might leave many high-IQ people dead. Even in Russia today, many of the high-IQ people who made it into once prestigious jobs such as that of college professor are now poor and in some cases having trouble surviving, whereas people who have entrepreneurial skills but not necessarily the highest IQs have risen to the top. Indeed, Grigorenko et al. (2001) found that tests of practical abilities measure skills that are more important to adaptation in Russia today than do tests of conventional fluid and crystallized abilities. In particular, the tests of practical abilities were better

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454 HANDBOOK OF MULTICULTURAL ASSESSMENT predictors of reduced levels of anxiety and depression and of higher levels of physical health than were the academic ability tests. Good performance on ability tests, then, requires certain kinds of expertise. To the extent these kinds of expertise overlap with the kinds of expertise required by schooling or by the workplace, there will be a correlation between the tests and performance in school or in the workplace. But such correlations represent no intrinsic relation between abilities and other kinds of performance, but rather overlaps in the kinds of expertise needed to perform well under different kinds of circumstances. Thus, abilities represent a form of attainment, as do other forms of attainment. A culture might value forms of attainment quite different from those relevant to conventional tests of abilities. In a collaborative study among children near Kisumu, Kenya (see Sternberg and Grigorenko, 1997; Sternberg et al., 2000, 2001), we devised a test of practical abilities that measures informal knowledge for an important aspect of adaptation to the environment in rural Kenya: knowledge of the identities and use of natural herbal medicines that can be used to combat illnesses. The children use this informal knowledge an average of once a week in treating themselves or suggesting treatments to other children, so this knowledge is a routine part of their everyday existence. By informal knowledge, we are referring to kinds of knowledge not taught in schools and not assessed on tests given in the schools. The idea of our research was that children who knew what these medicines were, what they were used for, and how they should be dosed would be in a better position to adapt to their environments than would children without this informal knowledge. We found substantial individual differences in the tacit knowledge of like-aged and -schooled children about these natural herbal medicines. More important, however, was the correlation between scores on this test and scores on an English-language vocabulary test (the Mill Hill), a Dholuo equivalent (Dholuo is the community and home language), and the Raven Coloured Progressive Matrices. We found significantly negative correlations between our test and the English-language vocabulary test, as well as with tests of school-based English-language achievement. Correlations of our test with the other tests were also negative. The better children did on the test of indigenous tacit knowledge, the worse they did on the tests of conventional abilities and achievement, and vice versa. Why might we have obtained such a finding? Based on ethnographic observation, we believe a possible reason is that parents in the village may emphasize either a more indigenous or a more Western education. Some parents (and their children) see little value to school. They do not see how success in school connects with the future of children who will spend their whole lives in a village, where they do not believe they need the expertise the school teaches. Other parents and children seem

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to see Western schooling as of value in itself or potentially as a ticket out of the confines of the village. The parents thus tend to emphasize one type of education or the other for their children, with corresponding results. The kinds of developing expertise the families value differ, and so therefore do scores on the tests. From this point of view, the intercorrelational structure of tests tells us nothing intrinsic about the structure of intelligence, but rather something about the way abilities as developing forms of expertise structure themselves in interaction with the demands of the environment. Although we cannot now prove it, we doubt this kind of finding is limited to rural Kenya or to Africa or to developing countries. There is nothing privileged about conventional ability tests. Although they are used as predictors, they could be and sometimes are used as criteria. One could as easily use, say, academic achievement to predict ability-related scores as ability-related scores to predict academic achievement. According to this view, although ability tests may have temporal priority relative to various criteria in their administration (ability tests are administered first, and later, criterion indexes of performance, such as grade point average or achievement test scores, are collected), the constructs measured by the ability tests have no psychological priority. All of the various kinds of assessments are of the same kind psychologically. What distinguishes ability tests from other kinds of assessments is how the ability tests are used (usually predictively) rather than what they measure. There is no qualitative distinction among the various kinds of assessments. All tests measure various kinds of developing expertise. Conventional tests of abilities and related abilities measure achievement that individuals presumably should have accomplished several years back (see also Anastasi and Urbina, 1997). Of course, this presumption assumes Western schooling, and thus is very limited. Tests such as vocabulary, reading comprehension, verbal analogies, arithmetic problem solving, and others are all in part tests of achievement. Even abstract reasoning tests measure achievement in dealing with geometric symbols, skills taught in Western schools (Laboratory of Comparative Human Cognition, 1982). One might as well use academic performance to predict ability test scores. The problem regarding the traditional model is not in its statement of a correlation between ability tests and other forms of achievement but in its proposal of a causal relation whereby the tests reflect a construct that is somehow causal of, rather than merely temporally antecedent to, later success. The fine distinction between ability and achievement tests is shown in dynamic testing, which combines elements of each (see Brown and Ferrara, 1985; Budoff, 1987a, 1987b; Campione, 1989; Carlson and Wiedl, 1980; Feuerstein, Rand, and Hoffman, 1979; Grigorenko and Sternberg, 1998; Guthke, 1992; Lidz, 1987, 1995; Sternberg and Grigorenko, 2002; Vygotsky, 1978).

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456 HANDBOOK OF MULTICULTURAL ASSESSMENT In a collaborative study near Bagamoyo, Tanzania (Sternberg et al., 2002), we investigated dynamic tests administered to children. Although dynamic tests have been developed for a number of purposes (see also Grigorenko and Sternberg, 1998; Sternberg and Grigorenko, 2001, 2002), one of our purposes was to look at how dynamic testing affects score patterns. In particular, we developed more or less conventional ability tests but administered them in a dynamic format. The tests were of sorting of geometrical figures, linear syllogisms, and twenty questions. First students took a pretest. Then they received a short period of instruction (generally no more than ten to fifteen minutes per subtest) on how to improve their performance in the expertise measured by each test. Then the children took a posttest. A first finding was that scores increased significantly from pretest to posttest. Such an effect could be due, of course, to practice effects. But the finding suggests that the scores are not stable and that one probably should not draw strong conclusions about the levels of abilities of people in developing cultures on the basis of scores on a single administration of a static test (as did, for example, Herrnstein and Murray, 1994). A second finding was that the correlation between pretest scores and posttest scores, although statistically significant, was weak (about .3). In other words, even a short period of instruction fairly drastically changed the rank orders of the students on the test. Thus, identifying ‘‘bright’’ students on the basis of a static test appeared to be a questionable enterprise. The third finding pertained to the correlation of test scores with other kinds of performance. The critical question, of course, is not whether there is a change, but what it means. In particular, which predicts other kinds of cognitive performance better: pretest scores or learning? We found that posttest scores predicted other kinds of cognitive performance better than did pretest scores. We examined the pretest data for floor effects, as the lower correlation for the pretest might have been due to such effects. There were no such effects. We again interpret these results in terms of the model of developing expertise. The Tanzanian students had developed very little expertise in the skills required to take American-style intelligence tests. Thus, even a short intervention could have a fairly substantial effect on their scores. When the students developed somewhat more of this test-taking expertise through a short intervention, their scores changed and became more reflective of their true capabilities for cognitive work. The developing expertise view in no way rules out the contribution of genetic factors as a source of individual differences in who will be able to develop a given amount of expertise. People may differ genetically in their ability to acquire expertise. But how genes play themselves out inevitably is affected by the environment. Phenotypes always represent covariations and interactions between genotypes and the environment. The contribution

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of genes to an individual’s intelligence cannot be directly measured or even directly estimated. Rather, what is measured is a portion of what is expressed: manifestations of developing expertise.

WHAT ABILITIES SHOULD BE MEASURED Intelligence is a term that is sometimes used to refer to those abilities deemed most important by a society and thus worthy of measurement. What is intelligence? It turns out that the answer depends on whom you ask and that the answer differs widely across disciplines, time, and place. Ability tests need to reflect these differences.

Western Psychological Views How have Western psychologists conceived of the abilities constituting intelligence? Almost none of these views are adequately expressed by Boring’s operationistic view of intelligence (1923) as what intelligence tests test. Thus, whatever ability tests measure is what should be measured. This definition is about as circular as one can get. Not all definitions have been circular, however. In a symposium on experts’ definitions of intelligence, ‘‘Intelligence and Its Measurement: A Symposium,’’ held in 1921, researchers emphasized the importance of the ability to learn and the ability to adapt to the environment. Sixty-five years later, Sternberg and Detterman (1986) conducted a similar symposium, again asking experts their views on intelligence. Learning and adaptive abilities retained their importance, and a new emphasis crept in—metacognition, or the ability to understand and control one’s self. Of course, the name is new, but the idea is not: Aristotle emphasized the importance for intelligence of knowing oneself.

Views from Cultures Around the World In some cases, Western notions about intelligence are not shared by other cultures. For example, at the mental level, the Western emphasis on speed of mental processing (Sternberg, Conway, Ketron, and Bernstein, 1981; see also Berry, 1984) is not shared in many cultures. Other cultures may even be suspicious of the quality of work that is done very quickly. Indeed, other cultures emphasize depth rather than speed of processing. They are not alone: some prominent Western theorists have pointed out the importance of depth of processing for full command of material (Craik and Lockhart, 1972). Yang and Sternberg (1997a) have reviewed Chinese philosophical conceptions of intelligence. The Confucian perspective emphasizes the characteristic of benevolence and of doing what is right. As in the Western notion, the intelligent person spends a great deal of effort in learning, enjoys learning,

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458 HANDBOOK OF MULTICULTURAL ASSESSMENT and persists in life-long learning with a great deal of enthusiasm. The Taoist tradition, in contrast, emphasizes the importance of humility, freedom from conventional standards of judgment, and full knowledge of oneself as well as of external conditions. The difference between Eastern and Western conceptions of intelligence may persist even now (Nisbett, 2003). Yang and Sternberg (1997b) studied contemporary Taiwanese Chinese conceptions of intelligence and found five factors underlying these conceptions: (1) a general cognitive factor, much like the g factor in conventional Western tests; (2) interpersonal intelligence; (3) intrapersonal intelligence; (4) intellectual self-assertion; and (5) intellectual self-effacement. In a related study but with different results, Chen (1994) found three factors underlying Chinese conceptualizations of intelligence: nonverbal reasoning ability, verbal reasoning ability, and rote memory. The difference may be due to different subpopulations of Chinese, differences in methodology, or differences in when the studies were done. The factors uncovered in both studies differ substantially from those identified in U.S. people’s conceptions of intelligence by Sternberg et al. (1981)—practical problem solving, verbal ability, and social competence— although in both cases, people’s implicit theories of intelligence seem to go quite far beyond what conventional psychometric intelligence tests measure. Of course, comparing the Chen (1994) to the Sternberg et al. (1981) study simultaneously varies both language and culture. Chen and Chen (1988) varied only language. They explicitly compared the concepts of intelligence of Chinese graduates from Chinese-language versus English-language schools in Hong Kong. They found that both groups considered nonverbal reasoning skills as the most relevant skill for measuring intelligence. Verbal reasoning and social skills came next, and then numerical skill. Memory was seen as least important. The Chinese-language-schooled group, however, tended to rate verbal skills as less important than did the English-language-schooled group. Moreover, in an earlier study, Chen, Braithwaite, and Huang (1982) found that Chinese students viewed memory for facts as important for intelligence, whereas Australian students viewed these skills as of only trivial importance. Das (1994), also reviewing Eastern notions of intelligence, has suggested that in Buddhist and Hindu philosophies, intelligence involves waking up, noticing, recognizing, understanding, and comprehending, but it also includes such things as determination, mental effort, and even feelings and opinions, in addition to more intellectual elements. Differences between cultures in conceptions of intelligence have been recognized for some time. Gill and Keats (1980) noted that Australian university students value academic skills and the ability to adapt to new events as critical

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to intelligence, whereas Malay students value practical skills, as well as speed and creativity. Dasen (1984) found Malay students to emphasize both social and cognitive attributes in their conceptions of intelligence. The differences between East and West may be due to differences in the kinds of skills valued by the two kinds of cultures (Srivastava and Misra, 1996). Western cultures and their schools emphasize what might be called ‘‘technological intelligence’’ (Mundy-Castle, 1974), and so things like artificial intelligence and so-called smart bombs are viewed, in some sense, as intelligent, or smart. Western schooling also emphasizes other things (Srivastava and Misra, 1996), such as generalization, or going beyond the information given (Connolly and Bruner, 1974; Goodnow, 1976), speed (Sternberg, 1985), minimal moves to a solution (Newell and Simon, 1972), and creative thinking (Goodnow, 1976). Moreover, silence is interpreted as a lack of knowledge (Irvine, 1978). In contrast, the Wolof tribe in Africa views people of higher social class and distinction as speaking less than others (Irvine, 1978). This difference between the Wolof and Western notions suggests the usefulness of looking at African notions of intelligence as a possible contrast to U.S. notions. Studies in Africa provide yet another window on the substantial differences. Ruzgis and Grigorenko (1994) have argued that in Africa, conceptions of intelligence revolve largely around skills that help to facilitate and maintain harmonious and stable intergroup relations; intragroup relations are probably equally important and at times more important. For example, Serpell (1974, 1982, 1993) found that Chewa adults in Zambia emphasize social responsibilities, cooperativeness, and obedience as important to intelligence; intelligent children are expected to be respectful of adults. Kenyan parents also emphasize responsible participation in family and social life as important aspects of intelligence (Super and Harkness, 1982b, 1983). In Zimbabwe, the word for intelligence, ngware, means to be prudent and cautious, particularly in social relationships. Among the Baoule, service to the family and community and politeness toward and respect for elders are seen as key to intelligence (Dasen, 1984). Similar emphasis on social aspects of intelligence has been found as well among two other African groups: the Songhay of Mali and the Samia of Kenya (Putnam and Kilbride, 1980). The Yoruba, another African tribe, emphasize the importance of depth—of listening rather than just talking—to intelligence and of being able to see all aspects of an issue and place the issue in its proper overall context (Durojaiye, 1993). The emphasis on the social aspects of intelligence is not limited to African cultures. Notions of intelligence in many Asian cultures also emphasize the social aspect of intelligence more than does the conventional Western or IQ-based notion (Azuma and Kashiwagi, 1987; Lutz, 1985; Poole, 1985; White, 1985).

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460 HANDBOOK OF MULTICULTURAL ASSESSMENT In our own collaborative work, we have found that conceptions of intelligence in Kenya are quite different from those in the West (Grigorenko et al., 2001). The rural Kenyan conception seems to have four parts: • The concept of rieko can be translated as intelligence, smartness, knowledge, ability, skill, competence, and power. Along with the general concept of rieko, the Luo people distinguish among various specialized representations of this concept. Some representations are characterized by the source of rieko, such as school or home. • Luoro is the second main quality of children and people in general. It encompasses a whole field of concepts roughly corresponding to social qualities such as respect and care for others, obedience, diligence, consideration, and readiness to share. Luoro has an unequivocal positive meaning and was always mentioned as a necessity in response to questions such as, ‘‘What is most important for a good child to have?’’ and, ‘‘What should people have to lead a happy life?’’ When people were asked to compare the relative importance for an individual’s life of rieko and luoro, respondents generally gave preference to luoro. Interestingly, the only two respondents ranking rieko higher, when compared with luoro, were outsiders to the local community who had a tertiary education and considerable wealth by village standards. Rieko and luoro are complementary. Rieko is a positive attribute only if luoro is also present. Ideally, the power of pure individual abilities should be kept under control by social rules. A child lacking luoro potentially will use his or her rieko for selfish interests and even against others. And the child lacking rieko but possessing luoro is likely to develop rieko because, as a primary school teacher put it in an interview, ‘‘her humbleness [luoro] would lead her to asking people and learning by accepting their advice.’’ • Paro overlaps with both luoro and rieko and, roughly translated, means thinking. Specifically, paro refers to the thought processes required to identify a problem and its solution and to the thought processes involved in caring for other people. A child with good thinking (paro maber) could thus, for example, be a child who is able to react rationally in case of another person’s accident or one who is able to collect wood, burn charcoal, and sell it favorably in order to help his old grandmother. The concept of paro stresses the procedural nature of intelligence. In essence, paro occupies an intermediate position between the potentiality of rieko (its ability aspects) and the partially moral connotation of an outcome (the deed) done with or without luoro. Paro also reflects the idea of initiative and innovation, for example, in designing a new technical device. Paro encompasses the process of thinking, the ability to think, and the specific kind of thinking that an individual demonstrates.

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Paro, like rieko, is morally ambiguous and can lead to good or bad outcomes. Also, a person can have too much paro. For example, too much thinking prevents the person from doing something: the person just thinks (oparo kende) but does not act. • Winjo, like paro, is linked to both rieko and luoro. Winjo means comprehending and understanding. It points to the child’s abilities to comprehend, that is, to process what is said or what is going on—here it is linked to rieko—and to grasp what is appropriate and inappropriate in a situation, that is, to understand and do what he or she is told by adults or to derive from the situation what is appropriate to do. Here it is linked to luoro. It shares with the other key terms the feature that its meaning is a function of context. For a teacher in school, it means that a child runs an errand as told. In contrast, a grandmother teaching a child about healing might emphasize the aspect of procedural learning combined with attention to another person. These conceptions of intelligence emphasize social skills much more than do conventional U.S. conceptions of intelligence, at the same time that they recognize the importance of cognitive aspects of intelligence. But it is important to realize again that there is no one overall U.S. conception of intelligence. Indeed, Okagaki and Sternberg (1993) found that different ethnic groups in San Jose, California, had rather different conceptions of what it means to be intelligent. For example, Latino parents of schoolchildren tended to emphasize the importance of social competence skills in their conceptions of intelligence, whereas Asian parents tended rather heavily to emphasize the importance of cognitive skills. Anglo parents also emphasized cognitive skills more. Teachers, representing the dominant culture, emphasized cognitive competence more than social competence skills. The rank order of children of various groups’ performance (including subgroups within the Latino and Asian groups) could be perfectly predicted by the extent to which their parents shared the teachers’ conception of intelligence. In other words, teachers tended to reward children who were socialized into a view of intelligence that happened to correspond to the teachers’ own. Yet as we shall argue, social aspects of intelligence, broadly defined, may be as important as or even more important than cognitive aspects of intelligence in later life. Sometimes accepted social skills may interfere with the Western paradigm for taking ability tests. Differences are found not only between East and West, North and South. They can be found in the United States. We have found related although certainly not identical results in a study we have done among Yup’ik Eskimo children in southwestern Alaska (Grigorenko et al., 2004). We assessed the importance of academic and practical intelligence in rural and semiurban Alaskan communities. A total of 261 children were rated for practical skills by

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462 HANDBOOK OF MULTICULTURAL ASSESSMENT adults or peers in the study: 69 in grade 9, 69 in grade 10, 45 in grade 11, and 37 in grade 12. Of these children, 145 were females (74 from the rural and 71 from the semiurban communities) and 116 were males (62 were from the rural and 54 were from the semiurban communities). We measured academic intelligence with conventional measures of fluid (the Cattell Culture Fair Test of g; Cattell and Cattell, 1973) and crystallized intelligence (the Mill-Hill Vocabulary Scale, Raven et al., 1992). We measured practical intelligence with a test of tacit knowledge of skills (hunting, fishing, dealing with weather conditions, picking and preserving plants, and so on) as acquired in rural Alaskan Yup’ik communities (the Yup’ik Scale of Practical Intelligence, YSPI). The semiurban children statistically significantly outperformed the rural children on the measure of crystallized intelligence, but the rural children statistically significantly outperformed the semiurban children on the measure of the YSPI. The test of tacit knowledge skills was superior to the tests of academic intelligence in predicting practical skills as evaluated by adults and peers of the rural children (for whom the test was created) but not of the semiurban ones.

TAKING ABILITY TESTS Patricia Greenfield (1997) has done a number of studies in a variety of cultures and found that the kinds of test-taking expertise assumed to be universal in the United States and other Western countries is by no means universal. She found, for example, that children in Mayan cultures (and probably in other highly collectivist cultures as well) were puzzled when they were not allowed to collaborate with parents or others on test questions. In the United States, of course, such collaboration would be viewed as cheating. But in a collectivist culture, someone who had not developed this kind of collaborative expertise, and moreover, someone who did not use it, would be perceived as lacking important adaptive skills (see also Laboratory of Comparative Human Cognition, 1982). Cognitive categories also may interfere with Western paradigms for test taking. In another famous example, Cole et al. (1971) asked adult members of the Kpelle tribe to sort names of various kinds of objects, such as names of fruits, names of vegetables, or names of vehicles of conveyance. They found that the adults sorted functionally rather than taxonomically. For example, they might sort ‘‘apple’’ with ‘‘eat’’ or ‘‘car’’ with ‘‘gas,’’ rather than sorting various kinds of apples together, under the word ‘‘apple,’’ and then ‘‘fruits,’’ and perhaps then ‘‘foods.’’ The Kpelle way of doing this task would be considered cognitively immature in the West. It is the way young children would complete the task. Indeed, virtually any theorist of cognitive development (Piaget, 1972) would view functional sorting as inferior; and on the vocabulary section of

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an intelligence test such as the Wechsler or the Stanford-Binet, a functional definition of, say, an automobile as using gas would receive less credit than a taxonomic definition, say, of an automobile as a vehicle of conveyance. Cole and associated tried without success to get the Kpelle to sort in an alternative way. Finally, they gave up and started packing up. As an afterthought, a researcher asked a member of the tribe how a stupid person would sort. The man had no trouble sorting the terms taxonomically. In other words, he considered stupid what a Western psychologist would consider smart. Why? Because in everyday life, for the most part, our thinking really is functional. For example, we think about eating an apple; we do not think about the apple as a fruit, which is a food, which is an organic substance. Luria (1976) ran into similar issues in studies of peasants in one of the former Asian republics of the Soviet Union. In one study, peasants were shown a hammer, a saw, a log, and a hatchet and were asked which three items were similar. An illiterate central Asian peasant insisted that all four fit together, even when the interviewer suggested that the concept of tool could be used for the hammer, saw, and hatchet but not for the log. The participant in this instance combined the features of the four items that were relevant in terms of his culture and arrived at a functional or situational concept (perhaps one of the ‘‘things you need to build a hut’’). In many of Luria’s studies, the unschooled peasants have great difficulty in solving the problems given them. Often they appear to be thrown off by an apparent discrepancy between the terms of the problem and what they know to be true. For example, take one of the math problems: ‘‘From Shakhimardan to Vuadil it is three hours on foot, while to Fergana it is six hours. How much time does it take to go on foot from Vuadil to Fergana?’’ The participant’s response to this problem was, ‘‘No, it’s six hours from Vuadil to Shakhimardan. You’re wrong. . . . It’s far and you wouldn’t get there in three hours’’ (Luria, 1976, p. 129). Clearly the peasant did not accept the task.

CONCLUSION Ability testing is often conceived of in a culturally limited way. It is understandable that people in any culture will view the abilities that are important to them as the abilities that are important to test anywhere. The problem is that these abilities may not have the value elsewhere that they have in the culture that creates the tests, at the same time that other abilities may be fundamentally important that are not in the culture that creates the tests. Ability testing needs to take into account the context in which it is done and exactly what kinds of developing expertise are important in a given locale.

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468 HANDBOOK OF MULTICULTURAL ASSESSMENT Rowe, D. C. (2005). Under the skin: On the impartial treatment of genetic and environmental hypotheses of racial differences. American Psychologist, 60(1) 60–70. Rushton, J. P. (1995). Race, evolution, and man. Princeton, NJ: Princeton University Press. Rushton, J. P., & Jensen, A. R. (2005). Thirty years of research on race differences in cognitive ability. Psychology, Public Policy, and Law, 11(2) 235–294. Ruzgis, P. M., & Grigorenko, E. L. (1994). Cultural meaning systems, intelligence and personality. In R. J. Sternberg & P. Ruzgis (Eds.), Personality and intelligence (pp. 248–270). Cambridge: Cambridge University Press. Sarason, S. B., & Doris, J. (1979). Educational handicap, public policy, and social history. New York: Free Press. Serpell, R. (1974). Aspects of intelligence in a developing country. African Social Research, no. 17, 576–596. Serpell, R. (1982). Measures of perception, skills, and intelligence. In W. W. Hartup (Ed.), Review of child development research (Vol. 6, pp. 392–440). Chicago: University of Chicago Press. Serpell, R. (1993). The significance of schooling: Life journeys in an African society. Cambridge: Cambridge University Press. Srivastava, A. K., & Misra, G. (1996). Changing perspectives on understanding intelligence: An appraisal. Indian Psychological Abstracts and Review, 3, 1–34. Sternberg, R. J. (1985). Beyond IQ: A triarchic theory of human intelligence. Cambridge: Cambridge University Press. Sternberg, R. J. (1990). Metaphors of mind: Conceptions of the nature of intelligence. New York: Cambridge University Press. Sternberg, R. J. (1996a). What should we ask about intelligence? American Scholar, 65, 205–217. Sternberg, R. J. (1996b). Matching abilities, instruction, and assessment: Reawakening the sleeping giant of ATI. In I. Dennis & P. Tapsfield (Eds.), Human abilities: Their nature and measurement (pp. 167–181). Mahwah, NJ: Erlbaum. Sternberg, R. J. (1997). Successful intelligence. New York: Plume. Sternberg, R. J. (1998). A balance theory of wisdom. Review of General Psychology, 2(4), 347–365. Sternberg, R. J. (1999). Intelligence as developing expertise. Contemporary Educational Psychology, 24, 359–375. Sternberg, R. J. (2004). Culture and intelligence. American Psychologist, 59(5), 325–338. Sternberg, R. J., Conway, B. E., Ketron, J. L., & Bernstein, M. (1981). People’s conceptions of intelligence. Journal of Personality and Social Psychology, 41, 37–55. Sternberg, R. J., & Detterman, D. K. (1986). What is intelligence? Norwood, NJ: Ablex.

ABILITY TESTING ACROSS CULTURES Sternberg, R. J., Forsythe, G. B., Hedlund, J., Horvath, J., Snook, S., Williams, W. M., et al. (2000). Practical intelligence in everyday life. Cambridge: Cambridge University Press. Sternberg, R. J., & Grigorenko, E. L. (1997, Fall). The cognitive costs of physical and mental ill health: Applying the psychology of the developed world to the problems of the developing world. Eye on Psi Chi, 2(1), 20–27. Sternberg, R. J., & Grigorenko, E. L. (2001). All testing is dynamic testing. Issues in Education, 7(2), 137–170. Sternberg, R. J., & Grigorenko, E. L. (2002). Dynamic testing. Cambridge: Cambridge University Press. Sternberg, R. J., & Grigorenko, E. L. (Eds.). (2004). Culture and competence. Washington, DC: American Psychological Association. Sternberg, R. J., Grigorenko, E. L., Ngorosho, D., Tantufuye, E., Mbise, A., Nokes, K., et al. (2002). Assessing intellectual potential in rural Tanzanian school children. Intelligence, 30, 141–162. Sternberg, R. J., & Kaufman J. C. (1998). Human abilities. Annual Review of Psychology, 49, 479–502. Sternberg, R. J., Nokes, K., Geissler, P. W., Prince, R., Okatcha, F., Bundy, D. A., et al. (2001). The relationship between academic and practical intelligence: A case study in Kenya. Intelligence, 29, 401–418. Stigler, J. W., Shweder, R. A., & Herdt, G. (Eds.) (1990). Cultural psychology: Essays on comparative human development. Cambridge: Cambridge University Press. Super, C. M. (1983). Cultural variation in the meaning and uses of children’s ‘‘intelligence.’’ In J. B. Detregowski, S. Dziurawiec, & R. C. Annis, Expectations in cross-cultural psychology (pp. 199–212). Lisse: Swets & Zeitlinger. Super C. M., & Harkness, S. (1982a). The development of affect in infancy and early childhood. In D. Wagner & H. Stevenson (Eds.), Cultural perspectives on child development (pp. 1–19). San Francisco: W.H. Freeman. Super C. M., & Harkness, S. (1982b). The infant’s niche in rural Kenya and metropolitan America. In L. L. Adler (Ed.), Cross-cultural research at issue (pp. 47–56). Orland, FL: Academic Press. van de Vyjver, F. J., & Leung, K. (1997). Methods and data analysis of cross-cultural research. In J. W. Berry, Y. Poortinga, & J. Pandley (Eds.), Handbook of cross-cultural psychology: Theoretical and methodological perspectives (Vol. 1, pp. 257–300). Needham Heights, MA: Allyn & Bacon. Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press. White, G. M. (1985). Premises and purposes in a Solomon Islands ethnopsychology. In G. M. White & J. Kirkpatrick (Eds.), Person, self, and experience: Exploring Pacific ethnopsychologies (pp. 328–366). Berkeley: University of California Press.

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470 HANDBOOK OF MULTICULTURAL ASSESSMENT Wober, M. (1974). Towards an understanding of the Kiganda concept of intelligence. In J. W. Berry & P. R. Dasen (Eds.), Culture and cognition: Readings in cross-cultural psychology (pp. 261–280). London: Methuen. Yang, S., & Sternberg, R. J. (1997a). Conceptions of intelligence in ancient Chinese philosophy. Journal of Theoretical and Philosophical Psychology, 17(2), 101–119. Yang, S., & Sternberg, R. J. (1997b). Taiwanese Chinese people’s conceptions of intelligence. Intelligence, 25(1), 21–36.

CHAPTER TWENTY-ONE

Educational Assessment of English-Language Learners Graciela N. Borsato Amado M. Padilla

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he number of school-age children (ages five to seventeen) who speak a language other than English at home more than doubled between 1979 and 2004, increasing from 3.8 to 9.9 million, or from 9 to 19 percent of all children in this age group (U.S. Department of Education, 2006). Population projections suggest that they will account for 40 percent of the entire school-aged population in the United States by the year 2030, and possibly sooner if current demographic trends continue (Thomas and Collier, 2002). Of the children who speak a language other than English at home, a significant proportion have limited English proficiency. Students who are English-language learners face considerable challenges to their academic success. (The term English-language learners is used in this chapter in reference to students from non-English-speaking backgrounds whose difficulties in speaking, reading, writing, or understanding English may prevent them from learning successfully in classrooms where the language of instruction is English.) Indeed, they need to acquire subject matter knowledge at the same time that they are developing language skills in English. In addition, a number of factors that tend to co-occur with limited English proficiency, such as poverty and membership in a racial/ethnic minority group, further hinder the chances of these students doing well in school (Christian, 2006). According to the National Clearinghouse for English Language Acquisition and Language Instruction Educational Programs (2006), over 5.1 million English-language learning students were enrolled in public schools, pre-K

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472 HANDBOOK OF MULTICULTURAL ASSESSMENT through grade 12, for the 2004–2005 school year. This number represents approximately 10.5 percent of total public student enrollment. The five states with the largest number of public school English-language learners were California (1,591,525), Texas (684,007), Florida (299,346), New York (203,583), and Illinois (192,764). Of note, the states with the largest percentages of English-language learners are generally not the states with the fastest-growing number of these students. Between 1995 and 2005, the states that saw the five highest percentage growth rates in the nation were South Carolina, Kentucky, Indiana, North Carolina, and Tennessee. Consistent with the trend found by Capps et al. (2005) for the children of immigrants, the available data on English-language learners suggest that they are heavily concentrated in a few states but are dispersing rapidly. National Clearinghouse for English Language Acquisition and Language Instruction Educational Programs reports that although English-language learners speak more than 460 languages, Spanish is by far the language most commonly spoken (79.0 percent of English-language learners have Spanish as their first language), followed by Vietnamese (2.0 percent), Hmong (1.6 percent), Cantonese (1.0 percent), and Korean (1.0 percent). Assessment plays a central role in the schooling of all students, and it is, without a doubt, ‘‘one of the most critical aspects of education for English language learners’’ (Genesee and Riches, 2006, p. 136). According to the 1974 U.S. Supreme Court decision in Lau v. Nichols, providing students with the same facilities, textbooks, teachers, and curriculum does not ensure equal educational opportunity, for students who do not understand English cannot take advantage of those resources. School districts are therefore required to identify language-minority students and take affirmative steps to support their English-language development for eventual meaningful participation in a regular school program. Accurate initial assessment of the English-language proficiency and academic content knowledge of English-language learners is crucial to ensure that they receive the instructional services best suited to their needs. Once identified, English-language learners are assessed regularly to monitor the development of their language skills and readiness for reclassification as fluent English proficient (FEP), at which point they are considered no longer in need of language support services. In addition, under the provisions of the No Child Left Behind Act of 2001, English-language learners must take the same standardized assessments required of all other students (achievement tests in math, reading/English language arts, and, starting in school year 2007–2008, science). In other words, assessment has a preponderant role in the educational trajectory of English-language learners, influencing the identification, placement, reclassification, and promotion of these students. Given that so many important decisions are made on the basis of assessment data, it is of great concern that as currently implemented, the assessment of

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English-language learners is, ‘‘at best, a work in progress and, at worst, a biased and damaging process’’ (Rhodes, Ochoa, and Ortiz, 2005, p. 42). For example, the disproportionate representation of English-language learners in special education (Artiles, Rueda, Salazar, and Higareda, 2002, 2005) is likely to be related, at least in part, to the use of questionable assessment practices. These include the use of inadequately trained examiners, untrained interpreters, insufficient or inadequate language proficiency assessment, intellectual and academic assessments conducted only in English, and failure to comply with federal or state guidelines (Figueroa and Newsome, 2006; Rhodes et al., 2005). Furthermore, in a recent analysis, Abedi (2006) demonstrated that the likelihood of misclassifying low-performing English-language learners as students with learning disabilities due to the use of inappropriate assessment tools is not negligible. When such misclassification occurs, students are likely to be assigned to instructional programs that do not match their needs, which is likely to shortchange their education in the long term. The No Child Left Behind Act (NCLB) of 2001 mandates that all students be included in national and state educational assessments. Prior to this law, English-language learners were often exempted from accountability systems, and thus few data were available on their academic performance. As a consequence, the educational needs of these students were often overlooked (Lazar´ın, 2006). Although NCLB has elicited considerable and long-overdue attention to the education of English-language learners, the assessment instruments in place, which are not intended for use with students with limited English proficiency, actually have the potential to have an adverse impact on the educational prospects of these students. It is important to keep in mind that most academic achievement tests were constructed under the assumption that the test taker is a native English speaker. When such tests are used with English-language learners (since more appropriate instruments are not yet available), they are likely to function as measures of English-language proficiency and not as valid measures of subject content knowledge (Solano-Flores and Trumbull, 2003). To address this problem, NCLB allows the use of accommodations: changes in testing materials or administration that allow English-language learners to demonstrate what they know in a particular subject. However, the research on the impact of accommodations on the test performance of English-language learners is scarce and the emerging results inconclusive (Koenig and Bachman, 2004). To summarize, tests yield inaccurate results when students’ performance is affected by factors other than knowledge of the material being tested (Hakuta and Beatty, 2000). Language proficiency is one such prominent factor when tests that were designed for use with native English speakers are administered to English-language learners. Accommodations may help assuage this problem, but the research base on testing accommodations is

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474 HANDBOOK OF MULTICULTURAL ASSESSMENT quite limited and cannot yet fully inform assessment practices. Although the inclusion of English-language learners is important so that their needs are not overlooked, the assessment tools currently available may yield inaccurate information about these students (Hakuta and Beatty, 2000; Menken, 2000). Given that test scores are nonetheless used to make crucial decisions, such as grade promotion and high school graduation, standardized assessments can potentially have profound negative consequences on the education of English-language learners. A common misconception is that once students become proficient in English, academic achievement naturally follows (Linquanti, 2001). But as Linquanti points out, ‘‘Second language development and academic development are two separate sets of competencies, each needing to be explicitly addressed in instruction and in assessment’’ (p. 3). Thus, we address these two distinct dimensions of the assessment of English-language learners: assessment of English-language proficiency and assessment of academic knowledge. We also offer recommendations for sound assessment practices and suggest future research directions. Before closing this introduction, we call attention to the larger context in which the testing of English-language learners takes place. A recent report of the Urban Institute (Cosentino de Cohen, Deterding, and Clewell, 2005) indicates that the incidence of poverty and health problems is significantly higher in schools with a high enrollment of students with limited English proficiency (high-LEP schools) than in schools with few of these students. In addition, it is more difficult for high-LEP schools to fill teaching vacancies, and these schools are more likely to rely on uncertified and substitute teachers. The conditions of inequality that deny English-language learners’ full opportunity to learn came particularly into focus in California, as a consequence of Williams v. State of California (2004), a lawsuit filed by several organizations on behalf of a class of students attending substandard schools. The plaintiffs’ claims were substantiated in part with research evidence indicating that English-language learners in California receive unequal and inadequate access to appropriately trained teachers and appropriate instructional materials and tend to be concentrated in schools with poor physical facilities (Hakuta, 2002; Rumberger and G´andara, 2004). Of note, a settlement reached in this lawsuit in August 2004 ‘‘embodies every important principle on the plaintiffs’ case’’ (Oakes, 2004, p. 1897). However, as Oakes notes, the settlement is only the first step toward a more equitable education system in California. She warns that profound structural changes, not included in the lawsuit, need to be implemented in order for all students in California to have the learning conditions they deserve. We stressed in the opening chapter of this book that ‘‘neglect of the role of the sociocultural context in which testing takes place absolutely collides with the ideal of equity in assessment.’’ In particular, any discussion on the

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assessment of English-language learners should take into account the extent to which these students have fair access to opportunities to learn. When test results are used to make decisions bound to have a large impact on their educational and career prospects, this consideration becomes crucial.

ASSESSMENT OF ENGLISH-LANGUAGE PROFICIENCY Before we can adequately address the use of English proficiency assessments with language-minority students, we must first discuss two important and interrelated questions: What is meant by saying that a student is proficient in English as a second language? and How long does it take students to learn English so as to function well in an English-language classroom? We briefly discuss these two questions prior to tackling the empirical research on language proficiency assessment.

Determining Proficiency This question hinges on whether the English-language learner exhibits a high level of accuracy in the second language. Accuracy pertains to the precision of the message in terms of vocabulary, grammar, fluency, pronunciation, and sociolinguistic competence. Language practice that is contextualized and reflects real-world use forms the foundation for developing accuracy. Thus, an ideal classroom environment for students learning a second language is characterized by instruction that is grammatically correct, situationally appropriate, and culturally authentic. In such a classroom, students are exposed to a variety of print materials, such as textbooks, newspapers, and trade books, and oral input, such as audiotapes, videotapes, and podcasts. In addition, the teacher continuously monitors the language learner and provides corrective feedback as necessary. This is true regardless of age, grade level, and type of language program: bilingual, immersion, or foreign language. The demands of accuracy in a second language needed to function in the school context are high. However, there are not good classroom criteria yet for assessing the different dimensions of accuracy that students are required to develop at high levels in order to succeed academically. These dimensions correspond to the four modes of expression—listening, speaking, reading, and writing—that constitute the paths by which information and concepts are transmitted from one person to another. Listening and reading are receptive skills; speaking and writing are productive skills. English learners need to be able to understand the language input they receive from others before they try to produce those utterances comprehensibly. Students cannot create the language they are learning without first receiving input from the teacher, peers, television, and others. At each level of proficiency, students who are literate

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476 HANDBOOK OF MULTICULTURAL ASSESSMENT in the language they are learning can better comprehend what they hear and read. They are then able to express themselves with more accuracy through speaking and writing. Proficiency in each of these modes reinforces proficiency in the other modes. All four modes of expression are important elements in second-language learning, and their use is required in all formal classroom contexts. It is important to recognize that the language input provided to secondlanguage learners and the language output that is expected of them must be developmentally appropriate in two senses: (1) appropriate to the developing level of second-language learning that the person has attained and (2) appropriate to the cognitive and linguistic level of the student in his or her first language. Parents do not use linguistic features that are too complex—technical vocabulary, embedded grammatical structures—with their young children, and the same principle holds with second-language learners. Much has been made of the strategies that parents and other adult caretakers use in talking to young children: for example, slower rate of speech, repetition, simplified vocabulary, and simplified grammar. The same strategies are useful in the early stages of second-language acquisition in school. For example, English as a second language (ESL) and bilingual teachers are knowledgeable of developmentally appropriate ways of teaching and interacting with English-language learners. In planning and implementing strategies for assessing proficiency in English, it is equally important to understand what is developmentally appropriate linguistically in the home language as well as in English. Three categories of discourse describe language use on the basis of receptive and productive skills: interactive comprehension and production, receptive comprehension, and comprehensible production. In using the first category of discourse, interactive comprehension and production, English-language learners communicate during many activities with peers or with adults on topics that relate to their lives. This communication can be oral, as in telephone conversations, or written, as in correspondence with friends through e-mails or instant messaging. These activities provide for an exchange of ideas. If one person does not understand the interchange, it is relatively simple to achieve understanding by seeking clarification. The interactive comprehension and production category of discourse is common in the social use of language. The second category of discourse is receptive comprehension. Reading a book in a science class or viewing a video in a history class, activities that preclude seeking clarification from the author or narrator, exemplify this category. In such cases, the reader or listener relies solely on his or her reservoir of concepts and language decoding skills for comprehension. Receptive comprehension becomes increasingly important with each grade level as students are required to do more reading and integrate the information acquired in this fashion with new knowledge presented by the teacher. Also,

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it can be argued that students who do well in high-stakes testing such as state-mandated tests or the SAT do so because they have acquired a storehouse of knowledge through reading on their own. The third category is comprehensible production. Examples of activities that exemplify this category are delivering an oral class presentation or completing a job application. During such activities, the writer or speaker makes a presentation that precludes any seeking or clarification of meaning by the reader or listener. Such circumstances place a responsibility on the student to use English with clarity and accuracy. The comprehensible production category of discourse is common in the academic use of language. Furthermore, many assessments, such as high school exit tests and the SAT, now include a writing component that requires students to produce an essay that is scored not only for grammar but for the persuasiveness of an argument buttressed by supporting facts. Another concern that arises in assessing proficiency is how the English learner manages to negotiate meaning with native speakers in formal and informal settings. Specifically, negotiation of meaning refers to situations when it is important to interrupt the flow of the conversation in order for both speakers to understand what the conversation is about. In a discourse involving a native English speaker and a nonnative speaker, breaks for negotiation of meaning are much more frequent than when native speakers are conversing (Gass and Selinker, 2001; Oliver, 1998, 2002). The process of negotiation for meaning functions as both a means of preventing conversational trouble and a repair mechanism to overcome communication breakdown. Often the negotiations involve straightening out vocabulary or filling out background information unaccessible to the language learner. Thus, learning contexts that instigate negotiations for meaning between native and nonnative speakers can provide second-language learners with excellent practice in authentic discourse. The important message from this is that English learners need opportunities to interact with native speakers so that they can practice the skill of negotiating for meaning during authentic conversations. Furthermore, it is not possible to determine proficiency in English simply by a paper-and-pencil test; it is important to take into account what second-language teachers know through time-worn practice: observing the learners’ use of English in authentic contexts is the best way to determine their true level of developing competence in the language and the cultural context in which the language is embedded. In short, attaining second-language proficiency is complex and contextual. In schools, teachers need to be attentive not only to the developing linguistic skills of the English learner but also to ways to push students beyond the level of their zone of comfort in order to get to the next level of proficiency in the new language. Similarly, in assessment, the goals are to (1) determine the approximate level of developing proficiency in English, (2) select the

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478 HANDBOOK OF MULTICULTURAL ASSESSMENT forms of proficiency to be assessed (for example, simple oral proficiency and comprehension through vocabulary and grammar, reading comprehension, oral production of an academic content, or written production), and (3) selecting an appropriate instrument or assessment methodology suitable for meeting the goals of the assessment.

Length of Time to Learn English Usually it is policymakers who are the most interested in how long it takes students to learn English. Educational researchers (Cummins, 1991; Hakuta, Butler, and Witt, 2000; Snow and Hoefnagel-H¨ohle, 1978) have provided an empirical answer to this question, but the answer is not straightforward. If the question is simply about learning enough English to be able to interact on a social level with native English speakers, we get one answer. But if we want to know how long it takes to develop the English-language skills needed to succeed academically in a regular classroom, the answer is quite different. In addition, the length of time to learn English depends in part on the age of the learner and how much schooling he or she has received. Furthermore, Genesee (2004), in a review of Canadian research on immersion programs, concluded that ‘‘time alone is not always the most significant predictor of L2 [second language proficiency]—the intensity of exposure and, most importantly, the nature and quality of classroom instruction are very important’’ (p. 560). The learning of basic survival communication skills in a new language might take only a few months to a year or two (Cummins, 1991) depending on the amount of language input the learner receives from native speakers of English, the accuracy of English output demanded by the context, the motivation of the learner, and the amount of practice that the learner gets in listening and speaking English. It also depends on the age of the learner; for example, it is one thing for a young child to know enough English to interact with native English speakers on the playground and quite a different thing for an older child to interact effectively in school. Clearly the time needed to master a second language for purposes of interpersonal communication is considerably less than the time required to master instructional English (MacSwan and Rolstad, 2003). The reasons should be apparent. Instructional English language competence requires a high level of literacy (reading and writing) attainment in English as well as listening comprehension of decontextualized language and a more advanced level of oral proficiency. Again, depending on the age of the learner, the length of residence in the new country, motivation, and the amount of prior formal instruction in the home language, the attainment of English-language instructional competence might take considerably longer than one or two school years. Research findings indicate that acquiring the English-language skills needed in order to achieve at or even near grade level in a content area

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when instruction is done exclusively in English and at a pace intended for native English speakers may take as many as five to seven years (Collier, 1987; 1989; Cummins, 1991; Hakuta et al., 2000). In sum, there is no one answer to the question of how much time is necessary to learn English. The answer partly depends on what set of language skills (oral, listening, reading, or writing) and level of proficiency educators expect from English learners. If the expectations are low and center primarily on basic survival communication, we get one answer (a few months to a year or two); if the focus is on the proficiency in English needed for a student to succeed in an English-only classroom where the instructional language demands are high, the answer is totally different (four to seven years). Thus, the research informs us that we are likely doing students an injustice if they attend an ESL or bilingual program for only nine months with no further English-language assistance (Baker, 2001). For instance, Guerrero (2004) failed to find support for the assumption that a single year of structured English-immersion education was sufficient for English-language learners to develop competency in English to be successful in an English-only classroom. Interestingly, in foreign-language education the question of language proficiency rarely comes up in the same way as it does in bilingual or ESL instruction. Foreign-language teachers would not think of giving a high-stakes test such as an Advanced Placement test in a foreign language to a high school student who had completed only one or two years of foreign-language instruction. Unfortunately, the timing chosen to mainstream English-language learners into English-only classrooms is frequently driven by politics rather than by research findings, language pedagogy, and a learner’s instructional language competence.

ORAL LANGUAGE AND LITERACY ASSESSMENT In schools that serve language-minority students, the assessment of oral English language proficiency is commonplace (Saunders and O’Brien, 2006). Given that the administration of oral English-language assessments is so prevalent as part of the procedures used for identification, program placement, and reclassification of English language learners, it is troublesome that the research on the reliability and validity of the most commonly used measures is so limited. Furthermore, according to the thorough review conducted by Saunders and O’Brien, ‘‘most oral language instruments are imperfect and produce results that should be interpreted cautiously’’ (pp. 41–42). As a case in point, Pray (2005) found that none of the native-English-speaking children who took the ˜ Language Survey, an instrument commonly used to assess Woodcock-Munoz the oral-language skills in English of language-minority students, scored in the

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480 HANDBOOK OF MULTICULTURAL ASSESSMENT ‘‘fluent’’ or ‘‘advanced fluent’’ English-ability categories. Pray reasoned that if native English speakers are labeled nonproficient according to a test that purports to measure English-language ability, then the test cannot be trusted to accurately assess English-language learners’ oral skills in English. Of note, Pray’s research extends the work of MacSwan, Rolstad, and Glass (2002), who ˜ (Pre-LAS examined the validity of the Pre-Language Assessment Scales Espanol ˜ Espanol), an oral-language assessment that purports to measure oral Spanish native ability in children ages four to six. MacSwan et al. found that of the 38,887 Spanish-speaking children in their data set, approximately one-third were identified as having limited or no ability in Spanish on the Pre-LAS ˜ Espanol. These results are not consistent with solid findings from language acquisition research indicating that all normal children are able to successfully acquire the language of their speech communities. MacSwan et al. concluded that the use of potentially misleading native-language assessments brings confusion rather than clarity to the process of identification and placement. Therefore, they strongly recommended that the practice of routinely assessing children’s oral native-language ability should be abandoned. One other important issue is whether the instruments used to assess oral skills in English measure language proficiency or something else. The evidence indicates that some oral language tests have items that assess academic language proficiency and even include items unrelated to language ability at all (MacSwan et al., 2002; Pray, 2005). The use of these tests to inform referrals to special education is clearly questionable. As Pray points out, the development of an assessment is critically needed that measures oral language as a construct distinguishable from literacy and other forms of academic achievement. With regard to the identification of language disorders, it is also important to mention that emerging research findings point to the importance of conducting assessments in the children’s home language (Garc´ıa and McKoon, 2006). Some states use English-language proficiency measures to determine when English-language learners should be reclassified as fluent English proficient (FEP) and placed in all-English classrooms with no further language support. This practice has been criticized because of research findings indicating that these measures are not good predictors of academic language proficiency in English (Garc´ıa and McKoon, 2006). Indeed, language assessments measure the extent to which the test taker can effectively comprehend and communicate in English. They do not shed light on whether the student has developed the sophisticated language skills required to secure information in formal learning contexts and use such information productively. When Stevens, Butler, and Castellon-Wellington (2000) studied how the language measured on the Language Assessment Scales (LAS) Reading Component compares to that used on the Iowa Test of Basic Skills (ITBS) Social Studies for grade 7, they found that the LAS Reading contains language

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common to everyday contexts, whereas the ITBS contains content-specific academic language. In addition, the ITBS contains a wider range of grammatical constructions and requires students to process a wider variety of language. From their analysis, Stevens et al. concluded that the level of language measured by the LAS is not sufficient to indicate students’ ability to process the language of content-based assessments. Furthermore, although there was a statistically significant relationship between performance on the LAS and performance on the ITBS, the correlations were found to be modest. Because the commonly used language proficiency instruments do not constitute good predictors of the language competencies needed to succeed in an all-English classroom, the agreement among experts in second-language acquisition is that decisions about reclassification should be made on the basis of students’ academic language proficiency in English. As Garc´ıa and McKoon (2006) point out, the challenge ahead is the development of a valid and reliable instrument to measure academic language proficiency in English. As it is the case with regard to the assessment of oral language proficiency, limited empirical research exists to guide the literacy assessment of English-language learners (Garc´ıa and McKoon, 2006; Genesee and Riches, 2006). In particular, Snow (2006) identifies as particularly troubling the lack of diagnostic assessments in the domain of reading comprehension, given that the sources of difficulty with comprehension may be different for English-language learners than for native English speakers. For example, Garc´ıa (1991) identified linguistic and cultural factors that affected the performance of Spanish-speaking students on a reading comprehension test. In particular, the performance of these students was affected by their limited prior knowledge of certain test topics, their unfamiliarity with vocabulary terms used in the test, and their tendency to interpret the test questions literally. Garc´ıa concluded that the Hispanic students’ reading scores underestimated their reading comprehension potential. However, if taken at face value, the results on the test could prompt an instructional intervention aimed to address students’ difficulties with what Francis et al. (2006) call ‘‘pure’’ comprehension skills: retaining information from the text, connecting it to relevant information stored in memory, and incorporating both sources of information into integrated knowledge. Such intervention would be inappropriate since the students’ difficulty seemed to reside in their limited vocabulary and background knowledge. In this regard, a new instrument, the Diagnostic Assessment of Reading Comprehension (DARC; August, Francis, Hsu, and Snow, 2006), is promising in that it ‘‘places a premium on verbal processing of information and not simply on verbal knowledge’’ (Francis et al., 2006, p. 319). As Francis et al. point out, the use of the DARC in conjunction with other measures of discrete language skills could help identify students’ difficulties and strengths in reading and guide subsequent instruction.

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482 HANDBOOK OF MULTICULTURAL ASSESSMENT The multifaceted nature of language proficiency calls for the use of multiple assessment approaches. Paper-and-pencil tests do not capture students’ command of the language in real-world tasks. Thus, the information obtained by means of formal methods of assessment should be supplemented with the use of authentic tools of assessment, such as teacher observation checklists, directed dialogues, story retelling, writing checklists, and peer assessment of writing (Carrasquillo, Kucer, and Abrams, 2004; August and Hakuta, 1997). As Carrasquillo et al. point out, the use of formal means of assessment (tests) in combination with informal (authentic tools) measures ‘‘works for the benefit of everyone, but is especially helpful in providing an adequate picture of the strengths and needs of struggling ELLs’’ (p. 111). Catherine Snow (2006), in the closing chapter of the recent Report of the National Literacy Panel on Language Minority Children and Youth, refers to ‘‘the sorry state of assessment’’ (p. 635). Indeed, the brief review presented here points to the urgent need of research on the appropriate assessment of the oral and literacy skills of English-language learners. Because language is a multidimensional construct, the development of new measures should be informed by contributions from cognitive psychology, linguistics, and sociocultural considerations (Garc´ıa, McKoon, and August, 2006). Particularly important is to recognize that language development is a gradual process and that regular evaluation of students’ progress toward the development of proficiency should inform instructional decisions (August and Hakuta, 1997). Finally, serious concerns exist as to the reliability and validity of the instruments currently in use by school districts to inform program placement and reclassification decisions for English-language learners. Results from these assessments should be used with extreme caution and never be the sole or even main criterion on which high-stakes decisions are made.

ASSESSMENT OF ACADEMIC ACHIEVEMENT The two main contexts where academic assessment takes place are the classroom and large-scale assessment. By means of classroom assessment, teachers gain information about the effectiveness of their instructional strategies and the extent to which students have mastered the target material. They use this knowledge to provide feedback to students and plan the next steps of instruction. In addition, classroom assessment serves the purpose of monitoring students’ learning over time. Second-language learners are learning subject matter knowledge at the same time that they are acquiring the language of instruction. Assessments conducted in English may therefore pose difficulties for these students on account of their limited skills in this language. Coelho (2004) suggests several alternative

EDUCATIONAL ASSESSMENT OF ENGLISH-LANGUAGE LEARNERS

classroom assessment strategies that remove or minimize the language barrier in order to give second-language learners the best chance to demonstrate what they know. For example, students can be encouraged to use their first language to complete assignments if they are not yet able to do so in English or to substitute words from their first language for English words they have not yet learned. Coelho also recommends using visual representations such as charts and pictures and providing support for students’ written responses, for example, by creating a cloze passage for students to complete. As Coelho points out, when assessing for content knowledge, it is important to get past language mistakes and look for meaning. All of these strategies are useful to monitor students’ learning when they have not yet mastered comprehensible production in English. Large-scale assessment refers to tests that are administered to large numbers of students, as in the case of district, state, national, and international assessment programs. While classroom assessment serves primarily to guide instruction and monitor students’ learning, large-scale assessments are often used for accountability purposes. There are two types of accountability: systems accountability and student accountability (Redfield, 2001). Systems accountability refers to using assessment information to hold the educational system, including programs, administrators, and teachers, accountable for student achievement. Student accountability refers to using assessment information to make decisions about individual students (for example, academic tracking, promotion, or graduation) on the basis of their demonstrated achievement levels. Pellegrino, Chudowsky, and Glaser (2001) point out that even though large-scale assessments may be less relevant at the classroom level, they nevertheless have the potential to inform instruction and learning, assuming they are well designed and appropriately used. However, they also emphasize that ‘‘the more purposes a single assessment aims to serve, the more each purpose will be compromised’’ (p. 242). There are trade-offs in designing a single assessment to serve multiple purposes, and these need to be recognized and understood by both assessment designers and test users. Prior to the passage of the NCLB Act in 2001, which calls for inclusion of all students in large-scale assessment, most states did not include English-language learners in their assessment systems (Lazar´ın, 2006). The exclusion of these learners made their academic needs less likely to be considered in educational reforms. While the exclusion of these learners clearly constitutes a disservice to their educational prospects, their inclusion raises several difficult questions, including when and how they should be tested and how their test scores should be interpreted and used (Abedi, Hofstetter, and Lord, 2004). The key issue is that for English-language learners, any test administered in English becomes in part a test of English-language proficiency (Lacelle-Peterson, 2000). Given that virtually all educational tests rely to a

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484 HANDBOOK OF MULTICULTURAL ASSESSMENT degree on language skills, it is difficult to disentangle the academic knowledge of language-minority students from their English-language proficiency (Hakuta and Beatty, 2000). In other words, as Lacelle-Peterson points out, given the score of an English-language learner on an academic assessment administered in English, it is not clear to what extent this score reflects the student’s subject matter knowledge or her language proficiency in English. This is the reason that the practice of testing students in a language in which they are not yet proficient has been characterized as invalid and unethical (Rumberger and G´andara, 2004). While English-language learners must take the same large-scale academic assessments required of all other students, school districts are allowed to provide accommodations for those who have been in the United States for less than three years. Accommodations refer to ‘‘changes in the test process, in the test itself, or in the test response format’’ intended to give English-language learners the opportunity to demonstrate what they know without giving them an advantage over other students who take the test with no accommodations (Abedi et al., 2004, p. 2). Examples of accommodations are conducting the assessment in the student’s native language, providing extra time, and allowing the use of dictionaries. The three-year arbitrary cutoff in the length of time that English-language learners can receive accommodations is clearly inconsistent with the empirical evidence indicating that it takes anywhere from four to seven years for these students to develop academic language proficiency in English. Accommodations are intended to level the playing field so that Englishlanguage learners can demonstrate what they know; unfortunately, the findings that have emerged from research on the effects of accommodations on the test performance of these students are inconclusive (Koenig and Bachman, 2004). After reviewing the research literature on the topic, Abedi et al. (2004) concluded that simplifying the language of test items by reducing the use of low-frequency words and complex language structures is one of the most promising test accommodations. This accommodation is not, however, among the ones states use most frequently, which instead tend to be extra assessment time, small group or individual administration, directions read aloud or explained, reading aloud of questions in English, use of dictionaries, breaks during testing, and oral directions provided in the native language (Lazar´ın, 2006). One other important point emerging from the review conducted by Abedi et al. is that the language of assessment should match the language of instruction, as translated items may confuse students who learned the target material in English, including subject-specific vocabulary that they may not know in their first language. The criterion commonly used to examine the validity of accommodations, often referred to as the interaction hypothesis, rests on the assumption that

EDUCATIONAL ASSESSMENT OF ENGLISH-LANGUAGE LEARNERS

when accommodations are used, they should improve the test performance of English-language learners but not the test performance of native English speakers (Abedi et al., 2004; Koenig and Bachman, 2004; Sireci, 2004). In order to test whether an accommodation is valid, a randomized experiment is conducted with English-language learners and native English speakers. If an interaction between student group (English-language learner, native English speaker) and test accommodation condition (accommodated versus standard) is found, such that the accommodation improves the scores of English-language learners but not those of native English speakers, then the accommodation is considered valid. Of note is that if an accommodation benefits students in both language groups, then it would be unfair to make it available only to English-language learners. Koenig and Bachman (2004) argue that evidence that an accommodation satisfies the interaction hypothesis is not sufficient to warrant its use. As important as finding out what types of accommodations are effective (by yielding score gains for English-language learners but not affecting the performance of native English students), it is important to ascertain whether providing a particular accommodation changes the construct the test is measuring. One method to evaluate construct equivalence is to compare the factor structure of data from accommodated and standard test administrations. If both have the same factor structure, then some evidence is obtained that the two constructs are equivalent (Sireci, 2004). Koenig and Bachman (2004) argue that to assess the equivalence of the two constructs, it is necessary to compare the relationship between scores from accommodated and standard test administration to measures external to the test, such as teacher ratings, grade point averages, and course grades. If the relationship between test scores and criterion variables is the same for both accommodated scores and standard scores, the two scores can be considered equivalent. Little research is available on the validity of inferences based on scores from accommodated administrations. Therefore, we need to withhold judgment on the extent to which those scores accurately describe what English-language learners know until more research is available. To summarize, assessing the content knowledge of English-language learners is extremely challenging because language always emerges as a confounding factor that obscures the meaning of these students’ scores on academic achievement tests conducted in English. The use of accommodations may help address this problem, but the knowledge base on test accommodations, while steadily growing, is still insufficient to inform assessment practices. Although the inclusion of English-language learners is necessary to ensure that their educational needs are addressed, much harm can come from making high-stakes decisions based on assessment results that are inaccurate, including hampering the educational opportunities of many students.

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CONCLUSION The ever increasing reliance on testing to make high-stakes educational decisions warrants a close examination of the assessment instruments currently in use. The review of the literature presented in this chapter raises serious concerns with regard to the measures of English-language proficiency and academic achievement that are used with English-language learners. Although we believe that it is crucial to include English learners in testing so that their learning needs are recognized and addressed, the use of inaccurate results to make promotion or graduation decisions is clearly unfair and constitutes an ethical dilemma for psychologists participating in the assessment of English learners. In addition to the potential harm to individual students, it is not prudent to use questionable results to inform policy or plan and implement instructional practices that may be of limited utility. There is no easy or readily available solution to the dilemma of questionable assessment instruments used with English-language learners. The urgency is clear for research that informs the valid and reliable assessment of these students. In the meantime, caution must be exercised in interpreting the test results of English-language learners, and high-stakes decisions should be made taking into account multiple measures of what students know.

References Abedi, J. (2006). Psychometric issues in the ELL assessment and special education eligibility. Teachers College Record, 108(11), 2282–2303. Abedi, J., Hofstetter, C., & Lord, C. (2004). Assessment accommodations for English language learners: Implications for policy-based empirical research. Review of Educational Research, 74(1), 1–28. Artiles, A. J., Rueda, R., Salazar, J., & Higareda, I. (2002). English-language learner representation in special education in California urban school districts. In D. Losen & G. Orfield (Eds.), Racial inequity in special education (pp. 117–136). Cambridge, MA: Harvard Education Press. Artiles, A. J., Rueda, R., Salazar, J., & Higareda, I. (2005). Within-group diversity in minority disproportionate representation: English language learners in urban school districts. Exceptional Children, 71, 283–300. August, D., Francis, D., Hsu, H.-Y., & Snow, C. (2006). Assessing reading comprehension in bilinguals. Elementary School Journal, 107(2), 221–238. August, D., & Hakuta, K. (Eds.). (1997). Improving schooling for language-minority children: A research agenda. Washington, DC: National Academy Press. Baker, C. (2001). Foundation of bilingual education and bilingualism (3rd ed.). Clevedon: Multilingual Matters.

EDUCATIONAL ASSESSMENT OF ENGLISH-LANGUAGE LEARNERS Capps, R., Fix, M., Murray, J., Ost, J., Passel, J. S., & Herwantoro, S. (2005). The new demography of America’s schools: Immigration and the No Child Left Behind Act. Washington, DC: Urban Institute. Carrasquillo, A., Kucer, S. B., & Abrams, R. (2004). Beyond the beginnings: Literacy interventions for upper elementary English language learners. Clevedon, UK: Multilingual Matters. Christian, D. (2006). Introduction. In F. Genesee, K. Lindholm-Leary, W. M. Saunders, & D. Christian (Eds.), Educating English language learners: A synthesis of research evidence (pp. 1–13). Cambridge: Cambridge University Press. Coelho, E. (2004). Adding English: A guide to teaching in multilingual classrooms. Toronto, Ontario: Pippin Publishing. Collier, V. P. (1987). Age and rate of acquisition of a second language for academic purposes. TESOL Quarterly, 21(4), 617–641. Collier, V. P. (1989). How long? A synthesis of research on academic achievement in second language. TESOL Quarterly, 23(3), 509–531. Cosentino de Cohen, C., Deterding, N., & Clewell, B. C. (2005). Who’s left behind? Immigrant children in high and low LEP schools. Washington, DC: Urban Institute. Cummins, J. (1991). Interdependence of first- and second-language proficiency in bilingual children. In E. Bialystok (Ed.), Language processing in bilingual children. Cambridge: Cambridge University Press. Figueroa, R. A., & Newsome, P. (2006). The diagnosis of LD in English learners: Is it nondiscriminatory? Journal of Learning Disabilities, 39(3), 206–214. Francis, D. J., Snow, C. E., August, D., Carlson, C. D., Miller, J., & Iglesias, A. (2006). Measures of reading comprehension: A latent variable analysis of the diagnostic assessment of reading comprehension. Scientific Studies of Reading, 10(3), 301–322. Garcia, G. E. (1991). Factors influencing the English reading test performance of Spanish-speaking Hispanic children. Reading Research Quarterly, 26(4), 371–392. Garc´ıa, G. E., & McKoon, G. (2006). Language and literacy assessment of languageminority students. In D. August & T. Shanahan (Eds.), Developing literacy in second-language learners: Report of the National Literacy Panel on language minority children and youth (pp. 597–630). Mahwah, NJ: Erlbaum. Garc´ıa, G. E., McKoon, G., & August, D. (2006). Synthesis: Language and literacy assessment. In D. August & T. Shanahan (Eds.), Developing literacy in second-language learners: Report of the National Literacy Panel on language minority children and youth (pp. 583–596). Mahwah, NJ: Erlbaum. Gass, S., & Selinker, L. (2001). Second language acquisition (2nd ed.). Mahwah, NJ: Erlbaum. Genesee, F. (2004). What do we know about bilingual education for majority language students? In T. K. Bhatia & W. Ritchie (Eds.), Handbook of bilingualism and multiculturalism (pp. 547–576). Oxford: Blackwell.

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488 HANDBOOK OF MULTICULTURAL ASSESSMENT Genesee, F., & Riches, C. (2006). Literacy: Instructional issues. In F. Genesee, K. Lindholm-Leary, W. M. Saunders, & D. Christian (Eds.), Educating English language learners: A synthesis of research evidence (pp. 109–175). Cambridge: Cambridge University Press. Guerrero, M. D. (2004). Acquiring academic English in one year: An unlikely proposition for English language learners. Urban Education, 39(2), 172–199. Hakuta, K. (2002). English language learner access to basic educational necessities in California: An analysis of inequities. Retrieved December 10, 2006, from http://www.decentschools.com/expert reports/hakuta report.pdf. Hakuta, K., & Beatty, A. (Eds.). (2000). Testing English-language learners in U.S. schools: Report and workshop summary. Washington, DC: National Academy Press. Hakuta K., Butler, Y. G., & Witt, D. (2000). How long does it take English learners to attain proficiency? Santa Barbara: University of California Linguistic Minority Research Institute. Koenig, J. A., & Bachman, L. F. (Eds.). (2004). Keeping score for all: The effects of inclusion and accommodation policies on large-scale educational assessments. Washington, DC: National Academies Press. Lacelle-Peterson, M. (2000). Choosing not to know: How assessment policies and practices obscure the education of language minority students. In A. Filer (Ed.), Educational assessment and testing: Social practice and social product (pp. 27–42). London: Routledge Falmer. Lazar´ın, M. (2006). Improving assessment and accountability for English language learners in the No Child Left Behind Act. National Council of La Raza (NCLR), Issue Brief No. 16. Retrieved October 20, 2006, from http://www.nclr.org/content/publications/ download/37365. Linquanti, R. (2001). The redesignation dilemma: Challenges and choices in fostering meaningful accountability for English learners. Santa Barbara: University of California Linguistic Minority Research Institute. MacSwan, J., & Rolstad, K. (2003). Linguistic diversity, schooling, and social class: Rethinking our conception of language proficiency in language minority education. In C. B. Paulston & R. Tucker (Eds.), Sociolinguistics: The essential readings (pp. 329–340). Oxford: Blackwell. MacSwan J., Rolstad, K., & Glass, G. V. (2002). Do some school-age children have no ˜ language? Some problems of construct validity in the Pre-LAS Espanol. Bilingual Research Journal, 26(2), 213–238 Menken, K. (2000). What are the critical issues in wide-scale assessment of English language learners? Washington, DC: National Clearinghouse for Bilingual Education. Retrieved December 17, 2006, from http://www.ncela.gwu.edu/pubs/issuebriefs/ ib6.htm. National Clearinghouse for English Language Acquisition and Language Instruction Educational Programs. (2006). FastFAQs. Retrieved December 13, 2006, from http://www.ncela.gwu.edu/expert/fastfaq/index.html.

EDUCATIONAL ASSESSMENT OF ENGLISH-LANGUAGE LEARNERS Oakes, J. (2004). Investigating the claims in Williams v. State of California: An unconstitutional denial of education’s basic tools. Teachers College Record, 10(1), 1889–1906. Oliver, R. (1998). Negotiation of meaning in child interactions: The relationship between conversational interaction and second language acquisition. Modern Language Journal 82(3), 372–386. Oliver, R. (2002). The patterns of negotiation for meaning in child interactions. Modern Language Journal, 86(1), 97–111. Pellegrino, J. W., Chudowsky, N., & Glaser, R. (2001). Knowing what students know: The science and design of educational assessment. Washington, DC: National Academy Press. Pray, L. (2005). How well do commonly used language instruments measure English oral-language proficiency? Bilingual Research Journal, 29(2), 387–409. Redfield. D. (2001). Critical issues in large scale assessment: A resource guide. Washington, DC: Council of Chief State School Officers. Rhodes, R. L., Ochoa, S. H., & Ortiz, S. O. (2005). Assessing culturally and linguistically diverse students: A practical guide. New York: Guilford Press. Rumberger, R. W., & G´andara, P. (2004). Seeking equity in the education of California’s English learners. Teacher College Record, 106(10), 2032–2056. Saunders, W. M., & O’Brien, G. (2006). Oral language. In F. Genesee, K. Lindholm-Leary, W. M. Saunders, & D. Christian (Eds.), Educating English language learners: A synthesis of research evidence (pp. 14–63). Cambridge: Cambridge University Press. Sireci, S. (2004). Validity issues in accommodating NAEP reading tests. Amherst: School of Education, University of Massachusetts. Snow, C. (2006). Cross-cutting themes and future research directions. In D. August & T. Shanahan (Eds.), Developing literacy in second-language learners: Report of the National Literacy Panel on language minority children and youth (pp. 631–651). Mahwah, NJ: Erlbaum. Snow, C., & Hoefnagel-H¨ohle, M. (1978). The critical period for language acquisition: Evidence from second language learning. Child Development, 49, 1114–1128. Solano-Flores, G., & Trumbull, E. (2003). Examining language in context: The need for new research and practice paradigms in the testing of English language learners. Educational Researcher, 32(2), 3–13. Stevens, R. A., Butler, F. A., & Castellon-Wellington, M. (2000). Academic language and content assessment: measuring the progress of ELLs. Los Angeles: University of California, National Center for Research on Evaluation, Standards, and Student Testing. Thomas, W., & Collier, V. (2002). A national study of school effectiveness for language minority students’ long-term academic achievement. Santa Cruz, CA, and Washington, DC: Center for Research on Education, Diversity and Excellence. U.S. Department of Education. National Center for Education Statistics. (2006). The condition of education 2006. Washington, DC: U.S. Government Printing Office.

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CHAPTER TWENTY-TWO

Multicultural Issues and the Assessment of Aptitude Lisa A. Suzuki Lorelei Prevost Ellen L. Short

O

ne of the most contentious areas in psychology has been the use of intelligence and aptitude measures to estimate aptitude, potential, and cognitive abilities. Despite refinements in test development practices and the growth in the number of measures available, concerns regarding the use of these tests continue to emerge. In particular, members of racial and ethnic minority communities have pointed to group differences on a number of ability measures as evidence of the bias inherent in these tests. For example, the consistent gaps between racial and ethnic group differences found in intelligence have been identified as a ‘‘racial ethnic hierarchy.’’ This chapter provides updated information regarding current assessment practices in the areas of intelligence and aptitude with respect to various racial and ethnic groups. This chapter addresses group differences found on aptitude tests, alternative forms of intelligence, and variables with an impact on the assessment of intelligence and aptitude.

RACIAL AND ETHNIC GROUP DIFFERENCES ON INTELLIGENCE AND APTITUDE TESTS One of the most consistent findings of social science research continues to be racial and ethnic group differences on cognitive ability tests. Relying only on group differences in intelligence test scores places East Asian and Jewish

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groups at the top, with scores ranging from a few to ten points greater than Caucasians. African Americans are often found to be one standard deviation below Caucasians (fifteen points lower). Hispanics often score between African Americans and Caucasians (Herrnstein and Murray, 1994; Mainstream science on intelligence, 1994; O’Connor, 1989). Specific average IQs were cited by Herrnstein and Murray as follows: African Americans, 85; Latino, 89; White, 103; Asian, 106; and Jewish American, 113. Table 22.1 presents information regarding intelligence tests and characteristics of the standardization samples as noted in Buros’s reviews from 2000 to present. Evaluation of these twenty-four measures reflects the information that was made available in the reviews. It should be noted that the table includes references to the most recent versions of popular tests in this area.

THE SCHOLASTIC ASSESSMENT TEST Similar findings in terms of group differences are noted on the Scholastic Assessment Test (SAT), which continues to be identified as a gatekeeper to educational opportunity. The SAT underwent major revisions in 2005; a timed writing section was added to the SAT Reasoning Test (formerly SAT I), which combines an essay (twenty-five minutes) and multiple-choice questions (thirty-five minutes) that test students’ use of standard written English. The SAT Subject Test (formerly SAT II) has not been revised. Scales of the SAT (Verbal and Math) continue to have a score range from 200 to 800 and a mean of 500 (standard deviation of 100). The College Board (2006a) reported that among the first cohort of students to take the writing test, the average score was 497; females scored an average of 502, 11 points higher than males, who scored an average of 491. The findings showed stronger female performance across all racial/ethnic groups (www.Collegeboard.com/press release/150054. html). In 2006b, the College Board reported demographic information of total mean scores by ethnicity for the SAT Reasoning Test. These are presented in Table 22.2. It should be noted that not all college-bound students take the SAT Reasoning Test, and the population of test takers is self-selected. The timed writing section of the SAT Reasoning Test has tentatively been accepted by admissions departments of colleges and universities; among nineteen hundred four-year schools surveyed by the College Board, based on a response of approximately five hundred, 81 percent will require the new test (Sanoff, 2005). The inclusion of the writing test, however, has increased debates among scholars, colleges, and universities concerning the SAT as a predictor of academic success among students of color. Reports from the

491

Ages

16 years to college/ university

4 years 0 months to 6 years 6 months

6 years 0 months to 18 years 11 months

6 years to 17 years

Test Name

AH6 Group Tests of High Level Intelligence Test authors: A. Heim, K. Watts, V. Simmonds Reviewers: T. J. Kehle, P. Zelhart

An Adaptation of the Wechsler Preschool and Primary Scale of Intelligence for Deaf Children Test authors: S. Ray, S. M. Ulissi Reviewers: A. B. Silverstein, E. W. Testut

Comprehensive Test of Nonverbal Intelligence Test authors: D. D. Hammill, N. A. Pearson, J. L. Wiederholt Reviewers: G. P. Aylward, G. van Lingen

Hammill Multiability Intelligence Test Test authors: D. D. Hammill, B. R. Bryant, N. A. Pearson

Racial/Ethnic

X

X

1,350b

Representation

2,129

120a

112

Norming

X

X

Status

Socioeconomic

X

X

Sex

X

X

Country

Region of

X

Representation

Urban/Rural

X

X

Education

Table 22.1. Intelligence Tests and Characteristics of Their Standardization Samples as Noted by Buros’s Reviews Special

X

X

Education

Bias

X

Exam

11 to 85 years or over

4 to 90 years

17 years and older

14 years and over

Kaufman Adolescent and Adult Intelligence Test Test authors: A. S. Kaufman, N. L. Kaufman Reviewers: D. P. Flanagan, T. Z. Zeith

Kaufman Brief Intelligence Test, Second Edition Test authors: A. S. Kaufman, N. L. Kaufman Reviewers: R. A. Madle, S. R. Shaw

Mayer-Salovey-Caruso Emotional Intelligence Test Test authors: J. D. Mayer, P. Salovey, D. R. Caruso Reviewers: S. A. Leung, C. Cook-Cottone

MIDAS: Multiple Intelligence Developmental Assessment Scales

Reviewers: W. S. Lang, D. L. Wodrich

X

5,000e

700+f

X

X

(2001)2,1 20

(1988) 2,000

X

X

X

X

X

X?

Xc

?g

-

(continued overleaf)

Xd

X

3 to 8 years

5 to 21 years

Pictorial Test of Intelligence Test author: J. French Reviewers: M. Athanasiou, D. P. Flanagan, L. F. Caltabiano

Slosson Full-Range Intelligence Test Test authors: B. Algozzine, R. L. Eaves, L. Mann, H.R. Vance, &

S. W. Slosson

6 years 4 months to 8 years 3 months; 7 years 4 months to 9 years 3 months; 8 years 4 months to 10 years 11 months

Ages

Non-Reading Intelligence Tests, Levels 1–3 Test author: D. Young Reviewer: C. M. Krauthamer

Test author: C. B. Shearer Reviewers: A. Packard, M. S. Trevisan

Test Name

Racial/Ethnic

X

-?

1,509h

Representation

(1997) 970

Limited information

Norming

X

Status

Socioeconomic

?

X

Sex

Table 22.1. (continued)

?

X

Country

Region of

Urban/Rural

?

X

Representation

X?

X

Education

Special

X

Education

Bias

X

Exam

500 (limited information)i

2 years 6 months to 7 years 0 months

2 years 0 months to 7 years 3 months

2 years to 85 years or over

Snijders-Oomen Non-Verbal Intelligence Scale for Young Children Test authors: J. T. Snijders, N. Snijders Oomen Reviewers: D. K. Detterman, T.Z.S. Keith

Stanford-Binet Intelligence Scales for Early Childhood, Fifth Edition Test author: G. H. Roid Reviewers: C. A. Sink, C. Eppler, J. J. Vacca

Stanford-Binet Intelligence Scales, Fifth Edition Test author: G. H. Roid Reviewers: J. A. Johnson, R. C. D’Amato, J. C. Kush 4,800

4,800

? 1,854

Slosson Intelligence Test (1991 edition) Test authors: R. Slosson, C. Nicholson Reviewers: R. Kamphaus, T. Watson

Reviewers: G. S. Hanna

X

X

-?

X

X

X

X

X

X

X

X

X

-

X

X

X

X

X

X?

(continued overleaf)

X

X

-

5 years 0 months to 17 years 11 months 30 days

6 years to 89 years

Universal Nonverbal Intelligence Test Test authors: B. A. Bracken, R. S. McCallum Reviewer: D. L. Bandalos

Wechsler Abbreviated Scale of Intelligence

2,245

(1995) 2,100

3,451

5 years 0 months to 85 years 11 months

Test of Nonverbal Intelligence, Third Edition Test authors: L. Brown, R. Sherbenou, S. Johnson Reviewers: J. Atlas, G. DeMauro

983

Limited information

6 years 0 months to 20 years 11 months

Stoelting Brief Nonverbal Intelligence Test Test authors: G. H. Roid, L. J. Miller Reviewers: R. N. Carney, S. Urbina

Norming

Teele Inventory for Multiple Intelligences Test author: S. Teele Reviewers: A. K. Hess, S. Kuhlenschmidt

Ages

Test Name

X

X

X

X

Representation

Racial/Ethnic

X

X

X

Status

Socioeconomic

X

X

X

X

Sex

Table 22.1. (continued)

X

X

X

X

Country

Region of

Urban/Rural

X

X

X

Representation

X

X

Education

Special

X

X

X

Education

Bias

X

X

X

Exam

16 to 89 years

6 years 0 months to 16 years 11 months

2 years 6 months to 7 years 3 months

4 years to 85 years

Wechsler Adult Intelligence Scale-Third Edition Test author: D. Wechsler Reviewers: A. K. Hess, B. G. Rogers

Wechsler Intelligence Scale for Children-Fourth Edition Test author: D. Wechsler Reviewers: S. J. Maller, B. Thompson

Wechsler Preschool and Primary Scale of Intelligence-Third Edition Test author: D. Wechsler Reviewers: R. A. Madle, M. McCurdy

Wide Range Intelligence Test Test authors: J. Glutting, W. Adams, D. Sheslow

Test Author: The Psychological Corporation Reviewers: T. Z. Keith, C. O. Lindskog

2,285

1,700

(2000) 2,200

(1995) 2,450

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

(continued overleaf)

X (included in validity studies)

X

Ages

2,400 Limited information

Norming

Racial/Ethnic Representation

Status

Socioeconomic

X

Sex

Country

Region of

Urban/Rural Representation

X

Education

Special Education

Bias Exam

Source: All information for this table was obtained from the Ebsco Host Research Databases (2000-present) for the Mental Measurements Yearbook.

Note: Education = parent/adult educational level; special education = special education students included (learning disabled, gifted and talented); bias exam = special efforts made to examine measure with respect to race/ethnicity. In norming column, year in parentheses = time of census representation; blank = no information provided by reviewer; X = stratification variable;— = reviewer’s concern regarding this variable; ? = mixed reviews, X? = reviewer notes general concerns related to psychometric issue. a Attempts were made to replicate norming group characteristics of original Wechsler Preschool and Primary Scale of Intelligence. However, the Adaptation’s norm group has proportionally more females and African Americans than found in the general population or among the severely hearing-impaired population. In addition, there is a greater proportion of children from western and southern geographical regions of the United States than found in the original norm groups or in the U.S. Census at that time. b Sample was a mixture of cases collected in 1989–1990 and 1996–1997. c Sample overrepresented the southern and northeastern regions of the United States. d Special education students were included in the validation studies. e Demographic characteristics of the sample did not adequately reflect those in the United States. Despite procedures to weight cases in the sample to reflect U.S. demographic characteristics, the actual weighting procedures remain unclear. f Several reliability studies were conducted over a six-year period with more than seven hundred individuals. g Cultural bias was investigated with 119 participants with results suggesting that the MIDAS is not prone to cultural bias. h Caution must be used given that the normative sample was tested ten years ago and comparisons were made to census data twenty years ago. i Normative sample included only Dutch children.

Work Profile Questionnaire: Emotional Intelligence Test author: A. Cameron Reviewers: M. Pope, L. Smith

Reviewers: T. A. Stinnet, K. F. Widaman

Test Name

Table 22.1. (continued)

MULTICULTURAL ISSUES AND THE ASSESSMENT OF APTITUDE

Table 22.2. SAT Reasoning Test Score Breakdown by Racial and Ethnic Group Critical Reading Self-Descriptions of Test Takers

N

SD

Mean

SD

Mean

SD

American Indian or Alaska Native

9,301

1

487

106

494

106

474

101

Asian, Asian American, or Pacific Islander

138,303

9

510

122

578

122

512

119

Black or African American

150,643

10

434

98

429

100

428

93

Mexican or Mexican American

64,019

4

454

99

465

100

452

94

Puerto Rican

19,008

1

459

104

456

104

448

99

Other Hispanic, Latino, or Latin American

68,734

5

458

105

463

106

450

101

White

825,921

56

527

102

536

103

519

100

Other

54,469

4

494

116

513

115

493

110

135,346

9

487

135

506

128

482

127

1,465,744

100

503

113

518

115

497

109

No response Total

percent Mean

Mathematics Writing

Journal of Blacks in Higher Education (2005, 2006) hypothesized that the writing section of the SAT Reasoning Test will widen the racial scoring gap between Black-White SAT scores due to inconsistencies among percentages of Black students who have or have not taken composition classes in high school. However, the report also quotes analysts who predict that the new writing section may reduce the racial scoring gap due to probable biases of the test graders as opposed to the ability of the test taker (for example, scorers of the writing section may be able to detect the race of the writers by the vocabulary used and the subject matter of the students’ essays and may be inclined to ‘‘give a break’’ to Black students; p. 1). There is also speculation that for political and social reasons, scoring on the writing test may be manipulated to narrow the overall gap between Whites and Blacks, thus lessening criticism that the test is biased against minority students.

499

500 HANDBOOK OF MULTICULTURAL ASSESSMENT In 2005, the Journal of Blacks in Higher Education reported that 153,132 African Americans took the SAT, which made up 10.4 percent of all SAT test takers. Only 1,132 African American college-bound students scored 700 or above on the math SAT and 1,205 scored at least 700 on the Verbal SAT. More than 100,000 students of all races nationally who took the SAT scored 700 or above on the Math SAT and 78,025 students scored 700 or above on the Verbal SAT. The report concludes that Blacks made up only 1.1 percent of the students scoring 700 or higher on the Math SAT and only 1.5 percent of the students scoring 700 or higher on the Verbal SAT. A 2006 report cited 150,643 African Americans who took the SAT test, which made up 10.3 percent of all SAT test takers. Only 976 African American college-bound students scored 700 or above on the Math SAT, and only 1,117 scored at least 700 on the Verbal SAT. Nationally, among the 95,000 students of all races who scored 700 or above on the Math SAT and nearly 69,000 students who scored 700 or above on the Verbal SAT, Blacks made up only 1 percent of the students scoring 700 or higher on the Math SAT and only 1.6 percent on the Verbal SAT. In 2006, the gap on the writing portion of the SAT was slightly smaller than on the verbal section and significantly smaller than the racial gap on the math section of the SAT, with a mean Black score of 428 and a mean White score of 519. Other aspects of the SAT debate concern its validity for students who are not native English speakers. Two decades ago, Sue (1985) and his colleagues speculated that reports of ‘‘overrepresentation’’ of Asian American students at some universities had and would continue to rise to the adoption of policies, such as altering admissions criteria to give more weight to the verbal portions of the SAT, that might prohibit acceptance of Asian American students, due to typical patterns of high scores on the quantitative portions and low scores on the verbal portions of the SAT. A study conducted by Sue (1985) of the grades and achievement test scores of 177 Chinese undergraduates at a U.S. university reported findings that recent immigrants scored only in the eighteenth percentile on the verbal portion of the SAT. However, during their tenure at the university, grades among Chinese students included in the study as well as those not included exceeded the university’s grade point average of 2.87. Sue speculated that raising the English requirements on the SAT would deny the entry of students who may be able to exceed the academic performance of other students. Since that time, questions of validity concerning the SAT among nonnative English speakers continue to exist in the light of the passage of affirmative and antiaffirmative action legislation. Zwick and Schlemer (2004) focused on the validity of the SAT as admissions criteria for language minorities (Latinos and Asian Americans) at the University of California, Santa Barbara (UCSB). They cited the passage of antiaffirmative action laws in 1996 as well as some California educators’ assessment that the SAT played a key role in prohibiting Latinos from entering college as the

MULTICULTURAL ISSUES AND THE ASSESSMENT OF APTITUDE

impetus for the study. Their analyses were based on 1997 and 1998 USCB freshmen and focused on the effectiveness of SAT scores and high school grade point average in predicting the grade point averages (FGPAs) of college freshmen. For language minorities, and particularly for Latinos, the findings indicated that using only high school grades as a predictor led to FGPAs that tended to exceed actual FGPAs. Further analyses showed that while high school GPAs had the highest correlation with FGPAs for most groups, the SAT verbal scores were the strongest predictor of FGPAs for language minorities in 1998. The authors concluded that combining data across language groups could obscure important test validity information. Assessment of test content has also contributed to the ongoing SAT debate. Differential item functioning (DIF), a technique test makers use for comparing ethnic populations in order to ensure the fairness of certain tests, was focused on in a study conducted by Freedle and Kostin (1997). The authors used ethnic comparison as a method of investigating factors that may have a significant influence on DIF values associated with SAT and Graduate Record Exam (GRE) analogy items that were obtained by comparing large samples of Black and White examinees matched for total verbal score. The authors conducted two studies. The first showed findings that five significant regression predictors (item difficulty, word frequency, science content, social/personality content, part-whole relationship between words) of ethnic differences accounted for 30 percent of the DIF variance. The second study replicated these findings. In the study, factors influencing verbal DIF values were identified as (1) use of a contextualist framework for understanding the relationship between DIF and Verbal Item Difficulty, which emphasized the impact of culture and experience on how individuals comprehend and process test information and helped explain many ethnic group differences in test performance, and (2) item content analysis that affected analogy DIF (for example, word frequency, abstractness/concreteness, science content, social-personality content, and, analogical relationship). In addition to presenting new data comparing Black and matched White examinees on analogy item performance, the authors reviewed the literature on verbal item performance for a number of ethnic groups and hypothesized that the literature was consistent with what they defined as the cultural familiarity hypothesis in accounting for the persistent pattern of results. Specifically, they speculated that Black examinees and other minority groups consistently perform differentially better on the harder verbal items, including analogies, and differentially worse on the easier verbal items. The cultural familiarity hypothesis therefore supported a contextualist viewpoint that emphasized how culture and experience can influence test performance. It also supported the authors’ hypothesis that the easier verbal items contained concepts that may be differentially less familiar to minority groups, while the harder verbal items

501

502 HANDBOOK OF MULTICULTURAL ASSESSMENT contained concepts that may be differentially more familiar to minority groups. The authors hypothesized that differences in spoken words among different cultural communities reflect different experiences and activities, thus forming the basis for differences in familiarity with the easier vocabulary words. Among the ongoing debates concerning the SAT at the institutional level are colleges and universities that have made test scores optional for applicants, deemphasizing the use of standardized tests by making admissions decisions about applicants without using the SAT or ACT. According to Fair Test: The National Center for Fair and Open Testing, a Web site (2006a, b) that focuses on university testing alternatives, as of 2005 approximately four hundred four-year colleges and universities in the United States adhere to the belief that the preoccupation with applicants’ test scores impedes educational equity at the expense of students’ other school experiences and capabilities. The Fair Test Web site states that regardless of size or selectivity, institutions that have made test scores optional have reaped benefits such as increased student diversity, better-prepared applicants, and positive reactions from alumni and alumnae, students, guidance counselors, and the public.

Explanations for Racial and Ethnic Group Differences Explanations for these group differences fall within three camps: genetic, culture/environment, and test bias. It is beyond the scope of this chapter to elucidate the complex arguments underlying each of these perspectives. However, brief highlights of the work published since the previous edition of the Handbook are noteworthy. With regard to the genetic versus culture debate, Rushton and Jensen (2005) published a thirty-year monograph summarizing and critiquing the research on race differences in cognitive ability. The culture-only (0 percent genetic, 100 percent environmental) and hereditarian (50 percent genetic, 50 percent environmental) perspectives on race differences were examined based on ten categories of evidence: (1) worldwide distribution of test scores, (2) g factor of mental ability, (3) heritability, (4) brain size and cognitive ability, (5) transracial adoption; (6) racial admixture, (7) regression, 8) relative life history traits, (9) human origins research, and (10) hypothesized environmental variables. After reviewing the literature, the authors arrive at a conclusion that supports hereditarian explanation for Black-White differences in intelligence. Reactions from other researchers in the field cite alternative explanations to the differences in intelligence, noting environmental and cultural explanations for the race differences and point to studies supporting the malleability of the racial and ethnic group hierarchy. For example, in Chapter Twenty of this book, Sternberg and Grigorenko illustrate through examination of various cultural groups how the definition of intelligence changes.

MULTICULTURAL ISSUES AND THE ASSESSMENT OF APTITUDE

ALTERNATIVE FORMS OF INTELLIGENCE A number of ‘‘intelligences’’ have emerged in the literature. Four of the more prominent forms are biological measures of intelligence, emotional intelligence, social intelligence, and multiple intelligences.

Biological Measures of Intelligence Some scholars have moved toward an emphasis on biological measures of intelligence (Eysenck, 1998). Rushton and Jensen (2005) cite research using biological indicators of intelligence that have been linked to racial and ethnic group differences. These include average evoked potentials (AEPs), reaction times (RTs), and brain imaging techniques (such as positron emission tomography, PET). AEPs refer to the average electroencephalogram waves following presentation of an auditory or visual stimulus. RTs refer to a measure of an individual’s speed in responding to particular tasks or stimuli. Brain imaging techniques such as PET scans of glucose metabolic rates indicate the amount of energy being expended in relation to particular tasks presented to the individual. Negative correlations were found as individuals with higher scores on intelligence tests expended less energy. It should be noted that these measures are not culture free. Given historical misuses of biological differences, caution should be exercised in reaching any conclusion regarding biological explanations for racial and ethnic group differences on intelligence.

Emotional Intelligence A book by Daniel Goleman in 1995 launched widespread consideration of the concept of emotional intelligence (EI). Although considerable media attention triggered speculation that EI was a ‘‘new’’ topic of study, Roberts, Matthews, and Zeidner (2001) suggest that the concept of EI stems from constructs established in traditional psychometric intelligence models. EI emerged in the scientific literature in the early 1990s and initially described a form of intelligence associated with the ability to process emotional information (Roberts et al., 2001). Recent theories of emotional intelligence suggest the existence of four emotion-related ability groups that can be reliably measured: perception of emotions, use of emotions to facilitate thought, comprehension of emotions, and management of emotions. EI theory further maintains that individual differences found in these abilities correspond to significant outcomes (Salovey and Pizarro, 2003). The popularity of EI in the 1990s gave rise to the idea that the construct was a significant predictor of achievement. This belief led to the development of programs for enhancement of EI in children and adults (Parker et al., 2005).

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504 HANDBOOK OF MULTICULTURAL ASSESSMENT These programs, however, were ‘‘based on a very young scientific enterprise’’ (Mayer and Cobb, 2000, p. 178). Zeidner, Matthews, and Roberts (2001) emphasize that the poor quality of the EI work of that period was in part reflective of the dearth of valid and reliable EI assessment tools. Two major philosophies concerning the assessment of EI have emerged. Some theorists believe that EI should be measured as a set of abilities, that is, similar to traditional intelligence tests. Mayer and Cobb (2000) maintain that EI is most directly measured by ability tests in which individuals are presented with emotional problems to solve. An alternative technique of assessment encompasses questionnaires, self-report inventories, and observer ratings. The two schools of thought regarding EI testing reflect a larger debate concerning a consistent definition of EI (Matthews, Emo, Roberts, and Zeidner, 2006). Researchers have noted the absence of exploratory literature that investigates the generalizability of the construct of EI across diverse cultural groups (Parker et al., 2005; Zeidner et al., 2001). It has been suggested that EI is culture bound and ‘‘reflects an emphasis among European and North American health care professionals on introspection and psychological mindedness’’ (Parker et al., 2005; Loiselle and Cossette, 2001). Parker et al. (2005) maintain that sensitivity must be exercised when using EI constructs in other cultures because culture colors the way in which emotions are both experienced and expressed. Because the concept of EI has only recently emerged in the field, few research studies have reviewed group differences in test scores. In addition, those few studies have produced varying results concerning impacts of the construct on minority groups. For instance, in one study in which a self-report emotional intelligence scale (EIS) was administered, Van Rooy, Alonso, and Viswesvaran (2004) found that group differences existed for race and ethnicity. Minority groups comprising Hispanics and Blacks had higher EI scores than majority groups. Conte and Dean (2006) suggest that group differences found in EI measures may not have an adverse impact on protected groups, yet exploration of possible negative outcomes due to the use of EI measures in personnel selection is needed. Since EI may be culturally bound, researchers have noted the necessity of investigating cross-cultural similarities and differences in EI (Conte and Dean, 2006). However, in a 2005 study of North American aboriginal youth by Parker et al., different results concerning minority groups emerged. The BarOn Emotional Quotient Inventory: Youth Version, a self-report measure of EI, was administered to two samples of aboriginal and nonaboriginal (‘‘white/Caucasian’’) youth. The study found that the aboriginal sample scored significantly lower on the total EI scale than the nonaboriginal group (Parker et al., 2005). Another issue concerning the interplay of EI and group difference is raised in a 2001 study by Roberts et al. The Multi-Factor Emotional Intelligence Scale, which at that time was considered to be ‘‘the most comprehensive and

MULTICULTURAL ISSUES AND THE ASSESSMENT OF APTITUDE

contemporary performance-based measure of EI’’ (p. 206), was administered to an ethnically diverse sample of U.S. Air Force trainees. Expert scoring criteria indicated that White participants scored significantly higher than ethnic minority participants. Of note is the fact that the expert scorers in the study were White males. The authors of the study acknowledged the concern that ethnic and intelligence differences were present in the scores of the experts. The objectivity of expert-based protocols was questioned, and, expert scoring continues to be recognized as a difficulty in the scoring protocol of the refined version of the Multi-Factor Emotional Intelligence Scale and the Mayer-Salovey-Caruso Emotional Intelligence Test (Matthews et al., 2006). A branch of EI that is explored cross-culturally is emotional recognition and nonverbal accuracy. Some scholars suggest that tests for EI, when considered from an ability perspective, should be designed to assess the act of identifying emotions (Matthews et al., 2006). An element included in widely used EI models is the ability to recognize emotions from facial expressions; however, it seems that this ability shows a range of cultural variability (Parker et al., 2005). A meta-analysis conducted by Elfenbein and Ambady (2002) suggests that in-group advantage influences recognition accuracy when emotions are expressed and perceived. The research by Elfenbein and Ambady suggested that members of the in-group culture seemed to more accurately recognize emotion than out-group members do. Results of a study by Weathers, Frank, and Spell (2002) showed that race plays a significant role in the interpretation of prosody and facial expressions. This study supports the idea that individuals are more likely to interpret emotional cues from other individuals from their own specific ethnic tribe than from individuals from other groups. Nevertheless, a study conducted by Glanville and Nowicki (2002) indicated that African American children and European American children did not vary in the ability to interpret the facial expressions of the other ethnic groups.

Social Intelligence Thorndike (1920) referred to social intelligence as ‘‘the ability to understand and manage men and women’’ (cited in Goleman, 2006, p. 11). There is a great deal of overlap between emotional and social intelligences. Psychologists have continued to debate in the literature what constitutes a social ability as distinct from an emotional one (Goleman, 2006). In his latest book, Social Intelligence: The New Science of Human Relationship (2006), Goleman describes this construct in terms of two areas: social awareness and social facility. Social awareness refers to ‘‘a spectrum that runs from instantaneously sensing another’s inner state, to understanding her feelings and thoughts, to ‘getting’ complicated social situations’’ (p. 84). Social awareness includes attention to

505

506 HANDBOOK OF MULTICULTURAL ASSESSMENT primal empathy, attunement, empathic accuracy, and social cognition. Social facility refers to ‘‘sensing how another feels, or knowing what they think or intend, does not guarantee fruitful interactions. Social facility builds on social awareness to allow smooth, effective interactions’’ (p. 84). It includes attention to synchrony, self-presentation, influence, and concern. Cultural differences have been noted in how groups identify socially intelligent behavior. For example, in a comparison study of Chinese and German groups, researchers found that for the Chinese, socially intelligent behaviors were those that reflected the tradition and ideals of Confucianism (Willmann, Feldt, and Amelang, 1997). This included conforming to and fulfilling expected roles and acts that contributed to the good of society. German participants rated these behaviors much lower in relation to social intelligence. Few tests have been published that measure social intelligence. When the term social intelligence was entered into the Mental Measurements Yearbook database, no titles were noted. When entered separately for all domains, ten measures appeared that were only tangentially related to social intelligence. They were primarily related to emotional intelligence, academic skills, psychological processing, giftedness, and overall student abilities. There are a number of reasons that so few measures of social intelligence exist in published form. Silvera, Martinussen, and Dahl (2001) note that there have been difficulties in the following areas that contribute to the low number of existing measures: lack of an agreed-on definition and problems establishing social intelligence as distinct from other related constructs (for example, academic intelligence), concerns regarding how to represent this multifaceted construct adequately, and the measures that are available have been both time-consuming and difficult to administer. There exist different measures including self-report, behavioral, and assessment by observers; however, these were not highly correlated when studied together (Wong, Day, Maxwell, and Meara, 1995). The Tromso Social Intelligence Scale (Silvera et al., 2001) is one measure that was designed to address multiple facets of social intelligence as an important step in the process of defining this complex construct. The Tromso assesses three areas: social information processing, social skills, and social awareness. Information regarding racial and ethnic group differences on this scale were not reported. Table 22.3 presents information regarding published emotional and social intelligence measures and characteristics of their standardization samples taken from the Buros database. No qualifiers were given with respect to year of publication due to the limited number of assessments found in these areas. Information in the table is taken from the reviews of these measures in the database. As the table shows, little information is available regarding the standardization samples of these instruments.

375 (limited information)

13 years and over

Chapin Social Insight Test Test authors: F. S. Chapin, H. G. Gough

X

Xe

9,172 X?

7 to 18 years

BarOn Emotional Quotient Inventory: Youth Version Test authors: R. Bar On, J.D.A. Parker Reviewers: J. C. Ballard, F.T.L. Leong

X

3,174

BarOn Emotional 16 years and Quotient Inventory: Short over Development Edition Test author: R. Bar On Reviewers: R. A. Doggett, C. J. Sheperis, J. T. Willse X

X

3,831b X

Region of

Urban/Rural

Special

Bias

X

Xd

f

X

c

(continued overleaf )

Sex Country Representation Education Education Exam

16 years and over

BarOn Emotional Quotient Inventory: Test author: R. Bar On Reviewers: A. A. Cox, R. M. Guion

Status

Racial/Ethnic Socio-economic Representation X

16 years and over

BarOn Emotional Quotient-360: Test authors: R. Bar On, R. Handley Reviewers: D. L. Bandalos, R. Brown

Norming 1,900a

Ages

Test Name

Table 22.3. Emotional and Social Intelligence Tests and Characteristics of Their Standardization Samples as Noted by Buros’s Reviews

X

X

5,000l

Mayer-Salovey-Caruso 17 years and Emotional Intelligence older Test Test authors: J. D. Mayer, P. Salovey, D. R. Caruso Reviewers: S. A. Leung, C. Cook-Cottone

McCarthy Scales of 2 years 4 (1970) 1,032 Children’s Abilities months to 8 Test Author: D. McCarthy years 7 months Reviewers: K. Paget, D. L. Wodrich

j

Refinement sample of 143;h 527 participants in four validation samplesi

Xg

Status

Racial/Ethnic Socio-economic Representation

How I Think 12 to 21 years Questionnaire Test authors: A. Q. Barriga, J. C. Gibbs, G. B. Potter, A. K. Liau Reviewers: J. E. Gebart-Eaglemont, J. C. Kush

Norming

1,736

Ages

Emotional Judgment 16 years and Inventory over Test author: S. Bedwell Reviewers: P. L. Ackerman, D. S. Ones, S. Dilchert

Reviewers: F. M. Bernt, C. W. Conoley, L. Castillo

Test Name

Table 22.3. (continued) Region of

Urban/Rural

Special

Bias

X

X

X

k

X

X

(continued overleaf)

Sex Country Representation Education Education Exam

14 years and over (reading at or above eighth-grade level) 2,400 (limited information)

Two samples (n = 453 and 199). Limited informationm X

X

Source: All information for this table was obtained from the Ebsco Host Research Databases (2000-present) for the Mental Measurements Yearbook.

Note: Education = parent/adult educational level; special education = special education students included (learning disabled, gifted and talented); bias exam = special efforts made to examine measure with respect to race/ethnicity. In norming column, year in parentheses = time of census representation; blank = no information provided by reviewer; X = stratification variable;— = reviewer’s concern regarding this variable; ? = mixed reviews, X? = reviewer notes general concerns related to psychometric issue. a Standardization sample consists of 1,900 raters of 745 ratees. Although the sample included participants from several different countries (Australia, Canada, Mexico, the Netherlands, South Africa, Sweden, United Kingdom, and United States), norms were reported only across the entire group. b Representative North American sample was provided in addition to initial international normative sample (South Africa, Israel, Argentina, Nigeria, India, and Germany). c Geographical distribution was not specified. d Normative sample was drawn from the United States and Canada. However, the majority of data collection sites were located in the northeastern United States. e Although ethnicity percentages are provided, there is no information on percentages in each age and gender group. f No information provided on participants’ types of schools. g Manual states that the sample is ‘‘representative of the U.S. population.’’ However, the racial group predominantly represented in the standardization sample is Caucasian. h The refinement sample was composed of 92 adolescents incarcerated at a Department of Youth Services facility, and 51 students from an urban high school. i The majority of the participants in the ‘validation samples’ were in psychiatric facilities or court-ordered treatment facilities; 193 participants were enrolled in an introductory psychology course at a large Midwestern university. j Ethnic composition of the sample did not reflect ethnic distribution of most recent U.S. Census. k All five independent samples were collected from the midwestern region of the United States. l Demographic characteristics of the sample did not adequately reflect those in the United States. Despite procedures to weight cases in the sample to reflect U.S. demographic characteristics, the actual weighting procedures remain unclear. m Limited normative group used; two undergraduate college samples.

Work Profile Questionnaire: Emotional Intelligence: Test author: A. Cameron Reviewer: M. Pope, L. Smith

Social Skills Inventory, Research Edition Test author: R. E. Riggio Reviewers: J. C. Conger, S. M. Sheridan

510 HANDBOOK OF MULTICULTURAL ASSESSMENT

Multiple Intelligences The theory of multiple intelligences (MI) has attracted attention as an alternative theory of intellectual abilities. Gardner (2003) posited that MI comprises several ‘‘relatively autonomous intellectual capacities or potentials’’ (p. 46): linguistic, logical-mathematical, musical, bodily-kinesthetic, interpersonal, intrapersonal, naturalist, and possibly existential. For years theorists have surmised that alternative assessment strategies and more inclusive definitions of intelligence would contribute to an increased representation of children from ethnically diverse populations in gifted programs in schools (Patton, 1992). As calls for the use of alternative assessment techniques have increased, the MI theory has grown in popularity. Gardner has enthusiastically encouraged the application of MI to alternative assessment techniques, including performance-based assessment. Plucker, Callahan, and Tomchin’s study (1996) assessed subjects with the Multiple Intelligences Assessment Technique, which uses thirteen performancebased activities, teacher ratings, and observational checklists. Student performance was rated on a scale of 0 to 3 by teachers and external observers. Relatively high ratings of Asian American students were cause for speculation that teacher subjectivity may have affected the assessments. Alternatively, efforts to eliminate ethnic bias on standardized tests with implementation of performance assessments may have been misplaced. Project Spectrum, implemented at Harvard Project Zero is designed to enhance understanding, learning, thinking, and creativity in the arts, humanities, and scientific disciplines. The Project is an attempt at an alternative assessment method that identifies a broader range of children’s abilities while simultaneously considering contextual factors (Gardner, 2006). The premise of Project Spectrum is that each child possesses the ability to develop strengths in one or more domains. The project explores and reviews not only the intellectual abilities of preschool children but also the cognitive styles. The process requires that children spend one year in a Spectrum classroom, which offers enriching exposure to various learning styles. At the end of the year, a report assesses the child’s strengths and weaknesses. Some of the domains of cognitive ability assessed are numbers, science, music, language, visual arts, movement, and social.

INFLUENCES ON RACIAL AND ETHNIC GROUP VARIABILITY Information contained in the first two editions of the Handbook identified a number of sociodemographic and test-related variables that can potentially affect performance on cognitive ability tests. We have updated this listing to

MULTICULTURAL ISSUES AND THE ASSESSMENT OF APTITUDE

include the following sociodemographic variables: socioeconomic status (SES), home environment, health factors, education, residential and regional issues, language, and acculturation. Highlighted test-related variables are cultural loading, cultural equivalence, test bias, stereotype threat, and differential item functioning.

Socioeconomic Status Higher SES has been linked to higher scores on intelligence tests (Valencia and Suzuki, 2001). This finding has been consistent throughout the literature and is not disputed. SES is a complex social construction that has been measured in various ways. The relationship between SES and intelligence becomes even more complicated when one examines average differences in intelligence test scores for varying SES groups. Two approaches are cited in terms of how SES is measured. The first is socioeconomic status of origin, or parental SES, and the second is attained socioeconomic status, or what the individual as an adult has attained (for example, occupational status, educational attainment). Valencia and Suzuki provide an extensive review focusing on findings of empirical studies examining the relationships between racial/ethnic group membership, intelligence, and SES. They conclude that (1) SES is only weakly associated with intelligence; (2) when SES is controlled, group differences in intelligence are greatly reduced; (3) sampling bias may account for the remaining intellectual differences between minority groups and Whites; (4) indexes of SES have different levels of prediction in terms of measured intelligence for White and minority students and educational attainment and occupational status are ‘‘crude indexes’’; and (5) the veracity of the argument regarding the linkage of group differences and social class to innate factors is ‘‘quite shaky on empirical grounds’’ (p. 81).

Home Environment Home environment variables such as intellectual stimulation in the home, parental academic aspirations for their children, and parental language models have been linked consistently to higher indicators of ability (Valencia and Suzuki, 2001). ‘‘A major conclusion derived from home environment research is that an intellectually stimulating and supportive home environment tends to produce a bright child’’ (Valencia and Suzuki, 2001, p. 109). Valencia and Suzuki conclude that home environment may be more important than SES indicators in relation to measured intelligence: ‘‘It appears that what people do is of greater importance that what parents are in terms of SES’’ (p. 110).

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Health Factors Populations at higher risk for particular health impairments such as sensory loss tend to score lower on measures of aptitude. In addition, exposure to environmental toxins such as lead paint, alcohol, and drugs has had a significant impact on brain development and measured intelligence. Better health has also been linked to higher scores on emotional intelligence measures (Schutte, Malouff, Thorsteinsson, Bhullar, and Rooke, 2007).

Residential and Regional Issues Test score differences between children living in rural versus urban areas of the United States were noted in the literature thirty years ago (Vernon, 1979). These differences, however, were noted to be clinically nonsignificant a decade later (Kaufman, 1990). Advances in computer technology, mass communication, and improved education were noted as important factors in this change. Individuals from more isolated communities, however, may still show regional differences. Research examining indicators of academic and practical intelligences have noted differences between Yup’ik Alaskan rural and relatively urban communities (Grigorenko et al., 2004). The authors concluded that the pattern of differences ‘‘strengthens our arguments for the multidimensionality of human abilities and the importance of practical intelligence in nonacademic settings’’ (p. 207).

Language Issues pertaining to language are covered extensively in Chapters Ten (interpreters and translators) and Twenty-One (language assessment) of this Handbook. Understanding the complexities of language differences and cultural meaning play a critical role in the process of intelligence assessment.

Acculturation Acculturation refers to the ‘‘degree to which an individual integrates new cultural patterns into his or her original cultural patterns’’ (Paniagua, 2005, p. 9). This can occur through external processes set in motion when a person immigrates from one country to another. There can also be internal acculturation processes that occur when people move within a particular country, say, urban to rural or between regions of a country. Acculturation processes both internal and external can influence performance on measures of intelligence (Boland, 2005). We have noted that the relationship between acculturation and intelligence is being studied abroad in international settings as reflected by the number of dissertations on this topic. Berry and Ward (2006) provide commentary linking acculturation and intelligence in terms of cultural intelligence. They note that the meaning,

MULTICULTURAL ISSUES AND THE ASSESSMENT OF APTITUDE

development, display, and assessment of intelligence are closely tied to cultural context. When different cultural contexts come into contact, acculturation occurs. Therefore, the interaction between intelligence and cultural intelligence brings conflict and stress that must be resolved through cultural adaptation. Thus, cultural intelligence should be considered in the process of intelligence testing given potential differences in the cultural relevance of test materials and issues pertaining to familiarity with test stimuli given differences in cultural context.

Cultural Loading Cultural loading refers to the fact that all tests include information relevant to the culture in which the test was developed. Specifically, Kaufman (1990) noted that the ‘‘content of all tasks, whether verbal or nonverbal, is learned within a culture’’ (p. 25). All tests are culturally loaded and contain items reflecting what is considered to be intelligent within that particular culture (see Chapter Twenty, this volume).

Cultural Equivalence Cultural equivalence has been referred to in a number of chapters in this book as issues of equivalence are important to consider with all psychological tests. The importance of considering such issues as whether test items are equally familiar to all racial and ethnic group members and whether the language of the test pertains equally to all groups in terms of cultural meaning continue to be relevant to ability testing.

Test Bias A decade ago, Thorndike (2005) wrote about the importance of understanding issues of bias in relation to assessment practices with members of racial and ethnic minority communities. This description of obstacles remains salient to our discussion of the complex issues involved in understanding bias in testing: It is often asserted that standardized tests are used to deprive certain groups of access to educational and employment opportunities. To the extent that tests are used mechanically as selection and placement devices, and to the extent that some groups in our society have historically performed less well on tests, tests do become instruments through which access to education and employment is disproportionately barred to members of these groups. The question that must be addressed is whether individuals are unjustly barred and, more generally, what constitutes fair and equitable use of tests for the selection, placement, and classification of individuals [p. 432].

Psychometrically, test bias refers to measures that overestimate or underestimate the true scores of a particular group (for example, racial and ethnic

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514 HANDBOOK OF MULTICULTURAL ASSESSMENT groups). Most well-normed and standardized measures have withstood criticisms of bias. Rhodes, Ochoa, and Ortiz (2005) reviewed the extensive literature in this area and concluded: Despite recognition of the pervasive influence of culture, the vast majority of research into the nature of bias in intelligence tests has failed to find much evidence of it. Numerous studies have examined potential bias as a product of test items (including content and novelty), test structure (sequence, order, difficulty), test reliability (measurement error or accuracy), factor structure (theoretical structure, cluster or composite scores), and prediction (academic success or achievement) without producing any significant findings [p. 155].

They go on to note, however, that a purely psychometric definition of bias is inaccurate and unrealistic because intelligence tests and tests of cognitive ability measure quite well the degree to which anyone, irrespective of cultural background, has acquired and can access the culturally bound information inherent in their design [p. 155].

Test developers draw on a number of strategies to address potential issues of bias. These include using expert panels to review the content of test items; census-based norming (for example, representative samples of racial/ethnic groups stratified for SES, region of the country, parental education); oversampling of racial and ethnic minority groups; conducting specific reliability and validity studies with diverse populations; developing sociocultural norms; and incorporating statistical procedures to address potential bias (for example, Rasch modeling). Valencia and Suzuki (2001) provide information regarding the most prominent intelligence measures with respect to racial and ethnic group inclusion in norms and methods used to examine racial and ethnic group differences.

Stereotype Threat Stereotype threat has been identified as a phenomenon that involves the salience of race when taking a difficult test that adversely affected the performance of high-ability African American students (Steele and Aronson, 1995). In particular, it refers to the anxiety that is experienced when one’s performance on an ability test is related to stereotypes about one’s racial and ethnic group. For example, the negative stereotype that ‘‘Blacks are not intelligent’’ may be confirmed by one’s performance on the ability measure but not by one’s ability. Stereotype threat has been found to lower test performance in racial and ethnic minority groups whose stereotypes are associated with lower abilities. Sackett, Hardison, and Cullen (2004) highlighted what they believed to be the misrepresentation in the popular media and scholarly journals regarding

MULTICULTURAL ISSUES AND THE ASSESSMENT OF APTITUDE

the impact of stereotype threat on the test score gap. Specifically they noted that these misrepresentations identified stereotype threat as the explanation for the long-observed patterns of subgroup differences on a broad range of cognitive tests. Their interpretation of stereotype threat, based on the study conducted by Steele and Aronson (1995), was that even without stereotype threat, Black-White test score differences on tests like the SAT would remain at expected levels. With stereotype threat operating, the difference would be larger. Sackett et al. concluded that stereotype threat is an important phenomenon because it highlights the fact that test scores can be influenced by factors other than the test takers’ true level of skill and achievement. However, the authors also stated that removal of it does not eliminate subgroup test score differences, and they warned against misinterpreting findings concerning stereotype threat as a complete explanation for the Black-White test score gap and against ‘‘prematurely generalizing laboratory findings to high-stakes testing environments’’ (p. 12).

Differential Item Functioning As noted in the SAT section of this paper, it is important to examine the impact of DIF in interpreting scores on ability tests. The impact of DIF on racial and ethnic group differences on aptitude measures is important in understanding the meaning of obtained scores and offering a potential rationale for developing rescoring methods for major tests.

CONCLUSION This chapter has provided information regarding a multicultural perspective on the assessment of intelligence and aptitude. Issues pertaining to intelligence and aptitude are cited throughout the Handbook because these constructs serve as anchors in understanding many other psychological phenomena such as competency. The use of intelligence and aptitude test scores as indicators of potential remains one of the most controversial areas in psychology. The debate regarding heredity versus environment as explanations for group differences continues in the literature. Concerns regarding group differences are frequently identified despite more elaborate test development procedures, increased statistical sophistication in examining bias, and greater theoretical understanding of the impact of culture on assessment. The discussion of the SAT is critical given the important role that this test continues to play in determining the educational future of students. Information regarding the norming and standardization of recent cognitive ability tests from 2000 to the present is provided and reflects the continued

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516 HANDBOOK OF MULTICULTURAL ASSESSMENT importance of these measures in understanding human development. (For a more extensive evaluation of cognitive ability tests, see Valencia and Suzuki, 2001.) Growing attention to emotional and social forms of intelligence is also noted. However, the difficulties in assessing these complex constructs have limited the development of measures in these areas. Continued research on EI and SI is promising given the fact that abilities associated with these constructs are believed to be trainable. We hope that this chapter provides readers with a greater understanding of the wealth of information available with respect to intelligence and aptitude within a multicultural framework. We are optimistic that measures in this area can play a vital role in understanding cultural differences and provide information that will lead to culturally appropriate, effective and sensitive assessment practices.

References Berry, J. W., & Ward, C. (2006). Commentary on ‘‘redefining’’ interactions across cultures and organizations. Group and Organizational Management, 31 (1), 64–77. Boland, M. G. (2005). The effects of country of origin, education and acculturation on intelligence test performance in Asian Indian and Indian-American samples. Dissertation Abstracts International, ATT 3143806. College Board. (2006a). College Board announces scores for new SAT with writing section. Retrieved January 31, 2007, from www.collegeboard.com/pressrelease/150054. html. College Board. (2006b). College Board SAT connect to college success. 2006 college-bound seniors. Total group profile report. Retrieved February 2, 2007, from www.college board.com. Conte, J. M., & Dean, M. A. (2006). Can emotional intelligence be measured? In K. R. Murphy (Ed.), A critique of emotional intelligence: What are the problems and how can they be fixed? (pp. 59–77). Mahwah, NJ: Erlbaum. Elfenbein, A. E., & Ambady, N. (2002). On the universality and cultural specificity of emotion recognition: A meta-analysis. Psychological Bulletin, 128 (2), 203–235. Eysenck, H. J. (1998). A new look at intelligence. New Brunswick, NJ: Transaction Books. Fair Test: The National Center for Fair and Open Testing (2006a). Fair test university testing: Alternatives. Retrieved February 5, 2007, from www.FairTest.org. Fair Test: The National Center for Fair and Open Testing. (2006b). Fair test university testing: Test scores do not equal merit. Retrieved February 5, 2007, from www.FairTest.org. Freedle, R., & Kostin, I. (1997). Predicting Black and White differential item functioning in verbal analogy performance. Intelligence, 24 (3), 417–444.

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Gardner, H. (2003). Three distinct meanings of intelligence. In R. J. Sternberg, J. Lautrey, & T. I. Lubart (Eds.), Models of intelligence: International perspectives (pp. 43–54). Washington, DC: American Psychological Association. Gardner, H. (2006). Multiple intelligences: New horizons. New York: Basic Books. Glanville, D. N., & Nowicki, S. (2002). Facial expression recognition and social competence among African American elementary school children: An examination of ethnic differences. Journal of Black Psychology, 28 (4), 318–329. Goleman, D. (1995). Emotional intelligence. New York: Bantam Books. Goleman, D. (2006). Social intelligence: The new science of human relationships. New York: Bantam Dell. Grigorenko, E., Meier, E., Lipka, J., Mohatt, G., Yanez, E., & Sternberg, R. J. (2004). Academic and practical intelligence: A case study of the Yup’ik in Alaska. Learning and Individual Differences, 14, 183–207. Herrnstein, R., & Murray, C. (1994). The bell curve: Intelligence and class structure in American life. New York: Free Press. Journal of Blacks in Higher Education. (2005). The widening racial scoring gap on the SAT college admissions test. Retrieved January 31, 2007, from www.jbhe.com/features/ 49 college admissions-test.html. Journal of Blacks in Higher Education. (2006). A large Black-White scoring gap persists on the SAT. Retrieved January 30, 2007, from www.jbhe.com/features/53 SAT.html. Kaufman, A. S. (1990). Assessing adolescent and adult intelligence. Needham Heights, MA: Allyn & Bacon. Loiselle, C. G., & Cossette, S. (2001). Cross-cultural validation of the Toronto Alexithymia Scale (TAS-20) in U.S. and Peruvian populations. Transcultural Psychiatry, 38 (3), 348–362. Mainstream science on intelligence. (1994, December 13). Wall Street Journal, A18. Matthews, G., Emo, A. K., Roberts, R. D., & Zeidner, M. (2006). What is this thing called emotional intelligence? In K. R. Murphy (Ed.), A critique of emotional intelligence: What are the problems and how can they be fixed? (pp. 3–36). Mahwah, NJ: Erlbaum. Mayer, J. D., & Cobb, C. D. (2000). Educational policy on emotional intelligence: Does it make sense? Educational Psychology Review, 12 (2), 163–183. O’Connor, M. (1989). Standardized tests: Linguistic and sociocultural factors. Norwell, MA: Kluwer. Paniagua, F. A. (2005). Assessing and treating culturally diverse clients: A practical guide (3rd ed.). Thousand Oaks, CA: Sage. Parker, J.D.A., Salofske, D. H., Shaughnessy, P. A., Huang, S.H.S., Wood, L. M., & Eastabrook, J. M. (2005). Generalizability of the emotional intelligence construct: A cross-cultural study of North American aboriginal youth. Personality and Individual Differences, 39, 215–227. Patton, J. M. (1992). Assessment and identification of African-American learners with gifts and talents. Exceptional Children, 59 (2), 150–159.

518 HANDBOOK OF MULTICULTURAL ASSESSMENT Plucker, J. A., Callahan, C. M., & Tomchin, E. M. (1996). Wherefore art thou, multiple intelligences? Alternative assessments for identifying talent in ethnically diverse and low income students. Gifted Child Quarterly, 40 (2), 81–92. Rhodes, R. L., Ochoa, S. H., & Ortiz, S. O. (2005). Assessing culturally ands linguistically diverse students: A practical guide. New York: Guilford Press. Roberts, R., Matthews, G., & Zeidner, M. (2001). Does emotional intelligence meet traditional standards for an intelligence? Some new data and conclusions. Emotion, 1 (3), 196–231. Rushton, J. P., & Jensen, A. R. (2005). Thirty years of research on race difference in cognitive ability. Psychology, Public Policy and Law, 11, 235–294. Sackett, P. R., Hardison, C. M., & Cullen, M. J. (2004). On interpreting stereotype threat as accounting for African American-White differences on cognitive tests. American Psychologist, 59 (1), 7–13. Salovey, P., & Pizarro, D. A. (2003). The value of emotional intelligence. In R. J. Sternberg, J. Lautrey, & T. I. Lubart (Eds.), Models of intelligence: International perspectives (pp. 263–278). Washington, DC: American Psychological Association. Sanoff, A. P. (2005). All sides filling in dots on new SAT. USA Today. Retrieved January 30, 2007, from www.usatoday.com/news/education/2005–02–22-sat x.htm. Schutte, N., Malouff, J. M., Thorsteinsson, E. B., Bhullar, N., & Rooke, S. E. (2007). The meta-analytic investigation of the relationship between emotional intelligence and health. Personality and Individual Differences, 42 (6), 921–933. Silvera, D. H., Martinussen, M., & Dahl, T. I. (2001). The Tromso Social Intelligence Scale, a self report measure of social intelligence. Scandinavian Journal of Psychology, 42, 313–319. Steele, C. M., & Aronson, J. (1995). Stereotype threat and the intellectual test performance of African Americans. Journal of Personality and Social Psychology, 69 (5), 797–811. Sue, S. (1985). Asian Americans and educational pursuits: Are the doors beginning to close? Asian American Psychological Association Journal, 16–19 (Abstract). Thorndike, E. (1920). Intelligence and its use. Harper’s Magazine, 227–235. Thorndike, R. M. (2005). Measurement and evaluation in psychology and education (7th ed.). Columbus, OH: Pearson. Valencia, R. R., & Suzuki, L. A. (2001). Intelligence testing and minority students: Foundations, performance factors, and assessment issues. Thousand Oaks, CA: Sage. Van Rooy, D. L., Alonso, A., & Viswesvaran, C. (2004). Group differences in emotional intelligence scores: Theoretical and practical implications. Personality and Individual Differences, 38, 689–700. Vernon, P. E. (1979). Intelligence, heredity and environment. New York: Freeman. Weathers, M. D., Frank, E. M., & Spell, L. A. (2002). Differences in the communication of affect: Members of the same race versus members of a different race. Journal of Black Psychology, 28 (1), 66–77.

MULTICULTURAL ISSUES AND THE ASSESSMENT OF APTITUDE Willmann, E., Feldt, K., & Amelang, M. (1997). Prototypical behaviour patterns of social intelligence: An intercultural comparison between Chinese and German subjects. International Journal of Psychology, 32 (65), 329–346. Wong, C.M.T., Day, J. D., Maxwell, S. E., & Meara, N. M. (1995). A multitrait multimethod study of academic and social intelligence in college students. Journal of Educational Psychology, 87, 117–133. Zeidner, M., Matthews, G., & Roberts, R. D. (2001). Slow down, you move too fast: Emotional intelligence remains an ‘‘elusive’’ intelligence. Emotion, 1 (3), 265–275. Zwick, R., & Schlemer, L. (2004). SAT validity for linguistic minorities at the University of California, Santa Barbara. Educational measurement, issues and practice, 23 (1), 6, 11.

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CHAPTER TWENTY-THREE

Academic Achievement Testing for Culturally Diverse Groups Craig L. Frisby

I

n Chapter Twenty-Two in the previous edition of this handbook, I discussed conceptual issues in defining academic achievement, reviewed methods and techniques for assessing academic achievement, briefly reviewed literature on ethnic and racial group differences in academic achievement scores, discussed factors associated with group differences in academic achievement and context variables, and examined miscellaneous issues in reporting and using achievement test scores for decision making. The conclusions from this research continue to be relevant today. In subsequent years, research has deepened, illuminated, and expanded our understanding of factors that influence variation in achievement test results with ethnically diverse populations. This chapter adopts a narrower focus from that in the previous edition by limiting discussion to individual and group-administered achievement tests.

THE ROLE OF GENERAL MENTAL ABILITY The general mental ability factor, or g, is the most fundamental source of test score variance measured in various degrees by all mental tests, regardless of item type, item content, or administration format (Jensen, 1998). Numerous measures of diverse mental abilities show positive nonzero correlations, which is evidence of a common factor, identified through factor analysis, that is

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ACADEMIC ACHIEVEMENT TESTING FOR CULTURALLY DIVERSE GROUPS

present in all measured mental abilities. Due to the objective manner in which g is identified and studied, for all practical purposes it has become the operational definition of intelligence among researchers (Gottfredson, 2005). Individually and group-administered composite scores from IQ tests correlate highly (.95 to .99) with g factor scores derived from a factor analysis of the subtests that comprise the IQ test battery (Jensen, 1998; Ree and Earles, 1991). In short, individual and group-administered IQ tests are reasonably good measures of general mental ability, or g.

Average Group Differences in g Differences in mean IQ between Black and White racial groups (averaging one standard deviation) appear as early as three years of age (for a brief review, see Rushton and Jensen, 2005) and do not change in subsequent years (Jensen, 1998). In the United States, the mean IQ for various racial and ethnic groups has been estimated as 85 for African Americans, 89 for Latinos, 103 for Whites, 106 for Asians, and 113 for Jewish Americans (Herrnstein and Murray, 1994). Racial and ethnic differences in mean IQ have also been shown to be worldwide in scope (see the brief review by Rushton and Jensen, 2005). The size of group differences on various tests of mental ability has been shown to vary significantly and linearly as a function of the size of a test’s g loadings (Jensen, 1998). According to Rushton and Jensen (2005), numerous literature reviews seeking to explain reasons for these differences reduce to culture-only versus hereditarian explanatory models. Culture-only models deny that genetic factors play any independently effective role in explaining group differences and explain such differences as due, in varying degrees, to social discrimination, biased tests, deleterious environments, or culture-specific psychological variables. Hereditarian models acknowledge environmental components of observed group differences but hold that a substantial part of individual and group differences in intelligence is due to genetic factors (see the June 2005 issue of Psychology, Public Policy, and Law, 11, no. 2 for detailed arguments for both these positions).

The Relationship Between Learning, Ability, and Achievement Although the study of ‘‘learning’’ and the study of ‘‘intelligence’’ have quite distinct research histories (Jensen, 1989), they are closely related in several important ways. In learning new material within a school context, students must grasp complex concepts, understand meaning, make crucial comparisons, and be able to master appropriate conditions under which to apply facts, rules, and principles. All individuals are capable of learning; however, individuals differ considerably in their rates of learning. Under similar learning conditions,

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522 HANDBOOK OF MULTICULTURAL ASSESSMENT students require different amounts of time to learn the same material to the point of mastery. Differential amounts of time required to learn the same material are correlated with psychometric IQ (Gettinger, 1984). By the time students reach their last year in high school, some will be learning calculus while others will still be struggling with simple fractions (Jensen, 1998). After students have mastered the rules of word decoding (the learning-to-read stage, typically acquired by grade 4), individual differences in reading comprehension (the reading-to-learn stage) are highly correlated with individual differences in IQ (Jensen, 1998). Hence, adults with IQs in the eighties and below (tenth percentile and below) continue to struggle with effectively understanding what they read. Although there are clear-cut conceptual distinctions between intelligence and academic achievement tests (individually or group administered), operational distinctions in the design, format, and content between the two types of tests are more blurred. The following list summarizes these conceptual and operational distinctions, while acknowledging occasional exceptions to these criteria (adapted from Jensen, 1980): • Intelligence tests tend to sample more heterogeneous item content that taps novel problem solving gleaned from a broader and wider variety of experiences, whereas achievement tests typically sample a narrower range of knowledge and skills connected with instruction in schools. • Since intelligence can be measured by an infinite variety of test items that involve mental complexity, it is not describable in terms of specific test content, knowledge, or skills. Hence, the total composite score is the most useful score for interpreting intelligence tests. In contrast, achievement test items are describable in terms of specific classes of school-related content (for example, language arts, science, math reasoning, reading comprehension). Hence, the reporting of content area scores is most useful for interpreting these tests. • Intelligence tests minimize the importance of reading and writing skills for problem solving, whereas achievement tests evaluate these skills directly. • Intelligence and aptitude tests are typically used to predict academic achievements in the future, although the content of the academic achievements has not necessarily been included in the intelligence tests. In contrast, achievement tests are typically used to measure specific knowledge or skills acquired in the recent past, usually in connection with a specific course of instruction. • Most intelligence tests yield scores that are fairly stable across time, since a person’s relative standing in general mental ability with respect to age peers is also stable across time (barring cognitive deterioration due to brain injury or serious medical conditions). Achievement test scores are also influenced by

ACADEMIC ACHIEVEMENT TESTING FOR CULTURALLY DIVERSE GROUPS

variation in general mental ability. However, they are also more susceptible to additional minor fluctuations due to variability in the content of school curricula, variation in quality of classroom instruction, school absenteeism, low motivation to learn, or amount of explicit prior test coaching in test-taking behavior or skills that are directly evaluated by the achievement test. IQ tests display a substantial degree of predictive validity for achievement tests (see Deary, Strand, Smith, and Fernandes, 2007), in addition to other educational criteria such as school and college grades, retention in grade, school dropout rates, the number of years of schooling, probability of entering college, and the probability of receiving a bachelor’s degree after being admitted to college (Jensen, 1991, 1993). The irony is that the more educational opportunities are made available for larger portions of the general population, the more IQ will be predictive of educational outcomes. Academic achievement test scores of high school students correlate between .50 and .70 with IQ scores; however, IQ is far from a perfect predictor of academic achievement scores. At least 50 percent of the variance in academic achievement scores is unaccounted for by psychometric IQ (Jensen, 1998). Ramsay and Reynolds (2004) reviewed research that summarized the empirical associations between major and lesser known individually administered intelligence and achievement tests (for example, Cognitive Assessment System, Kaufman Test of Educational Achievement, Kaufman Assessment Battery for Children, Kaufman Brief Intelligence Test, Peabody Individual Achievement Test, Wechsler Adult Intelligence Scale–Third Edition, Wechsler Intelligence Scale for Children–Third Edition, Wechsler Individual Achievement Test, Woodcock Johnson Psycho-educational Battery–Third Edition, and Wide Range Achievement Test). As a result of this review, the authors advanced the following partial list of tentative conclusions: • In general, intelligence tests show moderately high correlations with achievement tests. • For full-scale IQs above the low range, verbal IQs tend to show higher correlations with achievement test scores compared to performance IQs for the WISC-III and its predecessors. • Performance IQs tend to have higher correlations with mathematics achievement than with verbal forms of achievement. • The WISC-III and its predecessors tend to show lower correlations with achievement for Hispanics than for Black or Whites. • Readers must exercise caution in evaluating the meaning of intelligence and achievement correlations, as a high correlation does not necessarily imply an equally high ability of one variable to predict another variable (particularly when the standard deviations of tests differ).

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524 HANDBOOK OF MULTICULTURAL ASSESSMENT More recent studies published since Ramsay and Reynold’s review confirm these findings (Rohde and Thompson, 2007). Naglieri and Bornstein (2003) exhaustively reviewed individually administered intelligence and achievement test manuals and published studies for correlations between different combinations of the intelligence-ability scales with the achievement scales (both within and between multitest batteries). For studies where the n > 200, the largest correlations between intelligence test full-scale scores with achievement test composite scores ranged between .63 and .74. The largest correlations between intelligence test full-scale scores and scores for specific achievement subtests ranged between .47 and .65. Watkins, Lei, and Canivez (2007) used cross-lagged panel analysis to show that WISC-III intelligence test scores significantly predicted achievement test scores obtained approximately 2.8 years later. However, the reverse did not hold: achievement test scores did not significantly predict later intelligence test scores, which suggests a causal relationship between intelligence and achievement.

GROUP DIFFERENCES IN STANDARDIZED ACHIEVEMENT TESTS Racial and ethnic group disparities are long standing, ubiquitous, and persistent across all forms of academic achievement, including results from psychometric achievement testing (Thernstrom and Thernstrom, 2003). Cognitive test scores predict academic achievement scores equally well across English-speaking racial and ethnic groups (Gottfredson, 2005; Herrnstein and Murray, 1994; Schmidt, 1988). If only the mean IQ gaps between ethnic and racial groups were responsible for observed gaps in academic achievement test scores, then the size of academic achievement gaps between any two groups would range from a minimum of dIQ × rIQ·ACH to a maximum of dIQ . Here, dIQ is the difference in mean IQ scores between two groups measured in standard deviation units, and dIQ × rIQ·ACH is this same difference multiplied by the correlation between the IQ and achievement measure (Gottfredson, 2005). Gottfredson (2005) presents national data from a variety of sources with direct bearing on this question. She found that during the 1960s, the achievement gaps were near the maximum predicted by IQ gaps, but during the 1980s, these gaps moved closer to the minimum predicted by IQ gaps (although remaining within the expected range). She concluded that ‘‘achievement gaps seem to be somewhat more elastic than IQ gaps, but still tethered to them’’ (p. 540). Gottfredson (2005) summarized data on trends in group-administered standardized academic achievement in reading, mathematics, and science from the U.S. Department of Education’s National Assessment of Educational Progress (NAEP) across three decades (1970s to 1990s). A comparison of

ACADEMIC ACHIEVEMENT TESTING FOR CULTURALLY DIVERSE GROUPS

Table 23.1. Mean Observed Black-White and Hispanic-White Achievement Gaps for NAEP, 1970s–1990s (standard deviations) Reading

Black/White comparisons

Math

Science

Age 9 Age 13 Age 17 Age 9 Age 13 Age 17 Age 9 Age 13 Age 17

1970s

.98

1.05

1.17

.88

1.08

1.07

1.22

1.10

1.23

1980s

.78

.73

.84

.79

.91

.96

.95

1.03

1.13

1990s

.81

.73

.73

.79

.92

.87

.97

1.09

1.08

1970s

.88

.83

.92

.59

.86

.85

.84

.98

.79

1980s

.72

.68

.63

.60

.65

.81

.88

.86

.91

1990s

.68

.69

.63

.72

.73

.73

.84

.90

.82

Hispanic/White comparisons

Note: The White mean is more than the Black and Hispanic means. Source: Adapted from Gottfredson (2005, p. 536).

mean Black-White and Hispanic-White differences (in standard deviation units) across ages nine, thirteen, and seventeen within academic areas and across decades is shown in Table 23.1. These results can be translated directly into implications for grade-level discrepancies between groups. Blacks trail Whites in reading and math by at least two grade levels by age thirteen, and by at least four grade levels by age seventeen. For Hispanics, the gap is roughly two grade levels by age thirteen and three grade levels by age seventeen. At the time of this writing, the most current NAEP data on group differences in reading, math, and science are from the year 2005. A description of these results is described briefly below.

NAEP Reading, Math, and Science Results for 2005 NAEP results are available for grades 4 and 8, although the science domain provides additional data for grade 12. Within reading and math subject areas, scores are calibrated to range from 0 to 500, whereas science scores are calibrated to range from 0 to 300. Cut scores represent a minimum score required for performance at basic, proficient, or advanced levels. Scores in the basic range denote ‘‘partial mastery of the knowledge and skills that are fundamental for proficient work at a given grade.’’ Scores in the proficient range ‘‘represent solid academic performance,’’ where ‘‘students reaching this level have demonstrated competency over challenging subject matter.’’

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526 HANDBOOK OF MULTICULTURAL ASSESSMENT Scores in the advanced range signify ‘‘superior performance’’ (Perie, Grigg, and Donahue, 2005, p. 3). Reading. The framework of the fourth-grade reading assessment measures reading performance in two subdomains: ‘‘contexts for reading’’ and ‘‘aspects of reading’’ (Perie, Grigg, and Donahue, 2005). Contexts for reading have two components. ‘‘Reading for literary experience’’ requires fourth graders to read short stories, legends, and myths, and ‘‘reading for information’’ requires fourth graders to read fact-based informational content such as magazine articles and biographies. The reading subdomain measures one of the following four processes: forming a general understanding (e.g., considering the text as a whole and providing a global understanding of it), developing interpretation (e.g., extending their initial impressions to develop a more complete understanding), making reader-text connections (e.g., connecting information in the text with knowledge and experience), and examining content and structure (for example, evaluating critically and understanding the effect of different text features). Each student receives a booklet containing two twenty-five-minute sections of reading passages (ranging in length from 250 to 800 words each) and comprehension questions (multiple choice or constructed response questions requiring short or extended written responses). As shown in Table 23.2, at least 50 percent of Black, Hispanic, and American Indian fourth graders achieved scores below the basic level. However, higher percentages of White, Black, Hispanic, and Asian fourth graders achieved scores that exceeded basic and proficient levels compared to 1992 (no data are provided for Native Americans; Perie, Grigg, and Donahue, 2005). The eighth-grade reading assessment measures the same subdomains assessed by the fourth-grade reading tests, albeit at more advanced levels, with one notable addition. In the contexts for reading subdomain, eighth graders also employ reading skills in understanding practical information from bus or train schedules, directions to locations, and other practical documents, forms, and charts. For eighth graders, reading passages range in length from four hundred to a thousand words, and the reading test for each examinee occurs over two twenty-five-minute or one fifty-minute session. As shown in Table 23.3, the performance of Black, Hispanic, and American Indian eighth graders (as compared to fourth graders) was slightly better relative to cut scores, although approximately 50 percent of Black eighth graders achieved scores at or below the cut score for basic-level skills. However, White, Black, and Hispanic students achieved mean scores that were higher, on average, compared to their 1992 scores (Perie, Grigg, and Donahue, 2005). Math. The framework for the assessment of fourth-grade mathematics covers five content areas (number properties and operations, measurement, geometry,

Math

Reading

Content Area

214

249

(Proficient): Ability to use whole numbers to estimate, compute, and determine whether results are reasonable; have a conceptual understanding of fractions and decimals; use four-function calculators, rulers, and geometric shapes appropriately; written solutions should be organized and presented with both supporting information and explanations

268

(Advanced): Ability to generalize about topics from written text; aware of how authors compose and use literary devices; ability to judge text critically and provide thorough answers that indicate careful thought

(Basic): Ability to estimate and use basic facts to perform simple computations with whole numbers; show some understanding of fractions and decimals; written responses will often be minimal and presented without supporting information.

238

(Proficient): Provides literal and inferential comprehension; ability to make clear connections between age-appropriate text and student inferences

246

229

226

203

226

204

220

200

(continued overleaf)

251

229

Asian/ Cut American Pacific Score Whites Hispanics Indian Islanders Blacks

(Basic): Understands overall meaning of written material; ability to make 208 obvious connections between age-appropriate text and own experiences; ability to make simple inferences from ideas in the text

Level Description

Group Average Score

Table 23.2. The Nation’s Report Card Assessment of Fourth-Grade Student Performance, 2005

Science

Content Area

Group Average Score

138

170

205

(Proficient): Understands concepts relating to the earth’s features, physical properties, structure, and function; formulates solutions to familiar problems; shows beginning awareness of issues associated with technology

(Advanced): Demonstrates solid understanding of the earth, physical, and life sciences; performs and critiques simple investigations, makes connections from one or more of the sciences for prediction; applies fundamental concepts to practical applications

282

162

133

138

158

129

Asian/ Cut American Pacific Score Whites Hispanics Indian Islanders Blacks

(Basic): Demonstrates some knowledge and reasoning required for understanding the earth, physical, and life sciences; carries out simple investigations and reads uncomplicated graphs and diagrams; shows beginning understanding of classification, simple relationships, and energy

(Advanced): Displays mastery in the use of four-function calculators, rulers, and geometric shapes; draws logical conclusions and justifies answers and solution processes; goes beyond the obvious in interpretations and is able to communicate thoughts clearly and concisely.

Level Description

Table 23.2. (continued)

323

(Proficient): Ability to show literal and inferential understanding from age- appropriate text; ability to make clear inferences, draw conclusions, and relate experiences to text; ability to identify some devices authors use in composing text

(Advanced): Ability to describe more abstract themes in written text; ability to analyze both meaning and form of text, and extend text information by relating it to their experiences and world events

(Proficient): Understands connections between fractions, percentages, decimals, and such topics as algebra and functions; has a thorough understanding of basic arithmetic operations

299

(Basic): Completes problems correctly using prompts such as diagrams, 262 charts, and graphs; uses fundamental algebraic and informal geometrical concepts in problem solving

281

(Basic): Ability to demonstrate a literal understanding of, and make some interpretations from, written material; ability to identify specific aspects of age-appropriate text that reflect overall meaning; ability to make simple inferences from ideas in text

Reading

Math

243

Level Description

Content Area

289

271

262

246

264

249

255

243

(continued overleaf)

295

271

Asian/ Cut American Pacific Score Whites Hispanics Indian Islanders Blacks

Group Average Score

Table 23.3. The Nation’s Report Card Assessment of Eighth-Grade Student Performance, 2005

Science

Content Area

Group Average Score

333

170

208

(Proficient): Interprets graphic information, designs simple investigations, explains concepts such as energy transfer; awareness of environmental issues involving energy and pollution

(Advanced): Demonstrates solid understanding of the earth, physical, and life sciences; performs and critiques the design of investigations, relates scientific concepts to each other; discusses the impact of human activities on the environment

160

129

—

156

124

Asian/ Cut American Pacific Score Whites Hispanics Indian Islanders Blacks

(Basic): Demonstrates some knowledge and reasoning required for 143 understanding the earth, physical, and life sciences; some understanding of concepts relating to the solar system and relative motion; beginning understanding of cause-and-effect relationships

(Advanced): Probes examples and counterexamples in order to shape generalizations from which to develop models; uses number sense and geometrical awareness to justify reasonableness of answers; uses abstract thinking to create unique problem-solving techniques

Level Description

Table 23.3. (continued)

ACADEMIC ACHIEVEMENT TESTING FOR CULTURALLY DIVERSE GROUPS

data analysis and probability, and algebra) at low, moderate, and high levels of complexity (Perie, Grigg, and Dion, 2005). Similar in format to the fourth-grade reading assessment, each student responds to a booklet containing two twenty-five-minute sections of math multiple choice and constructed response questions. Fourth-grade results are shown in Table 23.2. Unlike the fourth-grade reading results, Asians clearly pulled ahead of Whites to secure the top ranking in mean math scores compared to other groups. Blacks scored lowest; however, their mean score was six points higher than the basic cut score. Overall, higher percentages of students across all ethnic groups (except Native Americans, on which there is no reported data) scored at or above the basic level in 2005 compared to any previous testing year. In addition, the gaps between Black and White students were narrower in 2005 compared to any previous year (Perie, Grigg, and Dion, 2005). The eighth-grade math framework covers the same content areas as the fourth-grade framework, although in different proportions. Similar to the fourth-grade assessment, each eighth grader responds to a booklet containing two twenty-five-minute sections of math multiple-choice and constructed response questions. As shown in Table 23.3, the gaps between Black and Asian eighth graders widen relative to the fourth-grade results. Here, Asians (as judged by their mean score relative to cut scores) have the highest percentage of students in the proficient and advanced ranges, whereas for Blacks, the proportion of eighth graders with scores below the basic cut score exceeds 50 percent. Although the gap between White and non-White eighth graders narrowed between 1990 and 2005, the change was not statistically significant (Perie, Grigg, and Dion, 2005). Science. The framework for the assessment of fourth-grade science provides equal coverage to the earth, physical, and life sciences. Here, approximately 45 percent of assessment time addresses conceptual understanding, 45 percent addresses scientific investigation, and 10 percent of assessment time covers practical reasoning (Grigg, Lauko, and Brockway, 2006). Similar to reading and math assessment, each fourth grader is presented with two twenty-five-minute sections containing both multiple-choice and constructed response questions. As shown in Table 23.2, Blacks and Hispanics were the only groups with mean scores below the basic cut score. However, gaps between White and non-White fourth graders were smaller in 2005 compared to both 1996 and 2000. The framework for the eighth-grade science assessment mirrors the fourthgrade assessment, except that a larger proportion of the content focused on Life sciences (Grigg et al., 2006). As shown in Table 23.3, over 50 percent of Black and Hispanic eighth graders (as judged by their mean score relative to cut scores) scored below a Basic level. These gaps between Whites and Non-Whites have remained unchanged since 1996 (Grigg et al., 2006).

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532 HANDBOOK OF MULTICULTURAL ASSESSMENT

Implications of Achievement Gaps for Schooling Additional insights on group achievement gaps can be gleaned from data on student background variables and student perceptions of various aspects of school life. In 1999, fifteen middle- and upper-middle-income districts in California, Illinois, Massachusetts, Michigan, New Jersey, New York, North Carolina, Ohio, Virginia, and Wisconsin formed the Minority Student Achievement Network (MSAN). The general mission of the network is to investigate methods for reducing the academic achievement gap between Black and Hispanic students relative to White and Asian students (Ferguson, 2002a). In the 2000–2001 school year, the MSAN surveyed 7,120 Black, 17,562 White, 2,491 Hispanic, 2,448 Asian, and 4,507 multiracial students in grades 7 through 11 in ninety-five middle, junior high, and high schools. Self-report survey questions addressed six areas: (1) family background resources and living arrangements, (2) motivation when working hard, (3) comprehension and proficiency, (4) feelings about teachers and school, (5) homework hours and completion rates, and (6) social conditions and peer relations (for a complete description of survey questions, see Ferguson, 2002b). Certain patterns in the findings are worthy of note. Compared to Blacks and Hispanics, Whites and Asians have greater background advantages such as books, computers, and other learning resources in the home. However, the MSAN survey concluded that particular socioeconomic status advantages boost achievement less among Blacks and Hispanics relative to Whites and Asians. This finding is consistent with College Board data showing that economically advantaged Black and Hispanic high school seniors generally achieve mean Scholastic Achievement Test (SAT) scores that are no higher than those of economically disadvantaged Whites and Asians (Gottfredson, 2005). Compared to Whites and Asians, Black, Hispanic, and multiracial students reported lower grade point averages, less understanding of their teachers’ lessons, and less comprehension of the material that they read for school (Ferguson, 2002b). When asked, ‘‘When you work really hard in school, which of the following reasons are most important to you?’’ non-White students tended to identify teacher encouragement more frequently, whereas White students tended to cite teachers’ demands more often than non-Whites did. According to Ferguson (2002a), this ‘‘suggests the special importance of teacher-student relationships as a source of achievement motivation for Blacks and Hispanics, in particular’’ (p. 5). According to Ferguson (2002a), the best measure of student effort in the MSAN survey data are students’ self-reports of the amount of time spent on weekdays after school studying and doing homework. Among students who are not enrolled in honors or Advanced Placement (AP) classes, Asians report

ACADEMIC ACHIEVEMENT TESTING FOR CULTURALLY DIVERSE GROUPS

that they study and do homework for approximately a half-hour more per night compared to other groups. This figure increases to two-thirds of an hour more per night for students enrolled in at least one honors or AP class. Blacks and Hispanics, however, report lower rates of homework completion than Whites for any given amount of time spent studying.

WHAT ARE TEST DEVELOPERS DOING TO ENSURE FAIRNESS IN ACHIEVEMENT TESTING? Test Bias Since the late 1960s, there has been a substantial body of research by assessment scholars and psychometricians related to the development of increasingly sophisticated methods for detecting potential sources of bias in the measurement of intelligence and academic achievement (Reynolds, 2000). These efforts ensure that test interpretation and use are accurate, fair, and equitable for the widest range of test takers. The major categories within this literature are summarized briefly below. Content Bias. During the test development phase, psychometricians use a variety of approaches to reduce or eliminate characteristics of tests that may have an adverse impact on test scores of culturally diverse groups. Pursuant to Standard 7.4 of the Standards for Educational and Psychological Testing (American Educational Research Association, American Psychological Association, and National Council on Measurement in Education, 1999), test developers conduct sensitivity reviews before the final version of a test is made available to the general public. A sensitivity review refers to ‘‘the process of having a diverse group of professionals review tests to flag material that may unintentionally interact with demographic characteristics of some test takers’’ (Sireci, 2004, p. 22). Sensitivity reviews not only identify item content that may unintentionally offend test takers, but it also helps to identify construct-irrelevant test content that may provide an advantage to members of some groups relative to others. Content experts and test develops can then examine flagged items in order to determine if test objectives can be measured just as efficiently with alternate items that can pass the sensitivity review. Differential item functioning (DIF) is a method for identifying biased test items that reflects one among many applications of item response theory (Embretson and Reise, 2000). DIF occurs whenever test takers who are of equal proficiency on the latent trait but are members of different demographic groups (for example, gender or ethnicity) perform differently on the item.

533

534 HANDBOOK OF MULTICULTURAL ASSESSMENT Flagged items are then examined, and a subjective determination is made as to whether the DIF effect occurs from construct-irrelevant factors. This examination, in addition to an examination of the frequency, magnitude, and balance of the DIF effect among test items across groups, determines whether individual items may or may not be removed from an achievement test prior to its publication (Sireci, 2004). Construct Bias. According to Reynolds (1982), construct bias occurs ‘‘when a test is shown to measure different hypothetical traits (psychological constructs) for one group than another or to measure the same trait but with differing degrees of accuracy’’ (p. 194). One popular method for studying construct equivalence across groups is a comparison of the factor structure (pattern of intercorrelations between item or subtest clusters) of a test across groups (for a detailed review of statistical methods for testing the equivalence of factor structures, see Reynolds and Carson, 2005). In order to evaluate the equivalence of measurement accuracy across groups, researchers can compare internal consistency estimates, alternate form correlations, split-half reliability estimates, or test-retest stability estimates across groups (Reynolds and Carson, 2005). Differential Predictive Validity. The preceding methods can all be considered internal methods for detecting test bias, in that the analyses focus on test takers’ responses to items. Predictive validity methods for investigating test bias are considered to be external methods for investigating test bias. Here, test scores are compared to criteria that are external to the testing context. These analyses examine the degree to which test scores accurately predict scores on a criterion measure, and whether this relationship is consistent for examinees from different groups (Jensen, 1980; Reynolds and Carson, 2005). An example would be the comparison of high school achievement test scores with students’ grade point averages after a specific number of years in college.

PSYCHOMETRIC ISSUES IN STANDARDIZED ACHIEVEMENT TESTING AND ENGLISH-LANGUAGE LEARNERS At the time of this writing, the current Standards for Educational and Psychological Testing (American Educational Research Association, American Psychological Association, and National Council on Measurement in Education, 1999) state, ‘‘It is important to consider language background in developing, selecting, and administering tests and in interpreting test performance’’ (p. 91). Language background issues are particularly salient for English-language

ACADEMIC ACHIEVEMENT TESTING FOR CULTURALLY DIVERSE GROUPS

learners (ELLs), defined as students who are not native English speakers and are not reclassified as fluent in English. Federal (No Child Left Behind Act of 2001) and state legislation require the inclusion of all students, including ELLs, into large-scale assessments (Abedi, Lord, Hofstetter, and Baker, 2000; Mazzeo, Carlson, Voelkl, and Lutkus, 2000). School districts use high-stakes achievement tests for the assessment, instructional assignment, classification, and reclassification of ELL students (from their former ELL status; Zehler, Hopstock, Fleischman, and Greniuk, 1994). Although the exclusion of certain subgroups from test standardization samples is not evidence that a test is biased or unfair for members of the excluded group (see the discussion of the standardization fallacy in Jensen, 1980), standardized tests have been criticized for excluding ELL students from the norming group for these tests (Navarrette and Gustke, 1996). Abedi (2002) examined the test scores of students in grades 1 to 11 across four test sites on the Iowa Tests of Basic Skills and the Stanford Achievement Test, Ninth Edition. English language learners generally perform lower than non-ELL students on reading, science, and math. The level of impact of language proficiency on assessment of ELL students is greater in the content areas with higher language demand. For example, the size of the gap between ELL and non-ELL students was greatest in reading, smaller in science, and virtually nonexistent in math computation subscales (Abedi, 2002). Test item responses by ELL students at the lower end of the English proficiency spectrum suffered from low internal consistency reliability, suggesting that language background for this group adds a source of measurement error. Relationships between individual items, relationships between individual items and total test scores, and relationships between achievement test scores and external criterion measures were significantly larger for non-ELL students than for ELL students. Structural models for ELL students demonstrated lower statistical fit. The factor loadings were generally lower for ELL students, and the correlations between the latent content-based variables were also weaker for them. In general, these findings suggest that language factors may be a source of construct-irrelevant variance in standardized achievement testing.

Modification of Language Demands for ELL Students Abedi and Lord (2001) investigated the effects of modifying the linguistic structures of math achievement test items on students’ test performance by comparing the performance of ELL and English-proficient speakers on math word problems from the NAEP. In addition to English, ELL students spoke other languages, such as Spanish, Korean, Chinese, Cambodian, Vietnamese, Farsi, and Filipino. Math achievement test items can be modified according to the

535

536 HANDBOOK OF MULTICULTURAL ASSESSMENT following linguistic characteristics (adapted from Abedi, Lord, and Plummer, 1995; Abedi and Lord, 2001): 1. Unfamiliar or infrequent nonmath vocabulary was changed to more familiar, frequent vocabulary. 2. Passive verb forms were changed to active verb forms. 3. Lengthy word groups were shortened. 4. Conditional clauses were replaced with separate sentences, or the order of a conditional and main clause was changed. 5. Relative clauses were removed or recast. 6. Complex question phrases were simplified. 7. Abstract or impersonal descriptions were reworded in more concrete language. According to Abedi and Lord (2001), math experts reviewed both original and revised items to ensure that the math content and required operations were parallel. This study was conducted in two phases. In the first phase, thirty-six eighth graders were asked to read four pairs of math items, with each pair including an item written in an original and modified format. Students’ perceptions and preferences were assessed in structured interviews. Students were asked the following questions: ‘‘If you were really in a hurry on a test and you had to pick one of these problems to do, which one would you do? [After reading both items aloud] Are there words in either of them that might be confusing for some students or hard for them to understand? What is it about the one you chose that seems easier?’’ (Abedi and Lord, 2001, p. 222). Across two sets of interviews, the researchers found that on average, students preferred the modified items over the original items. In justifying this choice, some students remarked: ‘‘Well, it makes more sense,’’ ‘‘It seems simpler; you get a clear idea of what they want you to do,’’ and ‘‘It’s easier to read, and it gets to the point, so you won’t have to waste time’’ (reported in Abedi and Lord, 2001, p. 222). In the second phase, 1,174 eighth graders took paper-and-pencil math tests with original, linguistically modified, and control items. The researchers identified a reliable performance gap between English-proficient versus ELL learners, but investigated the extent to which linguistic modifications reduced the performance gap between the two groups. Although the researchers found a small but significant main effect favoring higher scores for revised items, the interaction between item type and ELL classification was not significant. However, the interaction effect had its greatest impact for low-performing students enrolled in lower-level math classes and least impact for higher-performing students enrolled in higher level math classes.

ACADEMIC ACHIEVEMENT TESTING FOR CULTURALLY DIVERSE GROUPS

Other Test Accommodations In addition to linguistic modifications of test items, Abedi et al. (2000) examined the effects of the following three additional accommodation strategies on mathematics word problem performance (on a thirty-five-point test) of over nine hundred eighth-grade ELL and non-ELL students: (1) the use of a glossary for explaining potentially difficult or unfamiliar nonmath words, (2) extra time (an additional twenty-five minutes), and (3) a combination of a glossary plus extra time. Students were assigned randomly to the different accommodation groups within participating classrooms. The greatest score improvements by both ELL and non-ELL students occurred in the glossary plus extra time condition, translating to an average of 2.5 additional points. The glossary-only condition was the only accommodation that did not significantly improve scores for the ELL students. The linguistic modification condition was the only condition that significantly narrowed the score gap between ELL and non-ELL students.

Analysis of Distracters in Multiple Choice Items Group differences in results from achievement testing are long-standing and ubiquitous, and they appear to be quite resistant to change. Nevertheless, the purpose of achievement testing is to collect information on student understanding of the academic curriculum. This not only involves identifying areas of the curriculum that are sufficiently mastered, but also identifying errors in understanding, so that instruction can be targeted to filling curriculum gaps and correcting thinking errors. Jorgensen (2004) argues that the ways in which groups may differ in how individual items are answered incorrectly is just as valuable in informing instruction as how groups answer items correctly (for an example of this methodology as applied to intelligence tests, see Jensen, 1976). Although broad group differences in mean scores are resistant to change, this does not mean that the design of achievement testing cannot be improved for the purpose of improving instruction for lower-performing groups. Jorgensen (2004) describes a method for applying this principle to the construction of multiple-choice items in achievement testing. In a typical multiple-choice item, the correct answer (assuming that the answer was not selected from random guessing) reflects knowledge and application of measured objectives. In contrast, the incorrect answers (called distracters) typically reflect common student errors. However, distracters have traditionally not been constructed in a manner that systematically examines thinking errors according to a conceptual model that explicitly articulates hierarchical relationships among the reasons responsible for errors (choice of an incorrect distracter).

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538 HANDBOOK OF MULTICULTURAL ASSESSMENT Jorgensen (2004) illustrates this principle as applied to the construction of multiple-choice distracter items for assessments of reading comprehension. At the first (bottom) level of this hierarchy, some thinking errors involve retrieval of facts that bear no relationship to the text, or the student is basing answers on bits and pieces of the text that are largely unrelated to the information required by the item stem. At the second level, the choice of this distracter demonstrates a basic understanding of facts from the text; however, the answer is still unrelated to the information required by the item stem. At the third level, the distracter choice illustrates analysis and interpretation skills, but the application of these skills results in a conclusion or inference that is secondary to the conclusion required for a correct response. Instead of constructing distracters that involve different variations of errors at the same level of cognitive sophistication, these distracters reflect choices arranged in a hierarchy ranging from blatant errors reflecting minimal understanding, to more sophisticated errors that involve partial but incomplete understanding. Two examples, adapted from Jorgensen, are illustrated in Exhibit 23.1.

Exhibit 23.1. Illustration of a Multiple-Choice Reading Comprehension and Math Item Using Distracters Written According to a Hierarchy of Thinking Skill Errors Reading Comprehension Read this sentence from the story ‘‘Snakes and Spiders’’: Both snakes and spiders are animals found in woods that frighten many people

Which of the following has the same meaning as frighten as it is used in this sentence? A. B. C. D.

Forgets [Cognitive Level 1: look-alike word] Many trees [Cognitive Level 2: related to woods but not related to frighten] Concerns [Cognitive Level 3: related to frightens somewhat but not precise] Scares [Cognitive Level 4: Correct Answer]

Math Find the answer to ? in the following math problem: 5.2 + .25 = ?

A. B. C. D.

4.57 [Cognitive Level 1: Random answer] 5.45 [Cognitive Level 4: Correct answer] 7.7 [Cognitive Level 3: Adding digits correctly, but with incorrect decimal place] 14 [Cognitive Level 2: Adding up all digits in the equation without regard to decimal place]

Source: Adapted from Jorgensen (2004).

ACADEMIC ACHIEVEMENT TESTING FOR CULTURALLY DIVERSE GROUPS

According to Jorgensen (2004), ‘‘By building assessments that provide increasingly precise information about why students choose the wrong answer, perhaps test publishers can [find answers to questions] about the cause of achievement gaps and help forge the link between assessment and instruction’’ (p. 52).

SUMMARY AND CONCLUSION As long as average group differences in general mental ability (g) exist both domestically and worldwide, corresponding group differences in academic achievement will also continue to exist. However, variation in intelligence test scores (a good proxy for g) does not explain all variation between individuals and groups in achievement test scores because unexplained variance is due to a variety of psychometric, social, cultural, and educational factors. Methods for identifying bias in standardized achievement tests are aggressively pursued by test publishers, and promising results have been observed from research on the effects of test modifications for English-language learners. Even when achievement tests measure skills accurately and fairly, the bottom line is that results from such testing should identify deficient skill areas to which teachers can target corrective instruction. When continuous improvements in achievement test design assist educators in this regard, then all learners, regardless of group membership, benefit.

References Abedi, J. (2002). Standardized achievement tests and English language learners: Psychometric issues. Educational Assessment, 8(3), 231–257. Abedi, J., & Lord, C. (2001). The language factor in mathematics tests. Applied Measurement in Education, 14(3), 219–234. Abedi, J., Lord, C., Hofstetter, C., & Baker, E. (2000). Impact of accommodation strategies on English language learners’ test performance. Educational Measurement: Issues and Practice, 19(3), 16–26. Abedi, J., Lord, C., & Plummer, J. (1995). Language background as a variable in NAEP mathematics performance: NAEP TRP Task 3D: Language background study. Los Angeles: UCLA Center for the Study of Evaluation/National Center for Research on Evaluation, Standards, and Student Testing. American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (1999). Standards for educational and psychological testing. Washington, DC: American Psychological Association. Deary, I. J., Strand, S., Smith, P., & Fernandes, C. (2007). Intelligence and educational achievement. Intelligence, 35(1), 13–21.

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540 HANDBOOK OF MULTICULTURAL ASSESSMENT Embretson, S. E., & Reise, S. P. (2000). Item response theory for psychologists. Mahwah, NJ: Erlbaum. Ferguson, R. F. (2002a). What doesn’t meet the eye: Understanding and addressing racial disparities in high-achieving suburban schools. Oak Brook, IL: North Central Regional Educational Laboratory. Ferguson, R. F. (2002b). Ed-Excel assessment of secondary school student culture tabulations by school district and race/ethnicity: Responses from middle school, junior high and high school students in districts of the Minority Student Achievement Network (MSAN), 2000–2001. Evanston, IL: Minority Student Achievement Network. Gettinger, M. (1984). Individual differences in time needed for learning: A review of literature. Educational Psychologist, 19, 15–29. Gottfredson, L. (2005). Implications of cognitive differences for schooling within diverse societies. In C. L. Frisby & C. R. Reynolds (Eds.), Comprehensive handbook of multicultural school psychology (pp. 517–554). Hoboken, NJ: Wiley. Grigg, W., Lauko, M., & Brockway, D. (2006). The nation’s report card: Science 2005. Washington, DC: National Center for Education Statistics. Herrnstein, R. J., & Murray, C. (1994). The bell curve. New York: Free Press. Jensen, A. R. (1976). Test bias and construct validity. Phi Delta Kappan, 58, 340–346. Jensen, A. R. (1980). Bias in mental testing. New York: Free Press. Jensen, A. R. (1989). The relationship between learning and intelligence. Learning and Individual Differences, 1, 37–62. Jensen, A. R. (1991). Spearman’s g and the problem of educational equality. Oxford Review of Education, 17, 169–187. Jensen, A. R. (1993). Psychometric g and achievement. In B. R. Gifford (Ed.), Policy perspectives on educational testing (pp. 117–227). New York: Kluwer Academic Publishers. Jensen, A. R. (1998). The g factor: The science of mental ability. Westport, CT: Praeger. Jorgensen, M. A. (2004). The achievement gap: Test bias or real differences? A test publisher’s perspective. In J. O’Reilly (Ed.), The achievement gap: Test bias or school structures? (pp. 44–53). San Diego, CA: National Association of Test Directors 2004 Symposia. Mazzeo, J., Carlson, J. E., Voelkl, K. E., & Lutkus, A. D. (2000). Increasing the participation of special needs students in NAEP: A report on 1996 NAEP research activities. Washington, DC: National Center for Education Statistics. Naglieri, J., & Bornstein, B. T. (2003). Intelligence and achievement: Just how correlated are they? Journal of Psychoeducational Assessment, 21, 244–260. Navarrette, C., & Gustke, C. (1996). A guide to performance assessment for linguistically diverse students. Albuquerque, NM: Highlands University. Perie, M., Grigg, W., & Dion, G. (2005). The nation’s report card: Mathematics 2005. Washington, DC: National Center for Education Statistics.

ACADEMIC ACHIEVEMENT TESTING FOR CULTURALLY DIVERSE GROUPS Perie, M., Grigg, W., & Donahue, P. (2005). The nation’s report card: Reading 2005. Washington, DC: National Center for Education Statistics. Ramsay, M. C., & Reynolds, C. R. (2004). Relations between intelligence and achievement tests. In G. Goldstein & S. R. Beers (Eds.), Comprehensive handbook of psychological assessment (Vol. 1, pp. 25–50). Hoboken, NJ: Wiley. Ree, M. J., & Earles, J. A. (1991). The stability of convergent estimates of g. Intelligence, 15, 271–278. Reynolds, C. R. (1982). Methods for detecting construct and predictive bias. In R. A. Berk (Ed.), Handbook of methods for detecting test bias (pp. 199–227). Baltimore, MD: Johns Hopkins University Press. Reynolds, C. R. (2000). Why is psychometric research on bias in mental testing so often ignored? Psychology, Public Policy, and Law, 6(1), 144–150. Reynolds, C. R., & Carson, A. (2005). Methods for assessing cultural bias in tests. In C. L. Frisby & C. R. Reynolds (Eds.), Comprehensive handbook of multicultural school psychology (pp. 795–823). Hoboken, NJ: Wiley. Rohde, T. E., & Thompson, L. A. (2007). Predicting academic achievement with cognitive ability. Intelligence, 35(1), 83–92. Rushton, J. P., & Jensen, A. R. (2005). Thirty years of research on race differences in cognitive ability. Psychology, Public Policy, and Law, 11(2), 235–294. Schmidt, F. L. (1988). The problem of group differences in ability test scores in employment selection. Journal of Vocational Behavior, 3(3), 272–292. Sireci, S. G. (2004). The role of sensitivity review and differential item functioning analyses in reducing the achievement gap. In J. O’Reilly (Ed.), The achievement gap: Test bias or school structures? (pp. 19–40). San Diego, CA: National Association of Test Directors 2004 Symposia. Thernstrom, A., & Thernstrom, S. (2003). No excuses: Closing the racial gap in learning. New York: Simon & Schuster. Watkins, M. W., Lei, P., & Canivez, G. L. (2007). Psychometric intelligence and achievement: A cross-lagged panel analysis. Intelligence, 35(1), 59–68. Zehler, A. M., Hopstock, P. J., Fleischman, H. L., & Greniuk, C. (1994). An examination of assessment of limited English proficient students. Arlington, VA: Development Associates.

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CHAPTER TWENTY-FOUR

Neuropsychological Assessment in a Multicultural Context Past, Present, and Future Arthur MacNeill Horton Jr.

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s interest in neuropsychology has continued to increase at a tremendous rate, the U.S. population has increased in terms of cultural diversity. As a result, there are questions regarding the application of neuropsychology to diverse samples. There, of course, are multiple examples of the cross-cultural validity of neuropsychological research findings and successful applications of neuropsychological assessment methods (Horton and Wedding, 1984; Reitan and Wolfson, 1992). Still, to assume that the assessment of neuropsychological behavior has escaped the cultural biases documented in psychological assessment (Helms, 1992; Fletcher-Janzen, Strickland, and Reynolds, 2000) would be foolish. Examining the cultural sensitivity of neuropsychological assessment methods would be important in providing effective services to the increasingly culturally diverse U.S. population. This chapter provides an overview of the history of clinical neuropsychology, a description of major neuropsychological assessment measures, and a discussion of the limitations of these measures across cultural domains.

OVERVIEW OF NEUROPSYCHOLOGICAL ASSESSMENT A frequently quoted definition of neuropsychology, which will be used in this chapter, is ‘‘the scientific study of brain-behavioral relationship’’ (Meier, 1974, p. 289). Because neuropsychology is composed of both brain and behavior components, Horton and Puente (1990) noted that neuropsychological performance

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is influenced by both organic (brain) and environmental (behavior) variables. The influence of brain variables in neuropsychology has been demonstrated through the work of neuropsychologists such as Ralph M. Reitan, Arthur L. Benton, Charles J. Golden, and A. R. Luria over many years. Behavior variables in neuropsychology are the cultural aspects addressed in this chapter. Cursory explanations of the concepts of brain damage and cerebral dysfunction are provided to clarify the neuropsychological context in which the concepts are applied. In this chapter, the term brain damage means structural injury to the brain (Horton, 1994). Neurodiagnostic imaging methods clearly identify many structural brain lesions (Horton and Wedding, 1984). Nevertheless, in some instances, neuroimaging fails to reflect changes in the physiological functioning of the human brain. While conditions that produce clear structural injury to the brain such as brain tumors or strokes may be seen, other neuropathological conditions, such as sequelae of traumatic brain injury and neurotoxic conditions, may not demonstrate clear structural brain changes under imaging, even though the conditions produce identifiable neurocognitive, sensory-perceptual, and motoric deficits (Horton and Puente, 1989). When behavioral changes can be documented but structural lesions in the brain are not seen by neuroimaging, the term cerebral dysfunction is used (Horton, 1994). Organicity was defined by Davison (1974) as follows: ‘‘The concept includes the assumption that any and all kinds of brain damage lead to similar behavioral effects and that behavioral differences among the brain-damaged are due primarily to severity of damage and premorbid personality characteristics’’ (p. 14).

CURSORY HISTORY OF NEUROPSYCHOLOGICAL ASSESSMENT In April 1861, Paul Broca, a physician, presented to the Paris (France) Anthropological Society Meeting the brain of a patient who had died but had been unable to talk when alive. The patient’s brain became available for study after his death. Broca found a lesion in the posterior third portion of the inferior frontal convulsion of the left hemisphere, or the left frontal lobe. He showed that the patient’s language difficulty, aphasia, was not related to either recall or motor problems and concluded that the language difficulty was due to the brain lesion in the posterior third portion of the inferior frontal convulsion of the left hemisphere. The case study proved for the first time that a specific brain area subserves a specific mental function—expressive speech (Horton and Wedding, 1984). The area of the brain was named Broca’s area. In 1874, Carl Wernicke, another physician, presented a case study of a patient who, when alive, had a speech comprehension deficit. Wernicke found

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544 HANDBOOK OF MULTICULTURAL ASSESSMENT the brain of the dead patient had a lesion in the posterior third portion of the superior temporal lobe of the left hemisphere of the patient’s brain. This area was another example of a specific brain area being responsible for a specific mental function (receptive language) and was named Wernicke’s area (Horton and Wedding, 1984). These important discoveries proved that specific brain areas subserve specific mental functions. That a specific brain area subserves a specific mental function was the main assumption of the localizationist school of brain-behavioral relationships. An opposing school of brain-behavior relationships proposed that all brain tissue is of equal relevance for subserving behavioral functions. This school was termed the equal potentiality school. Findings that supported it included those of Marie J. P. Flourens (cited in Luria, 1966), who demonstrated in animal research studies that how much behavioral function was destroyed was related more to the amount of brain tissue impaired than where in the brain a lesion was located. With brain-injured veterans of World War I, Kurt Goldstein found similar results. Goldstein’s research suggested that the major loss in brain injury was concrete thinking or, in his words, ‘‘the loss of the abstract attitude’’ (Goldstein, 1952, p. 245). Interestingly, the two different schools of thought developed in two different countries, France and Germany, that were next to each other. French scientists found evidence supporting a localization model, and German scientists found evidence supporting an equal potentiality model. It had been observed that surviving brain-injured veterans of the Franco-Prussian War and World War I provided the clinical samples on which both French and German scientists depended for data. The different data, it has been suggested, could be the result of the fact that German ammunition was technologically superior and tended to remain intact after impact, whereas the French ammunition was of lesser quality and fragmented on impact. Thus, brain lesions caused by German ammunition produced relatively localized lesions, whereas lesions from French ammunition tended to produce generalized lesions because the ammunition would fragment. This hypothesis is, of course, speculative. It is generally accepted, however, that both the localization and equal potential models of brain-behavior relationships fail to fully explain the full range of human neuropsychological abilities. Thomas Hughlings Jackson, another physician, formulated a third model (Luria, 1966, 1970). Jackson postulated that human brain functions were represented on multiple levels. Jackson proposed that there was a vertical organization with brain functions subsumed on a number of levels. Luria refined Jackson’s theoretical views and suggested that the brain is composed of distinct functional blocks with each section serving different behavioral functions. Luria (1966) postulated that higher mental processes

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involve multiple brain areas integrating in multiple points in time to subsume behavioral functions (Horton, 1987). As Horton and Wedding (1984) noted: Essentially, Luria thought that every complex form of behavior depended on the joint operations of several faculties located in different zones of the brain. Disturbance of any one of the number of faculties located in different areas of the brain will change behavior in a different way. But in another way this means no single behavior is localized in a specific brain area, and that each behavior is a result of the specific combinations of separate brain areas. Also the damage to a single brain area causes the behavior to be changed but not necessarily lost [p. 30].

Brain damage is a difficult and complex concept to understand, and complexities go far beyond these rather simplistic conceptualizations. There is a tremendous amount of heterogeneity among brain-injured individuals.

REVIEW OF BRAIN-BEHAVIOR RELATIONSHIPS The central nervous system has two major divisions: the brain and the spinal cord. The spinal cord transmits sensory impulses to the brain and sends motor impulses from the brain to the muscles. The spinal cord is made up of various segments (cervical, thoracic, lumbar, and sacral) that refer to specific groups of nerves. Injuries to segments of the spinal cord impair related levels of motoric and sensory functioning. The spinal cord is divided into sensory and motoric areas, as is the human brain. Understanding the sensory-motor organization of the brain and spinal cord is necessary to understanding the structure and functioning of the central nervous system. The human brain is divided into two cerebral hemispheres (Luria, 1966). Each hemisphere differs in structure and function from the other, differences that are expressed in the term cerebral asymmetry. As is well known, human beings are dominant on one side of the body, with one cerebral hemisphere usually larger than the other. In most right-handed individuals, the left cerebral hemisphere is slightly larger than the right cerebral hemisphere. The left cerebral hemisphere may be slightly larger because it subserves language functions in the human (Horton and Wedding, 1984). The need to speak has resulted in areas of the brain that have been further developed as human beings have evolved to an information-intensive society. It is also important to be aware of the concept of contralateral control, which refers to the nervous system organization of the brain. The cerebral hemisphere on the left cerebral hemisphere controls motor and sensory functions on the right side of the body, and the right cerebral hemisphere controls motor and sensory of the left side of the body. All functions of the sensory nature are not completely lateralized. Auditory ability is 80 percent under contralateral control and 20 percent under

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546 HANDBOOK OF MULTICULTURAL ASSESSMENT ipsilateral, or same-side, control and tactile functions are generally thought to be 90 percent under contralateral control and 10 percent under ipsilateral control (Horton and Wedding, 1984).

SELECTED NEUROPSYCHOLOGY ASSESSMENT APPROACHES In this section, the primary focus is on selected standardized neuropsychological test measures and batteries. The reason for this choice is that the multifaceted nature of neuropsychological assessment is best addressed by the use of standardized neuropsychological test measures and batteries. When neuropsychologically assessing individuals from diverse cultural and ethnic groups, a standardized neuropsychological battery is usually recommended. A standardized battery, for example, will allow for the use of multiple levels of inference (Horton and Wedding, 1984: Reitan and Wolfson, 1992) rather than simply rely on a level-of-performance model. The use of multiple levels of inference provides some control over false-positive and false-negative errors in diagnosis. A battery of a carefully selected group of neuropsychological tests is most helpful for comprehensively describing strengths and weaknesses exhibited by brain-impaired patients. At the same time, single neuropsychological test measures can be helpful in screening assessments and when the question is of a specific area of brain functioning. It is acknowledged that in some cases, circumstances such as time and money dictate that single measures will be used when assessing individuals from diverse cultural and ethnic groups. Still, given the limited space available for discussion of this area, the most profitable use would be to address only a couple of instruments. These will include the most widely used fixed standardized clinical neuropsychological battery and a new measure of executive functioning. The neuropsychological test battery to be discussed is the Halstead-Reitan Neuropsychological Test Battery (Reitan and Wolfson, 1992), and the measure of executive functioning is the Test of Verbal Conceptualization and Fluency (Reynolds and Horton, 2006). It should be noted that fixed neuropsychological test batteries are often supplemented by additional tests based on specific needs of the assessment situation such as the patient’s reported problem or chief complaint and particular educational, medical neurological, and social characteristics, as well as special circumstances when assessing individuals from diverse cultural and ethnic groups. There are too many neuropsychological test batteries and measures to cover all of them, so the treatment in this chapter must be selective. The term standard may not be entirely applicable with diverse cultural and ethnic groups. It indicates that the fixed neuropsychological test battery has been administered in a standard fashion to a sample of persons that includes

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a representative number of persons in the sample from which the results of this group can be generalized to the population group in question. All neuropsychological batteries and single measures have included few members of diverse cultural and ethnic group in their standardization. The majority of neuropsychological test batteries and measures can be assumed to be likely skewed to the values and beliefs of the dominant cultural and ethnic group in the country in which the test was developed. Additional research to identify appropriate strategies for correcting inherent problems of standardization is necessary.

Halstead-Reitan Neuropsychological Test Battery The Halstead-Reitan Neuropsychological Test Battery is based on the research of Ward Halstead at the University of Chicago Medical School on behavioral assessment of brain damage functioning preceding World War II (Horton and Wedding, 1984). Halstead attempted to develop behavioral measures that would characterize the changes secondary to impairment of the biological integrity of the human cerebral cortex through a research program. He attempted to identify ‘‘biological intelligence’’ or the unique component of adaptive ability dependent on intact brain functioning. Ralph M. Reitan was Halstead’s first doctoral student and realized the great clinical value of Halstead’s experimental research findings for work with individual braininjured patients. Reitan studied with Halstead and modified and added to Halstead’s battery of tests to develop a neuropsychological assessment battery for clinical use with brain-damaged patients. The Halstead-Reitan Neuropsychological Test Battery and the versions for older and younger children used today are adaptations of the original Halstead Neuropsychological Test Battery for Adults (Reitan and Wolfson, 1992). The major tests that were developed at Halstead’s laboratory at the University of Chicago, Medical School are as follows: • Category Test. This test is made up of 208 slides representing a number from one to four divided into seven subtests. Each subtest is based on a principle or concept for representing a number from one to four. The concept is identified by selecting a number between one and four for each slide as an answer, and the slide represents an answer between one and four. The principal or concept remains the same, but the stimulus materials vary from slide to slide within subtests. Immediate auditory feedback is given whether the answer is right or wrong, and the speed at which the correct concept is identified is used to evaluate visual abstract concept-formation skills. • Tactual Performance Test. This complex psychomotor problem-solving task involves multiple brain-based abilities, including tactile form identification, incidental memory, and spatial location recollection. A large form board is used

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548 HANDBOOK OF MULTICULTURAL ASSESSMENT on which there are ten geometric numbers of shapes and a series of blocks that fit into the geometric shapes on the board placed next to the board. Blocks are to be placed into the holes in the board into which the blocks will fit while the patient is blindfolded. The task is done in three trials of fifteen minutes. First, the dominant hand is used, then the nondominant hand, and then both hands. After three trials, the board is removed and the patient’s blindfold is removed; then the patient is requested to draw all the shapes and put the shapes in the same place relative to each other shape on the board. • Seashore Rhythm Test. This is a measure of auditory rhythm perceptual skills. The patient indicates which of thirty pairs of rhythm stimuli are similar or different. The test is used to assess the ability to discriminate different rhythmic sequences. • Speech Sound Perception Test. The patient responds by underlining the one word of the response alternatives that matches a tape-recorded stimulus of sixty nonsense words. This is a verbal measure of auditory perceptual skills and assesses the ability to discriminate speech-related sounds. • Finger Tapping Test. In this measure of motor speed, the patient taps a special mechanical finger-tapping device first with the dominant hand and then with the nondominant hand for five ten-second trials with each hand. The test measures motor speed and reflects the condition of the motor strip of the opposite cerebral hemisphere. There are also a number of ancillary measures that were adapted or developed by Reitan at his Neuropsychological Laboratory at Indiana University School of Medicine and added to produce the Halstead-Reitan Neuropsychological Test Battery. These added procedures were developed to improve the clinical value of the battery and include the Figure Localization Test, the Fingertip Numbering Writing Test, and the Tactile Form Recognition Test, as well as the Reitan Indiana Aphasia Screening Test, the Strength of Grip Test, the Trail-Making Test, and special procedures developed specifically for younger children, among a number of other measures (see Reitan and Wolfson, 1992, for test descriptions and details of administration). In addition, the age-appropriate Wechsler Intelligence measure and measures of academic achievement and personality functioning are often given in conjunction with the neuropsychological test battery.

Test of Verbal Conceptualization and Fluency The Test of Verbal Conceptualization and Fluency (TVCF) presents a standardized set of four subtests with a total administration time of twenty-five to thirty minutes for most individuals. The test is designed to measure multiple aspects of executive functions, principally related to the integrity of the frontal lobes of

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the brain, through the use of several different forms of verbal and nonverbal tasks. The tasks emphasize multiple aspects of verbal fluency, set shifting, and rule induction, along with sequencing and visual search skills. The TVCF was designed and standardized for use with individuals ranging in age from eight to eighty-nine years. Standardized (or scaled scores) are provided in the form of smoothed linear T scores, having a mean of 50 and a standard deviation of 10, along with their accompanying percentile ranks. The four subtests of the TVCF are: • Category Fluency, which measures word retrieval by conceptual category (for example, things to eat or wear) and fluency of ideation. • Classification, a verbal measure of set shifting and rule induction that is designed as a verbal or language-based analogue to the well-known Wisconsin Card Sorting Test (Grant and Berg, 1948). • Letter Naming, which measures word retrieval by initial sound and fluency of ideation. • Trails C, which measures the ability to coordinate high attentional demands, sequencing, visual search capacity, and the ability to shift rapidly between arabic numerals and linguistic representations of numbers. The Trails task used and conormed with the other TVCF subtests is a variation of several other ‘‘trailmaking’’ tasks and was taken from the earlier published Comprehensive Trail Making Test (Reynolds, 2003). The provision of a strong normative base, using population-proportionate stratified random sampling procedures to match U.S. Bureau of the Census 1998 population statistics adds another layer of methodological refinement to the psychometric enhancements in the TVCF. Validity and reliability data support the use of the TVCF in evaluating neuropsychological integrity. Alpha coefficients for the TVCF are reported by ethnic groups (for example, European American, Hispanic American, African American, and Asian Americans; Reynolds and Horton, 2006). Results for the cross-ethnic alpha coefficients are equally comparable, with high degrees of similarity seen across all four ethnic groups. All ethnic groups were self-identified as genetic DNA racial subtyping procedures, which were unavailable geographically and prohibitively costly. No evidence for differential interpretation of scores appears, as a function of ethnicity provides strong support for the presence of a common set of latent constructs for the TVCF variables across all of these groupings. Derived alpha coefficients support the notion that for selected groups of individuals, the latent constructs of the TVCF appear to be relatively constant across groups of patients. The results also suggest an absence of ethnic effects on TVCF tests scores for African Americans, Asian Americans, and Hispanic Americans.

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CRITICAL ISSUES IN NEUROPSYCHOLOGICAL TESTING Culture and ethnicity as important variables in neuropsychological assessment have been documented (Amante VanHouten, Grieve, Bader, and Margules, 1977; Campbell et al., 1996; Manley, Byrd, Touradji, and Stern, 2004; Lichenberg, Ross, and Christensen, 1994; Artiola i Fortney and Mullaney, 1998). The specific dimensions of culture and ethnicity to performance on neuropsychological tests, however, are still controversial (Ford-Booker et al., 1993; Campbell et al., 1996; Roberts and Hamsher, 1984). Issues in this debate include the lack of representativeness of widely used neuropsychological instruments due to failure to include diverse groups in the normative samples (Ford-Booker et al., 1993; Campbell et al., 1996; Roberts and Hamsher, 1984; Betancourt and Lopez, 1995; Lichtenberg et al., 1994).

Conceptual Domains of Culture Ethnocentrism. Ethnocentrism is a concept that includes all cultures and is often outside the individual’s awareness within the culture (Berry, 1980; Raminez and Price-Williams, 1974; Helms, 1992). The assumption that ‘‘human’’ is consistent with membership in a dominant cultural group is an underlying assumption in psychological assessment (Betancourt and Lopez, 1995). Psychology has generally ignored the existence of biases in assessment instruments. Not addressing assessment biases allows these biases to direct attitudes, perceptions, and beliefs in test construction, validation, and interpretations (Helms, 1992). Assessment practices in psychology are rooted in the dominant European American culture, which has emerged as a standard that equates to an assumption of cultural superiority (Pedersen, 1987). The various identities of a person expressed through his or her unique cultural identity should be appreciated (Pedersen, 1987). Cultural biases are seen as contributing to test error variance and thus obscure reality. In an American society that is becoming increasingly multicultural, clinical neuropsychologists will need to be able to separate the error variance of cultural biases from the true scores of brain-related variables. Acculturation. Acculturation, crucial to understanding cultural influences, refers to the degree to which persons from a nondominant culture have adopted the beliefs, values, and practices of the dominant culture (Westermeyer, 1993). Acculturation has been an important issue in the psychological assessment literature. Researchers have agreed that standard psychological assessment measures fail to assess behaviors subserved by acculturation (Cortes, Rogler, and Malgady, 1994). There are numerous variables related to acculturation (Manly et al., 2004), including age at the time of entering a new culture,

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educational and occupational status, gender, interactions with the dominant culture, relationships with extended family, access to ethnic support systems, and language (Berry, Trimble, and Olmedo, 1986; Cullar, Harris, and Jasso, 1980; Suinn, Richard-Figueroa, Lew, and Vigil, (1987). Acculturation can take multiple forms: bicultural, blended or assimilated, and marginal, for example. Acculturation is not simply the number of years living in a dominant culture, as some ethnic groups remain immersed in their culture of origin while residing in a foreign country (Berry, 1980). For example, Ralph M. Reitan, the father of American neuropsychology, was born in the United States, but his first language was Norwegian because he grew up in Lutheran communities in the upper Midwest and learned English (as a second language) only after he went to elementary school. Clearly the Lutheran/Norwegian community was a different culture from the dominant American/English community. Transculturation is a new development in which a new hybrid culture develops out of the interactions between a nondominant and a dominant culture (DeGranda, 1968). Modern American music forms such as rap and hip-hop may be seen as hybrids of European American and African American cultures. Assimilation is a transformation as a member of an ethnic group evolves from a primary cultural identification to a new cultural identity that may be seen as having multiple dimensions, such as bicultural or blended or others (LaFromboise, Coleman, and Gerton, 1993). If acculturation is not considered in the assessment process, considerable error variance may result if the person to be neuropsychologically assessed is from a nondominant culture and not acculturated to the culture within which the neuropsychological assessment procedures were developed.

Linguistics Language. In the ideal situation, the neuropsychologist speaks the language of the person being assessed (Artiola i Fortuny et al., 2005). In selected cases, a professional interpreter could be used, but that would be a last resort. Professional interpreters can induce their own biases so a neuropsychologist who can speak the patient’s language is the best option. Another consideration is the language and appropriateness of the neuropsychological tests used. Neuropsychological test measures that have been translated into another language may or may not have been appropriately translated (Artiola i Fortuny and Mullaney, 1998; Figueroa, 1990; Sandoval and Duran, 1998). Verbal Fluency. The expressive language skills of the clinician when assessing a patient who does not speak English (to cite the most common case) are crucial to appropriate neuropsychological assessment. If the clinician is not competent

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552 HANDBOOK OF MULTICULTURAL ASSESSMENT in the language that the patient uses, the validity of test administration and interpretations are highly questionable and the likelihood is grave that an error may be made (Artiola i Fortuny and Mullaney, 1998). Mistakes may be made in multiple aspects of language, such as wording, form and content, modulations of phrasing, and accent (Sandoval and Duran, 1998). Communicative Competence. Communicative competence requires capacities to use grammar properly (Canale and Swain, 1980), engage in discourse (that is, use word and phrase connections and boundaries to convey meaning), comprehend speaking and writing relative to the social purpose of the communication (Sandoval and Duran, 1998), and integrate social and linguistic meanings appropriately to deal with novel situations (Bachman and Palmer, 1982).

Culture-Specific Folkways and Mores One of the most problematic aspects of neuropsychological assessment is the lack of information due to a dearth of ethnically and culturally diverse courses in the curriculum in graduate programs in clinical psychology. These cultural issues have not been integrated into the full curriculum (Rogler, Malgady, and Rodriguez, 1989; Sue and Sue, 1987). Manly et al. (1998) examined the relationship of acculturation to neuropsychological test performance among African Americans and European Americans. African Americans reporting less acculturation obtained lower scores on standard neuropsychological tests such as the Wechsler Adult Intelligence Scale Revised (WAIS-R) Information subtest, the Boston Naming Test, and the Trail Making Test (Trails B). Moreover, they scored significantly lower than European Americans when both groups were HIV infected on selected neuropsychological tests such as the Halstead Category Test, Trails B, WAIS-Block Design and Vocabulary subtests, and the learning components of the Story and Figure Memory Tests. Cultural differences between ethnic groups that relate to neuropsychological test performance suggest that accounting for acculturation influences may improve the diagnostic accuracy of neuropsychological assessment.

Blind Spots in Assessors Neuropsychology has been called to task for not addressing cultural biases in neuropsychological assessment (Helms, 1992).

Socioeconomic Status Socioeconomic status (SES) is an important variable in evaluating biases in test interpretations. The major variable in determining SES is occupational

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status (Dohrenwend and Dohrenhend, 1974; Gray-Little, 1995). Research has suggested that the relationship between the social distance of the diagnostician and patient may promote diagnostic biases (Bernard, 1989; Betancourt and Lopez, 1995).

Subpopulation Cultural Differences Possible subpopulation cultural differences are a major difficulty in addressing the problem of minimizing cultural influences in neuropsychological assessment. In the United States, for example, the three largest Hispanic American groups are Puerto Ricans (in the New York Metropolitan area), Cubans (Florida), and Mexican Americans (southwestern United States). Cultural differences among these subpopulations of Hispanic Americans have been suggested. Indeed, dozens of culturally distinct subgroups of Hispanic Americans have been postulated, so to name only three subgroups of Hispanic Americans is a gross oversimplification. It is also important to consider Dominicans, Colombians, Central Americans, and Brazilians, among many others. To assume intracultural homogeneity of neuropsychological abilities would be a fatal error in neuropsychological assessment. At the same time, a difficult issue is determining what level of cultural identification is the appropriate basis of analyses. The multiple numbers of cultural subpopulations in the Hispanic Americans might also be postulated in other cultural and ethnic groups, such as Asian Americans, African Americans, and Native Americans.

MULTICULTURAL RESEARCH ON NEUROPSYCHOLOGICAL ASSESSMENT Clinical neuropsychology has only recently been established as a formal specialty area in psychology. There has been controversy among researchers over the role played by ethnic and cultural differences on the process of organization of brain functions (Reynolds, 2000). Some researchers have postulated that culture and ethnicity have significant influences on brain processes (Ardila, Rosselli, and Rosas, 1989; Raminez and Price-Williams, 1974; Stodolsky and Lesser, 1967; Adams, Boake, and Crain, 1982; Parsons and Prigatano, 1978; Seidenberg et al., 1984). The most widely used neuropsychological instruments were standardized on European Americans and reflect European American traditions, values, and culture. In the past, ethnic and culturally diverse groups were not included in the test standardization normative samples. As a result, the tests are inadequate to assess the cultural experiences of minority groups. Brain-behavior relationships are determined from the cultural social context in which the behavior develops (Cole and Bruner, 1971; Cole and Scribner,

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554 HANDBOOK OF MULTICULTURAL ASSESSMENT 1974; Helms, 1992, Miller-Jones (1989). Boykin (1991) and Miller-Jones (1989) have noted that standard psychological test items are culturally defined. For example, the Wechsler Scales include items related to umbrellas. Wechsler lived in New York City, adjacent to the Atlantic Ocean, when developing the scales that bear his name, and it rained often, so having an umbrella was a common cultural event. An intelligence test developed by authors who lived in the South and Southwest used items related to sundials in their intelligence test because it is sunny much of the time where they lived. These item selections are examples of how geography and culture influence the assessment of neuropsychological processes in specific test situations (Miller-Jones, 1989). Neuropsychological assessment occurs in the context of culture, and therefore it is important that these cultural processes be measured in similar contexts, or misinterpretations of neuropsychological test data will occur.

African Americans The pitfalls of a race-comparative paradigm in neuropsychology are multiple. Knuckle and Campbell (1984) found that published norms misclassified normal African American middle school children as neuropsychologically impaired on the Purdue Pegboard test (66 percent), and the Benton Visual Retention test (40 percent). Heverly, Isaac, and Hynd (1986) suggested that low scores of elementary school African American children on a neuropsychological test were due to neurodevelopmental delay of the left tertiary region in the parietal lobes. The study was severely flawed, as the practice of using a single test to judge the functional status of a specific cortical region is simplistic (Reitan and Wolfson, 1992). Studies of normal African American children that nevertheless show neuropsychological impairments are attributable to the race-comparison model’s failure to control for the effects of culture. The cultural influences on ethnic groups must be appreciated during the development and validation of neuropsychological measures. Without assurances of culture fairness, the diagnostic validity of neuropsychological tests with African Americans is questionable. Campbell et al. (1996) and Lewis-Jack et al. (1997) investigated the accuracy of neuropsychological tests with normal African American adults at a historically African American university. Only the level-of-performance approach was used for test score interpretation. The neuropsychological tests used were Russell’s revision of the Wechsler Memory Scale (R-RWMS; Russell, 1975); the Symbol Digit Modalities Test (SDMT; Smith, 1982); the Benton Visual Retention Test (BVRT), Administration A and C (Sivan, 1992); the Visual Form Discrimination Test (VFD), the multiple-choice version of the BVRT (Benton, Hamsher, Varney, and Spreen, 1983); the Purdue Pegboard Test (Costa, Vaughan, Levita, and Farber, 1963); and the Hooper Visual Organization Test (VOT) (Hooper, 1958). Results indicated that overall,

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the percentage of diagnostic errors was remarkably high considering a normal population was used. The study results argue for sets of norms based on ethnic populations. Ethnic differences have been shown by a number of neuropsychological studies. While the Verbal Intelligence Quotient (VIQ) and Performance Intelligence Quotient (PIQ) scores of African Americans with left hemisphere strokes are similar, African American patients with right hemisphere strokes have lower mean PIQ scores than VIQ scores (Ford-Booker et al., 1993). What the patterns of IQ scores observed in different groups of ethnic patients with lateralized brain damage means is unclear (Campbell et al., 1996). Roberts and Hamsher (1984) reported that normal African Americans did worse than normal European Americans on a measure of visual naming ability. And Bernard (1989) reported that African American males scored lower on the Halstead Category test and higher on the Seashore Rhythm Test than did European Americans and Hispanic Americans. These studies showed some discrepancies between scores of African Americans and European Americans on neuropsychological tests. It is noteworthy that researchers have developed demographic corrections for neuropsychological tests scores (Heaton, Grant, and Matthews, 1991), and these demographic corrections were recently revised to included ethnic differences (Heaton, Miller, Taylor and Grant, 2004), but the African American sample was primarily from a single geographical region (San Diego, California). While it was noteworthy that some of the studies equated groups on demographic variables such as age, education, sex, and socioeconomic status, the discrepancies remained. New research findings, however, have demonstrated that quality of education could explain differences in neuropsychological test scores between African Americans and European Americans (Manly, Jacobs, Touradji, Small, and Stern, 2002). When the Wide Range Achievement Test Third Edition (WRAT-3) Reading Recognition test scores were used to adjust the neuropsychological test scores, ethnic differences essentially disappeared. The suggestion was that previous adjustments for years of education were inadequate, and assessing actual reading skills was essential in obtaining a true measure of educational skills. The disparity in educational skills was the primary reason for previous research findings of discrepancies between ethnic groups. In assessing African Americans, neuropsychologists should be aware of biases found in neuropsychological tests and not diagnose impairment when none existed (Adams et al., 1982). The development of more adequate African American demographic normative data sets for neuropsychological tests to prevent misclassification errors is a critical issue for clinical neuropsychology, and the data sets may need to be based on reading level rather than ethnic status (Manly et al., 2002).

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Hispanic Americans Neuropsychological assessment of Hispanic Americans is problematic due to language inadequacy in test translations and adaptations (Artiola i Fortuny and Mullaney, 1998). For example, European Americans performed better than Hispanic Americans on the Trail Making test, Parts A and B, and the Fold Object Memory Test (Lowenstein, Duara, Arguelles, and Arguelles, 1995). Bernard’s study (1989) using the entire Halstead-Reitan Neuropsychological Test Battery found no racial or ethnic differences in overall rates of impairment in a sample of African Americans, European Americans, and Hispanic Americans. Individual scores for the Halstead Category test, Seashore Rhythm test, and Finger Tapping test, however, did differ on ethnic lines. Lowenstein, Rupert, Arguelles, and Duara (1995) found that different neuropsychological tests predicted different patterns of functional abilities in European American and Hispanic American patients. It is important to recall that cultural biases can influence neuropsychological tests even when linguistic factors are taken into consideration. English-speaking Hispanic Americans may not be acculturated to the dominant culture in the United States for a number of reasons, and that could influence their neuropsychological test performance. The best situation would be for a Spanish-speaking clinical neuropsychologist to assess Spanish-speaking Hispanic Americans. Neuropsychological tests have been developed for Spanish-speaking populations and should be considered for use. Professional translators are a last resort in situations where neuropsychological testing is necessary but a Spanish-speaking clinical neuropsychologist is not available. An additional concern for Hispanic Americans is bilingualism, that is, individuals who speak both Spanish and English. Some speakers of two languages are considered ‘balanced’’ in that they speak both languages very well and with equal facility. There are also individuals who speak two languages but are much more comfortable in one of the two languages and they are considered ‘‘unbalanced.’’ Research has demonstrated that when ‘‘nonbalanced’’ bilinguals were assessed on verbal learning, they did worse in learning and memory, but ‘‘balanced’’ bilinguals assessed in their dominant language were not different from monolingual English-speaking non-Hispanic subjects (Harris, Cullum, and Puente, 1995). Another study found that Hispanic American bilinguals who had lived longer in the United States did better on neuropsychological testing (Artiola I Fortuny, Heaton, and Hermosillo, 1998).

Asian Americans There have been relatively few studies of cultural difficulties on neuropsychological testing of Asian Americans (Wong, 2000). For example, Boyer

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and Tsushima (1975) assessed a heterogeneous Asian American sample in Hawaii that included both brain-injured and normal subjects. They found that the Halstead-Reitan Neuropsychological Test Battery correctly identified brain-injured Asian Americans and that many normal Asian Americans were labeled as brain injured. Additional work on cultural issues regarding neuropsychological testing of Asian Americans is clearly needed (Wong and Fujii, 2004).

Native Americans Similar to Asian Americans, there is a relative dearth of research on cultural influences on neuropsychological test performance of Native Americans. Ferraro (2002) reported that elderly Native American adults’ neuropsychological test performance and depression are negatively correlated. Additional research is needed on the cultural influences of Native Americans on neuropsychological testing.

COMMENTS ON NEUROPSYCHOLOGICAL TEST INTERPRETATION Essentially all research studies of cultural factors interpret test scores by a level-of-performance model. Traditional neuropsychological test interpretation of a standardized battery, such as the Halstead-Reitan, has focused on the use of multiple levels of inference (Reitan, 1986; Reitan and Wolfson, 1992). Briefly, a level-of-performance model refers to how high or low a specific test score is. The use of a multiple-levels-of-inference paradigm includes the additional factors of pathognomonic signs—patterns of performance and right-left comparisons, as well as the level-of-performance model (see Reitan, 1986; Reitan and Wolfson, 1992, for descriptions of the multiple-level-of-inference model). A standardized neuropsychological test battery has the significant advantage that it is designed to use multiple methods of inference and there is experience in using these methodological approaches. The level-of-performance method is the method of inference that is most subject to cultural bias (Reitan, 1986). The use of multiple levels of inference would be expected to reduce the influence of cultural bias in the clinical neuropsychological assessment as the methods of inference other than level of performance are based on biological rather than behavioral variables. The use of a standardized neuropsychological test battery, such as the Halstead-Reitan Neuropsychological Test Battery is the preferred strategy for the comprehensive neuropsychological assessment of non–European American ethnic group members. It is also noted that the Halstead-Reitan has the most developed demographic correction norms available (Heaton et al., 2004), albeit with a geographically restricted sample

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558 HANDBOOK OF MULTICULTURAL ASSESSMENT of African Americans (from San Diego, California) that may not be reflective of African Americans in other areas. At the same time, the development of new test measures for specific domains of neuropsychological abilities such as the TVCF (Reynolds and Horton, 2006) that are demonstrated to be unbiased relative to ethnic differences is also important.

SUMMARY AND CONCLUSION The neuropsychological research literature clearly suggests that specific crosscultural assessment competencies need to be developed for the practice of clinical neuropsychology with minority patients. The scientific literature on neuropsychological research on cultural issues is weak to virtually nonexistent. Only a small number of studies have compared African Americans and Hispanic Americans with European Americans, and little exists for Asian Americans and almost none for Native Americans. An interesting point is that in an earlier version of this chapter, included in the first edition of this Handbook, the largest number of studies addressed cultural assessment issues related to African Americans; in this version, it is noteworthy that the largest number of studies conducted in the ensuing years addressed cultural assessment issues related to Hispanic Americans. Nevertheless, the existing studies are problematic with respect to methodological weaknesses, such as inappropriate statistical controls for educational differences and type 1 error rates (Gasquoine, 2001). Future research with Hispanic Americans will need to address better controls for educational differences, which may require testing for reading recognition levels (Manly et al., 2002), adequacy of English-Spanish translations, and acculturation and bilingualism, among other issues (Manly et al., 2004). An additional issue that deals with all of the ethnic groups considered here is the appropriate characterization of intracultural subpopulations. There are normative databases that include ethnic samples to assist in neuropsychological assessment (Heaton et al., 2004), but they are from circumscribed samples and may not generalize to samples from other geographical locations or language groups. This issue also raises the question of the relevance of subpopulations. To consider, for example, the situation of Asian Americans, should separate subpopulation normative databases be constructed for Japanese American, Korean Americans, Chinese Americans, and Vietnamese Americans, to cite a very few of the possible Asian American subpopulations? And that does not even begin to consider the many subgroups on the Indian subcontinent that would also be considered Asian Americans. Hispanic Americans and African Americans and Native Americans likely have similar subdivisions.

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Adequate separate normative databases are not currently available, and not everyone even agrees they are needed (Manly, 2005). Therefore the question arises, What is a clinical neuropsychologist to do when assessing someone from a culture different from that of him or her? The most important thing to do is to be sensitive to the cultural aspects of the neuropsychological assessment process and become knowledgeable regarding various non-European American cultures. Next, administer a standardized clinical neuropsychological test battery, such as the Halstead-Reitan, that was designed and constructed to allow for the use of multiple levels of inference and for which there are some normative data sets on ethnic differences. Every study demonstrating cultural differences used a level-of-performance model rather than the multiple levels of inference. It is proposed that the use of multiple levels of inference could minimize the influence of cultural factors. Also, it would be wise to be careful to have strong evidence from more than one level of inference before making any conclusions regarding brain damage in non-European Americans when using tests standardized on European American populations. In addition, assessment of acculturation issues or degree of bilingualism is an important component of any clinical neuropsychological assessment. The sincere expectation and hope is this chapter contributes to improving the process of clinical neuropsychological assessment in a multicultural context.

References Adams, R., Boake, C., & Crain, C. (1982). Bias in a neuropsychological test classification related to education, age, and ethnicity. Journal of Consulting and Clinical Psychology, 50, 143–145. Amante, D., VanHouten, V., Grieve, J., Bader, C., & Margules, P. (1977). Neuropsychological deficit, ethnicity, and socioeconomic status. Journal of Consulting and Clinical Psychology, 45(4), 524–535. Ardila, A., Rosselli, M., & Rosas, P. (1989). Neuropsychological assessment in illiterates: Visuospatial and memory abilities. Brain and Cognition, 11, 147–166. Artiola i Fortuny, L., Garolera, M., Hermosillo Romo, D., Feldman, E., Fernandez Barillas, H., Keefe, R., et al. (2005). Research with Spanish-speaking populations in the United States: Lost in translation. A commentary and a plea. Journal of Clinical and Experimental Neuropsychology, 27(5), 555–564. Artiola i Fortuny, L., Heaton, R. K., & Hermosillo, D. (1998). Neuropsychological comparisons of Spanish-speaking participants from the U.S.-Mexico border region versus Spain. Journal of the International Neuropsychological Society, 4(4), 363–379. Artiola i Fortuny, L., & Mullaney, H. A. (1998). Assessing patients whose language you do not know or, can the absurd be ethical. Clinical Neuropsychologist, 12, 113–126.

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560 HANDBOOK OF MULTICULTURAL ASSESSMENT Bachman, L. F., & Palmer, A. S. (1982). The construct validation of some components of communicative proficiency. TESOL Quarterly, 16, 449–465. Benton, A., Hamsher, K., Varney, N., & Spreen, O. (1983). Contributions to neuropsychological assessment. New York: Oxford University Press. Bernard, L. C. (1989). Halstead-Reitan Neuropsychological Test performance of Black, Hispanic, and White young adult males from poor academic backgrounds. Archives of Clinical Neuropsychology, 4, 267–274. Berry, J. W. (1980). Acculturation as varieties of adaptation. In A. M. Padillo (Ed.), Acculturation: Theory, models and some new findings (pp. 9–26). Boulder, CO: Westview Press. Berry, J. W., Trimble, J. E., & Olmedo, E. L. (1986). Assessment of acculturation: In W. J. Lonner & J. W. Berry (Eds.), Field methods in cross-cultural research (pp. 291–324). Thousand Oaks, CA: Sage. Betancourt, H., & Lopez, S. R. (1995). The study of culture, ethnicity, and race in American psychology. In N. R. Goldberger & J. B. Veroff (Eds.), The culture and psychology reader (pp. 87–107). New York: New York University Press. Boyer, J. I., & Tsushima, W. T. (1975). Cross-validation of the Halstead-Reitan neuropsychology battery: Application in Hawaii. Hawaii Medical Journal, 34(3), 94–96. Boykin, A. (1991). Black psychology and experimental psychology: Functional confluence. In R. Jones (Ed.), Black psychology (3rd ed.). Berkeley, CA: Cobb and Henry. Campbell. A. L., Rorie, K. D., Dennis, G., Wood, D., Combs, S., Hearn, L., et al. (1996). Neuropsychological assessment of African Americans: Conceptual and methodological considerations. In R. Jones (Ed.), Handbook of tests and measurements for Black populations. Berkeley, CA: Cobb & Henry. Canale, M., & Swain, M. (1980). Theoretical bases of communicative approaches to second language teaching and testing. Applied Linguistics 1, 1–47. Cole, M., & Bruner, J. (1971). Cultural differences and inferences about psychological processes. American Psychologist, 26, 867–876. Cole, M., & Scribner, S. (1974). Culture and thought: A psychological introduction. Hoboken, NJ: Wiley. Cortes, D. E., Rogler, L. H., & Malgady, R. G. (1994). Biculturality among Puerto Rican adults in the United States. Journal of Community Psychology, 27, 707–721. Costa, L., Vaughn, H., Levita, E., & Farber, N. (1963). Purdue Pegboard as a predictor of presence and laterality of cerebral lesions. Journal of Consulting Psychology, 27, 133–137. Cullar, I., Harris, L. C., & Jasso, R. (1980). An acculturation scale for Mexican-Americans normal and clinical populations. Hispanic Journal of Behavioral Sciences, 2, 199–217. Davison, L. A. (1974). Introduction. In R. M. Reitan & L. A. Davison (Eds.), Clinical neuropsychology: Current status and applications (pp. 1–18). Hoboken, NJ: Wiley.

NEUROPSYCHOLOGICAL ASSESSMENT IN A MULTICULTURAL CONTEXT DeGranda, G. (1968). Transculturation and linguistic interference in contemporary Puerto Rico. Bogato, Colombia: Ediciones Bogota. Dohrenwend, B. P., & Dohrenwend, B. S. (1974). Social and cultural influences on psychotherapy. Annual Review of Psychology, 25, 417–452. Ferraro, F. R. (Ed.). (2002). Minority and cross-cultural aspects of neuropsychological assessment. Lisse, The Netherlands: Swets & Zeitlinger. Figueroa, R. (1990), Best practices in the assessment of bilingual children. In A. Thomas & J. Grimes (Eds.), Best practices in school psychology (Vol. 2, pp. 93–106). Washington, DC: National Association of School Psychologists. Fletcher-Janzen, E., Strickland, T. L., & Reynolds, C. R. (2000). Handbook of crosscultural neuropsychology. New York: Plenum. Ford-Booker, P., Campbell, A., Combs, S., Lewis, S., Ocampo, C., Brown, A., et al. (1993). The predictive accuracy of neuropsychological tests in a normal population of African Americans. Journal of Clinical and Experimental Neuropsychology, 15, 64. Gasquoine, P. G. (2001). Research in clinical neuropsychology with Hispanic American participants: A review. Clinical Neuropsychology, 15(1), 2–12. Goldstein, K. (1952). The effects of brain damage on personality. Psychiatry, 15, 245–260. Grant, D. A., & Berg, E. A. (1948) A behavioral analysis of the degree of reinforcement and ease of shifting to new responses in a Weigl-type card sorting problem. Journal of Experimental Psychology, 38, 404–411. Gray-Little, B. (1995). The assessment of psychopathology in racial and ethnic minorities. In J. N. Butcher (Ed.), Clinical personality assessment (pp. 140–157). New York: Oxford University Press. Harris, J. G., Cullum, C. M., & Puente, A. E. (1995). Effects of bilingualism on verbal learning and memory in Hispanic adults. Journal of International Neuropsychological Society, 1(1), 10–16. Heaton, R., Grant, I., & Mathews, C. (1991). Comprehensive norms for an expanded Halstead-Reitan Battery. Odessa, FL: Psychological Assessment Resources. Heaton, R., Miller, S. W., Taylor, M. J., & Grant, I. (2004). Revised comprehensive norms for an expanded Halstead-Reitan Battery: Demographically adjusted neuropsychological norms for African American and Caucasian adults. Odessa, FL: Psychological Assessment Resources. Helms, J. (1992). Why is there no study of cultural equivalence in standardized cognitive ability testing? American Psychologist, 47, 1083–1101. Heverly, L., Isaac, W., & Hynd, G. (1986). Neurodevelopmental and racial differences in tactile-visual (cross-modal) discrimination in normal Black and White children. Archives of Clinical Neuropsychology, 1, 139–145. Hooper, H. (1958). The Hooper Visual Organization Test manual. Los Angeles: Western Psychological Services.

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562 HANDBOOK OF MULTICULTURAL ASSESSMENT Horton, A. M., Jr. (1987). Luria’s contributions to clinical and behavioral neuropsychology. Neuropsychology, 1(2), 39–44. Horton, A. M., Jr. (1994). Behavioral interventions with brain injured children. New York: Plenum. Horton, A. M., Jr., & Puente, A. E. (1989). Neuropsychological considerations. In M. Hersen (Ed.), Innovations in behavior therapy (pp. 105–133). New York: Springer. Horton, A. M., Jr., & Puente, A. E. (1990). Life-span neuropsychology: An overview. In A. M. Horton Jr. (Ed.), Life-span neuropsychology across the life-span: Assessment and treatment (pp. 1–15). New York: Springer. Horton, A. M., Jr., & Wedding, D. (1984). Clinical and behavioral neuropsychology. Westport, CT: Praeger. Knuckle, E., & Campbell, A. (1984). Suitability of neuropsychological tests norms with Black adolescents. Paper presented at the International Neuropsychological Society Meeting, Houston, TX. LaFromboise, T., Coleman, H.L.R., & Gerton, J. (1993). Psychological impact of biculturalism: Evidence and theory. Psychological Bulletin, 114, 395–412. Lewis-Jack, O., Campbell, A., Ridley, S., Ocampo, C., Brown, A., Dennis, G., et al. (1997). Unilateral brain lesions and performance on Russell’s version of the Wechsler Memory Scale in an African American population. International Journal of Neuroscience, 91(3–4), 229–240. Lichenberg, P. A., Ross, T., & Christensen, B. (1994). Preliminary normative data on the Boston Naming Test for an older urban population. Clinical Neuropsychologist, 8, 109–111. Lowenstein, D. A., Duara, R., Arguelles, T., & Arguelles, S. (1995). Use of the Fuld Object-Memory Evaluation in the detection of mild dementia among Spanish and English-speaking groups. American Journal of Geriatric Psychiatry, 3, 300–307. Lowenstein, D. A., Rubert, M. P., Arguelles, T., & Duara, R. (1995). Neuropsychological test performances and prediction of functional capacities among Spanish speaking and English speaking patients with dementia. Archives of Clinical Neuropsychology, 10, 75–88. Luria, A. R. (1966). Higher cortical functions in man. New York: Basic Books. Luria, A. R. (1970). The functional organization of the brain. Scientific American, 222, 66–78. Manly, J. J. (2005). Advantages and disadvantages of separate norms for African Americans. Clinical Neuropsychologist, 19(2), 270–275. Manly, J. J., Byrd, D., Touradji, P. Sanchez, D., & Stern, Y. (2004). Literacy and cognitive change among ethnically diverse elders. International Journal of Psychology, 39, 47–60. Manly, J. J., Byrd, D. A., Touradji, P., & Stern, Y. (2004). Acculturation, reading level, and neuropsychological test performance among African American elders. Applied Neuropsychology, 11(1), 37–46.

NEUROPSYCHOLOGICAL ASSESSMENT IN A MULTICULTURAL CONTEXT Manly, J. J., Jacobs, D. M., Touradji, P., Small, S. A., & Stern, Y. (2002). Reading level attenuates differences in neuropsychological test performance between African American and White elders. Journal of the International Neuropsychological Society, 8, 341–348. Manly, J., Miller, S. W., Heaton, R. K., Byrd, D., Reilly, J., Velasquez, R. J., et al. (1998). The effect of African American acculturation on neuropsychological test performance in normal and HIV-positive individuals. Journal of the International Neuropsychology Society, 4, 291–302. Meier, M. J. (1974). Some challenges for clinical neuropsychology. In R. M. Reitan & L. A. Davison (Eds.), Clinical neuropsychology: Current status and applications (pp. 289–323). Hoboken, NJ: Wiley. Miller-Jones, D. (1989). Culture and testing. American Psychologist, 44, 360–366. Parsons, O., & Prigatano, G. (1978). Methodological considerations in clinical neuropsychological research. Journal of Consulting and Clinical Psychology, 46, 608–619. Pedersen, P. B. (1987). Ten frequent assumptions of cultural bias in counseling. Journal of Multicultural Counseling and Development, 5, 7–25. Raminez, M., & Price-Williams, D. (1974). Cognitive styles of children of three ethnic groups in the United States. Journal of Cross-Cultural Psychology, 5, 212–219. Reitan, R. (1986). Theoretical and methodological basis of the Halstead-Reitan Neuropsychological Test Battery. In I. Grant & K. Adams (Eds.), Neuropsychological assessment of neuropsychiatric disorders. New York: Oxford University Press. Reitan, R. M., & Wolfson, D. (1992). The Halstead-Reitan Neuropsychological Test Battery: Theory and clinical interpretation (2nd ed.). Tucson, AZ: Neuropsychology Press. Reynolds, C. R. (2000). Methods for detecting and evaluating cultural bias in neuropsychological assessment tests. In E. Fletcher-Janzen, T. L. Strickland, & C. R. Reynolds (Eds.), Handbook of cross-cultural neuropsychology (pp. 249–286). New York: Kluwer Academic/Plenum Publishers. Reynolds C. R. (2003). Comprehensive Trail Making Test-Examiner’s manual. Austin, TX: Pro-ED. Reynolds, C. R., & Horton, A. M., Jr. (2006). Test of Verbal Conceptualization and Fluency-Examiner’s manual. Austin, TX: Pro-ED. Roberts, R. J., & Hamsher, K. (1984). Effects of minority status on facial recognition and naming performance. Journal of Clinical Psychology, 40, 539–540. Rogler, L. H., Malgady, R. G., & Rodriguez, O. (1989). Hispanics and mental health: A framework for research. Malabar, FL: Krieger. Russell, E. W. (1975). A multiple scoring method for the assessment of complex memory functions. Journal of Clinical and Experimental Neuropsychology, 43, 800–809. Sandoval, J., & Duran, R. (1998). Language in Sandoval. In J. Frisby, C. Gelsinger, K. Scheuneman, & J. Grenick (Eds.), Test interpretation and diversity: Archiving equity in assessment (pp. 181–203). Washington, DC: American Psychological Association.

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564 HANDBOOK OF MULTICULTURAL ASSESSMENT Seidenberg, M., Gamache, M., Beck, N., Smith, M., Giordani, B., Berent, S., et al. (1984). Subject variables and performances on the Halstead Neuropsychological Test Battery: A multivariate analysis. Journal of Consulting and Clinical Psychology, 52, 658–662. Sivan, A. (1992). Benton Visual Retention Test manual (5th ed.). San Antonio: Psychological Corporation. Smith, A. (1982). Symbol Digit Modalities Test (SDMT) manual (Revised). Los Angeles: Western Psychological Services. Stodolsky, S., & Lesser, G. (1967). Learning patterns in the disadvantaged. Harvard Educational Review, 37, 546–593. Sue, D., & Sue, S. (1987). Cultural factors in the clinical assessment of Asian Americans. Journal of Consulting and Clinical Psychology, 55, 479–487. Suinn, R. M., Richard-Figueroa, K., Lew, S., & Vigil, P. (1987). Career decisions and an Asian acculturation scale. Journal of the Asian American Psychological Association, 10, 20–28. Westermeyer, J. J. (1993). Cross-cultural psychiatric assessment. In A. Gaw (Ed.), Culture, ethnicity and mental illness (pp. 125–144). Washington, DC: American Psychiatric Press. Wong, T. M. (2000). Neuropsychological assessment and intervention with Asian Americans. In E. Fletcher-Janzen, T. L. Strickland, & C. R. Reynolds (Eds.), Handbook of cross-cultural neuropsychology (pp. 43–53). New York: Kluwer Academic/Plenum. Wong, T. M., & Fujii, D. E. (2004). Neuropsychological assessment of Asian Americans: Demographic factors, cultural diversity, and practical guidelines. Applied Neuropsychology, 11(1), 23–36.

CHAPTER TWENTY-FIVE

Family-Oriented, Culturally Sensitive (FOCUS) Assessment of Young Children Paul J. Meller Phyllis S. Ohr

T

he assessment of developing skills in infants and preschoolers has a long and rich history. The area came to prominence following Arnold Gesell’s pioneering work in which he set out to create normative developmental maps for children (Gesell, 1925). On the heels of Gesell’s research was a rapid expansion of interest in early childhood development, as demonstrated by the implementation of large-scale longitudinal research such as the Harvard Growth Study, the Fels Growth Study, the Iowa Growth Study, and the Berkeley Growth Study. As a consequence on this focus on the life span development and the growth of the testing movement, assessment instruments for young children were developed. Among the earliest instruments constructed were the Merrill-Palmer Scale of mental Tests (Stutsman, 1931), the Minnesota Preschool Scale, (Goodenough, 1926), and the California First Year Mental Scale (Bayley, 1933). During subsequent decades, the development and application of psychological tests for adults and children began to grow dramatically. However, a large-scale movement into the area of assessment of young children did not occur until the 1960s to the early 1970s with the development of the Bayley Scales of Infant Development (Bayley, 1969), the Uzgiris and Hunt Ordinal Scale of Development (1975), the Wechsler Primary and Preschool Scale of Intelligence (Wechsler, 1967), and the McCarthy Scales of Children’s Abilities (McCarthy, 1972). Although the field of early childhood

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566 HANDBOOK OF MULTICULTURAL ASSESSMENT assessment has gone through great expansion since these pioneering years, the assessment of and intervention with young children has been a source of much added concern and controversy. Although there had been several instruments designed to assess the developmental functioning of young children prior to the 1986 passage of the Education of the Handicapped Act (the Bayley Scales of Infant Development and the McCarthy Scales of Cognitive Abilities, for example), assessment of young children was treated as in essence a downward extension of traditional psychoeducational evaluation, not taking into account the developmental characteristics of children and their lack of familiarity with the task demands. Specifically, the focus of the assessment was to determine static abilities in comparison to a reference group, an approach devoid of the process or context of development. This approach is in stark contrast with the mandates of the Education of the Handicapped Act (and subsequently of Part C of the Individuals with Disabilities Education Act in 1997) to develop intervention programs (and consequently assessment approaches) in which the family is the principal facilitator of the child’s development. Four recent events have dramatically increased the focus and controversy surrounding the assessment of young children. The first was the passage of the No Child Left Behind Act of 2001 (NCLB). Its stated goal was to improve all children’s educational outcomes by developing a set of standards for teachers, curricular approaches, and schools and providing federal funding for schools in poverty. For preschool children, these goals translated into enhanced early literacy programs (for example, Title I and Reading First), as well as subsequent demands for the assessment of literacy skills. Juxtaposed to NCLB is the passage of the reauthorization in 2004 of the Individuals with Disabilities Education Act (IDEA). In this reauthorization, the definition of learning disabilities was modified from a psychometrically based discrepancy model to an idiographic response to interventions (RTI) model. The RTI model requires a deemphasis of psychometric testing with standardized norm-referenced tests and replaces these long-standing instruments with more behavioral and curricular-based assessment approaches. A third cultural shift that is changing the parameters of early childhood assessment, related to the increase in early literacy programs, is a national movement toward universal preschool. Recently Virginia, Arizona, New Jersey, Georgia, Illinois, New York, and California have all taken steps to try to implement preschool programs through the state’s lead educational agency or greatly expand their existing preschool programs. This increased focus on early childhood education will serve to bring to the light the many issues associated with preschool assessment. Finally, the last significant press that has focused additional attention on the assessment of preschool children is the rapid changes in the composition of the population of the United States. For

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example, the U.S. Census Bureau estimated that in 2005, people of Hispanic origin comprise 12.4 percent of the population of the United States. The Census Bureau projects that by 2050, this proportion will increase to approximately 24.5 percent of the total population. The need to develop approaches and technologies for assessment of young children is ever present as the population continues to shift in the United States and we move away from a single-majority culture to a truly pluralistic society. Despite the apparent shift in the zeitgeist, the fundamental issues surrounding early childhood assessment have remained fundamentally the same. Meller and Ohr (1996; Meller, Ohr, and Marcus, 2001) have stressed the profound influence of the home environment for very young children by pointing out that the majority of stimulation that infants and toddlers receive is limited to that which they receive in their home, provided primarily by their family. Given that involvement with families is at the core of assessment and intervention planning for very young children, the influence of family and social and cultural contexts on the child are critical factors to be assessed (Bagnato, 2005). According to Meller and Ohr, the developmental context provided to the child depends to a large degree on the cultural characteristics of the family. Cultural experiences represent a critical component of the very young child’s home environment. Although strides have been made recently, models of culturally sensitive assessment are not abundant in the literature. In addition, despite the call for the development of new techniques or instruments for assessing young children, truly new technologies that are reliable and valid for all populations have not yet appeared. Thus, developing an efficacious model of family-oriented, culturally sensitive assessment and intervention continues as a priority. Approaches to early childhood assessment and intervention are still marred by limitations, including inadequate training of evaluators, reliance on traditional models and techniques, and legislative mandates to perform early childhood evaluations within a brief, specified time frame.

TRAINING PRACTITIONERS TO BE FAMILY FOCUSED AND CULTURALLY SENSITIVE Training early interventionists to be family focused and culturally sensitive is essential given the requirement in the IDEA Amendments and the reauthorization of the law in 1991 that an Individualized Family Service Plan (IFSP) be developed that addresses both child and family competencies. According to this legislation, evaluations must be racially and culturally nonbiased and should be done in the family’s primary language (Lynch and Hanson, 2004). In both the first and second editions of this Handbook, it was noted that there

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568 HANDBOOK OF MULTICULTURAL ASSESSMENT was a scarcity of professionals who could work adequately with culturally diverse families (Meller and Ohr, 1996; Meller et al., 2001). According to a review of the current literature, this concern has not abated, although opinions are divided regarding whether sufficient efforts have been made to improve training. A 1997 study by Ochoa, Rivera, and Ford indicated that nearly 70 percent of surveyed bilingual school psychologists described their training in assessing culturally diverse clients as inadequate. However, a survey done in 1999 by Loe and Miranda (2005) found that a majority of five hundred school psychologists, all members of the National Association of School Psychologists, were satisfied with the diversity training they received during graduate training and felt confident in their skills to provide culturally competent assessments. Nevertheless, Loe and Miranda still voiced concerns that a portion of psychologists did not receive any diversity training experiences, and a number were dissatisfied with the training they did receive. These concerns prompted Loe and Miranda to conclude that continuing-education programs for diversity training were still necessary. Meanwhile, participants of the first National Multicultural Conference and Summit, held in January 1999, unanimously agreed that addressing training of psychologists to be culturally competent needs to be made a priority (Sue, Bingham, and Porche-Burke, 1999). In August 2002, the APA Council of Representatives addressed these training issues in its publication, Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists (2003). According to the Guidelines, to foster successful outcomes, particularly when cultural incompatibilities exist, psychologists need to be cognizant of both the client’s cultural practices and beliefs and their own biases and the effect these biases have on the client. Recommendations were made to teach psychologists cultural competence in courses, workshops, and journal articles. However, direct exposure to and experience with diverse populations, along with the use of mentors as supervisors, were cited as the best ways for psychologists to develop cultural competence (Spruill et al., 2004). Spruill and colleagues also stress the need for assessing whether an adequate level of cultural competence has been achieved and suggest evaluating competencies through direct observation, examinations, or client satisfaction surveys. Investigations regarding practice parameters for infants, toddlers, and preschoolers that have emerged within the past five years suggest that practitioners are still not being trained sufficiently to conduct nondiscriminatory assessments of young children from culturally and linguistically diverse backgrounds (Espinosa, 2005; Lynch and Hanson, 2004; Sanchez and Brisk, 2004). In addition, there continues to be a lack of psychologists and other mental health professionals from diverse backgrounds who are involved in assessment of children from early childhood through adolescence (Miranda and

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Gutter, 2002). Therefore, assessing young children in their native language and responding to their families in a culturally sensitive manner continues to be a challenge. Despite recent efforts, it is clear that a need still exists for training programs to better prepare psychologists specializing in early intervention to provide competent services to culturally diverse populations.

Content of Family-Focused, Culturally Sensitive Practitioner Training Over the past ten years, multiple perspectives have emerged regarding the content of curricula to adequately train family-focused, culturally sensitive practitioners. Lowenthal (1996), for example, emphasized teaching psychologists to be aware of how their own self and cultural heritage influence their cognitions, affect, and behavior; how a family’s culture influences child rearing and views on disabilities and interventions; and the cultural components of communication styles. According to Lowenthal, successfully proceeding through this progression of cultural awareness is essential to develop competency in family centered assessment and intervention. Brown and Barrera (1999) conceptualized a training model that assesses the ways children and their families ‘‘perceive, believe, evaluate, and behave’’ and takes into account the ‘‘perceptions and mindsets’’ of the evaluators. They described three elements of cultural competency that professionals, particularly those assessing infants and toddlers, need to be trained in: how to use ‘‘multiple perceptual and conceptual lenses’’ to develop perspective, the use of ‘‘third space’’ rather than ‘‘dualistic’’ thinking to encourage respect for ‘‘disparate values,’’ and the use of ‘‘skilled dialogue,’’ which is ‘‘reciprocal, respectful, and responsive,’’ in order to elicit engagement of all family and assessment team members equally’’ (p. 37). Brown and Barrera recommended that in the case in which the evaluator is not familiar with the family’s culture and language, a ‘‘culture-language mediator’’ should be employed as a resource to fully understand the interplay of the personal-social, communicative-linguistic, and sensory-cognitive dimensions of the family’s particular sociocultural context. Using a culture-language mediator is one way to strive toward ensuring a culturally responsive assessment; however, it is not always possible for evaluators to have such an individual at their disposal. Rather, training in the area of early childhood assessment and intervention necessitates instructing how to assess both the child and the sociocultural context in which he or she lives. Recently Recchia and Williams (in Foley and Hochman, 2006) suggested that preparing through the use of vignettes to view families through different cultural lenses would benefit early childhood professionals who need to be more responsive to and aware of a family’s perspective.

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Traditional Versus Alternative Assessment Methods In a 2005 supplement to an earlier position statement on early childhood practices, the National Association for the Education of Young Children (NAEYC) and the National Association of Early Childhood Specialists in State Department of Education (NAECS/SDE) asserted that young children were being underdiagnosed because of inadequate assessment tools. It was also noted that many of the measures adapted for use with culturally and linguistically diverse populations were not reliable and valid, contained culturally unfamiliar material, or were ‘‘predicated on culturally inappropriate expectations for children’s responses’’ (p. 9). The authors of the position statement, as well as most experts in the early childhood field, caution against the overreliance on standardized, norm-referenced tests during the early years, particularly for children from linguistically and culturally diverse backgrounds (Espinosa, 2005; Santos, 2004). Rather, they recommend the use of alternative assessment approaches that include ongoing assessments and take into account the importance of individual background and history while respecting the child’s primary language and home culture. Unfortunately, most graduate school training of early interventionists still relies on models of assessment that overly use norm-referenced measures and neglect the assessment of family, social-ecology, and cultural factors (Bagnato, 2005; Macy, Bricker, and Squires, 2005). In fact, traditional testing has been referred to as the ‘‘mis-measure of young children’’ (Neisworth and Bagnato, 2004, p. 199). Bagnato suggested that alternatives to standardized testing be developed that are ‘‘authentic, universal, and useful’’ (p. 199), and for this to occur, early childhood assessment needs to be multidimensional. Information from multiple sources, multiple settings, on multiple occasions, and about multiple aspects of child and family functioning need to be integrated in order to understand the abilities of developing children.

Legislative Mandate for Quick Assessment The demand of federal legislation to complete early childhood assessments also places limitations on the form and type of assessment that may be performed. This often results in evaluations that are short on process and social data, both necessary to understand the child in a cultural context. Using primarily normative measures does not capture the ‘‘dynamic developmental process as it occurs in infancy and early childhood’’ (Greenspan and Meisels, 1996, p. 15). Recently, Greenspan (2006) indicated that because of the demands for quick information, despite awareness that this is in opposition to best practice, professionals use procedures that do not reflect a model of how young children develop within the context of their home environment. As a result, typical early childhood assessment may not reflect the specific types of difficulties and

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developmental challenges that children and families face during the first three years of life (Greenspan and Meisels, 1996).

CULTURALLY COMPETENT AND FAMILY-CENTERED EARLY CHILDHOOD EVALUATION In response to the demands of the federal mandates for assessment and interventions for young children, and the inadequacies of traditional psychoeducational models to meet these needs, several comprehensive, process-oriented, and family-centered assessment models have been developed. These include the Assessment, Evaluation, and Programming System for Infants and Children (AEPS; Bricker, Capt, and Pretti-Frontczak, 2002), the Hawaii Early Learning Profile (HELP; Parks, 1994), the Carolina Curriculum for Infants and Toddlers with Special Needs (Johnson-Martin, Attermeier, and Hacker, 2004), the Infant-Toddler Developmental Assessment (IDA; Provence, Erikson, Vater, and Palmeri, 1995), and the High/Scope Child Observation Record for Infants and Toddlers (High/Scope Educational Research Foundation, 2005). However, most measures such as these do not permit comparison between a child’s performance and a standard, such as an age group, to help determine eligibility. Recently Macy et al. (2005) adapted content from the AEPS to permit age-based comparisons, called the Assessment, Evaluation, and Programming System for Eligibility (AEPS:E). These assessment systems represent major steps forward in evaluating young children in broader social contexts. However, although they do include the family as an essential microsystem for development, they only implicitly assess the child in the cultural context of their family. A system in which the cultural context of the child is directly considered is necessary. Meller and Ohr originally described such a system in the first edition of this Handbook, referred to as FOCUS (family-oriented, culturally sensitive assessment).

FAMILY-ORIENTED, CULTURALLY SENSITIVE INFANT/TODDLER ASSESSMENT AND INTERVENTION An approach to assessing infants, toddlers, and preschool children within the cultural context of their development is family-oriented, culturally sensitive assessment (FOCUS). The FOCUS approach has five essential components to the assessment process. First, all professionals who are involved in the assessment of children from diverse cultural backgrounds must be adequately trained during their graduate studies or through continuing professional development.

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572 HANDBOOK OF MULTICULTURAL ASSESSMENT Second, a FOCUS assessment must involve a comprehensive evaluation of family characteristics, resources, competencies, and needs. Third, a FOCUS assessment must assess all areas of developmental competencies. This assessment should include both formal and informal techniques, across settings and time. The fourth aspect of FOCUS assessment is the ongoing assessment of both the child and the family during the development and implementation of the (family) intervention plan. Finally, FOCUS assessment always considers program evaluation and developmental change due to interventions. A summary of the FOCUS approach is presented in Table 25.1. The nature of FOCUS evaluations varies as a function of the goal of the assessment, the age of the child, the referral question, and the sociocultural context in which the child lives. The evaluation of young children must entail the collection and integration of information that may be used to describe a child’s current functioning, as well as facilitating the ongoing development of the child. Toward this end, information must be gathered regarding the child’s developmental history, the cultural influences on this development, family background and support, and an assessment of strengths and weaknesses across multiple domains. Barona (1990) and de Barona and Barona (1991) advocate for assessment to follow a four-step process: (1) an initial interview, (2) language assessment, (3) assessment of developmental processes, and (4) placing the assessment data into a natural learning context to provide a comprehensive assessment of young children. Neisworth and Bagnato (2004) suggest that assessment of young children should yield information that may be used by significant adults in the child’s life, such as parents and teachers, to facilitate the child’s growth and development. That is, assessment must be more than diagnostic; it must also demonstrate a high level of treatment validity. FOCUS evaluations yield data with sufficient treatment and social validity to produce acceptable and efficacious interventions.

Training and Continuing Professional Development in FOCUS Objectives. The goal behind this step is to train professionals to evaluate the impact of family and cultural values on child development and enable them to develop an awareness of their own values and stereotypes, which may impede an accurate assessment of the child and family. Graduate programs are limited in training students to use measures assessing family and environmental factors. According to Able-Boone and Crais (1999), early interventionists fail to acknowledge parent input and react to culturally diverse clients according to their worldview, which is often influenced by stereotypical thinking. This suggests that personal biases influence the decision-making process in early intervention. In addition, research in cross-cultural counseling suggests that

FAMILY-ORIENTED, CULTURALLY SENSITIVE (FOCUS) ASSESSMENT OF YOUNG CHILDREN

Table 25.1. Family-Oriented, Culturally Sensitive Assessment of Young Children Steps

Objectives

Methods

Training in family-oriented, culturally competent infant and toddler assessment and intervention

Train how to select and administer culturally sensitive measures and evaluate impact of family and cultural values on development of child. Train to evaluate and change stereotypical preconceptions of assessors that bear on the objective assessment of and intervention with family.

Provide appropriate courses in graduate school training programs.

Assessing family competencies and needs

Develop a profile of the family’s strengths and weaknesses by objectively evaluating the sociocultural environment. Determine the impact of sociocultural influences on the family, assess unique contributions of each family member, and look at the interaction of these variables. Determine similarities and divergences from culture. Specify the multiple dimensions of the home environment that contribute to developmental status. Family language assessment.

Interview; formal and informal observation; observer report surveys; parent report surveys.

Assessing developmental competencies and needs

Choose culturally appropriate modes of assessment. Develop a profile of the infant or toddler’s strengths and weaknesses in the following areas: cognitive, language, motor, visual-motor, adaptive and social-interactive. Be sensitive to multiple dimensions of the child’s environment.

Formal and informal observation; normative-, curriculum-, criterion-based measures; parent report surveys, observer report surveys. Traditional and nontraditional formats of assessment (trans- and multidisciplinary, ARENA).

Family intervention planning

Multidisciplinary and parental determination of appropriate interventions considering the infant or toddler’s developmental profile and sensitive to multiculturally competent evaluation of family strengths and needs.

Planning meeting of all professionals involved in assessment and family members.

Ongoing evaluation and planning

Interview; normative-, Continually update the profile of the infant or toddler and family competencies curriculum-, criteria-based evaluations; formal and and needs. informal observation; parent report surveys; observer report surveys.

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574 HANDBOOK OF MULTICULTURAL ASSESSMENT members of diverse cultural groups are differentially responsive to directive or expert approaches in treatment (as opposed to collaborative or referent approaches; REFS [Sue and Sue, 2004]). These findings suggest that evaluators must assess the need for a more directive or collaborative approach with the family while gathering the assessment data. Methods. University training programs need to include at least one course that focuses solely on early intervention assessment and intervention, with an emphasis on how to conduct an infant or toddler evaluation in a family-oriented, culturally sensitive manner. This includes selecting and administering culturally sensitive measures, administering these measures in a nontraditional format, and evaluating and changing stereotypical preconceptions of assessors that may interfere with an objective assessment of and interaction with the child and family. To fully understand the nature of the child and family requires understanding how they function within their greater cultural context. Trainers should provide information on identifying broad aspects of culture, such as values, beliefs, language, and rules. Courses may be offered in ethnic and cultural diversity that include, for example, information on family structures and styles of communication. In order to help early interventionists recognize subjective values that may contribute to bias in how they assess and intervene with culturally diverse families, a set of training guidelines has been offered (Chan, 1990; Chen, Brekken, and Chan, 1997; Mallach, 1993). It is recommended that more university programs provide course work to help professionals (1) develop an awareness of their own cultural influences on decision making, (2) evaluate the degree of a family’s convergence with and divergence from their culture as well as identify unique aspects of the family and each member, (3) develop the ability to mobilize community and family resources, and (4) gain an understanding of how cultural factors contribute to the family’s ability to address their young child’s needs. Similar training must also be made available to professionals who have begun to work with young children from diverse cultures midcareer.

Assessing Family Characteristics Objectives. The goal behind this step is to understand family factors and dynamics in order to develop a profile of the family’s strengths and weaknesses within a sociocultural context. Determining the impact of social and cultural influences on family functioning is the focus of this stage. Given that multiple dimensions of the family and home environment contribute to the developmental status of the infant and toddler, a diversity of measures should be considered, and they will be if the assessor has received training in the

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FOCUS model. Identifying the similarities due to culture is not sufficient and may actually contribute to a stereotypical classification. It is also necessary to understand divergences from the culture, as well as the degree of cultural assimilation. The interactions among cultural convergence, cultural divergence, and the unique contributions of the child and each family member must be considered. Importantly, the evaluator needs to determine the degree to which these influences contribute to the family’s ability to address their young child’s special needs. Finally, it is important to note that the most common form of developmental delay in early childhood is in speech and language processes. Therefore, examiners who assess the abilities of young children must exhibit some caution, as many young children who do not have English as their dominant language may also demonstrate limited proficiency in their native language. An issue to consider when assessing language development in young children is their language history. To facilitate the development of language, it is important to note to what extent English is being spoken in the home and to which other sources of English is the child exposed. Methods. Measures of the family and home environment are critical in a FOCUS evaluation of a young child. When these types of measures are used in an evaluation, however, they are primarily formal inventories and do not include specific references to sociocultural factors. Informal observation and a thorough interview will yield additional important information about cultural similarities and divergences, as well as the unique contributions of the child and each family member. In addition, an evaluator who is successful in evaluating his or her own subjectivity will feel more confident about the objective nature of informal assessment. There are a few reliable specialized scales that assess home and family environment. The Home Observation and Measurement of the Environment (HOME; Caldwell and Bradley, 1984) yields information regarding the content, quality, and responsiveness of the infant or toddler’s home environment and is obtained through formal observation by a trained observer. This is an effective tool for assessing the home environments of nonimpaired children, but its application for young children with disabilities is viewed as somewhat limited (Bagnato, Neisworth, and Munson, 1997). Another scale, the Infant/Toddler Environment Rating Scale (Harms, Cryer, and Clifford, 1990), is a blend of norm-referenced and curriculum-based assessment and emphasizes the use of observations of skills in structured and unstructured settings and parental input. Assessment of family needs is also accomplished through informal observation and interview. Surveys are available as well to identify family strengths and needs. The Family Needs Survey (Bailey and Simeonsson, 1985) is a criterion-referenced measure that clearly identifies parent perceptions

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576 HANDBOOK OF MULTICULTURAL ASSESSMENT of competencies and weaknesses. It is applicable to parents of infants with various disabilities. Other useful measures are the Family Support Scale (Dunst, Jenkins, and Trivette, 1988), the Family Strengths Scale (Olson, Larsen, and McCubbin, 1983), the Multidimensional Scale of Perceived Social Support (Zimet, Dahlem, and Zimet, 1988), and the Maternal Social Support Index (Pascoe, Ialongo, Horn, Reinhart, and Perradatto, 1988). Interestingly, few measures assessing family needs have been developed since the 1990s. (For a more detailed discussion on the assessment of family issues and cultural identity and acculturation, refer to Chapters Five and Eight.) Assessing the level of stress experienced by one or both parents of a very young child is central to the early interventionist’s ability to assess family competencies and address the needs of all members involved in the development of the IFSP. The birth of a child, commonly acknowledged as a positive event for parents, is also recognized as an event many parents experience as stressful, particularly if that parent perceives his or her child as not developing typically. A widely used measure, the Parenting Stress Index (PSI; Abidin, 1990), was designed for the early identification of parenting and family characteristics that fail to promote normal development and functioning in children. This popular scale was developed on the theory that the stress a parent experiences is due to certain salient child characteristics, parent characteristics, and situations that are directly related to the role of being a parent and can be used with parents of children as young as one month. The Parenting Daily Hassles Scale (Crnic and Greenberg, 1990) assesses the contribution of life stress and minor daily parenting stress factors to child and parent functioning. A cognitive-behavioral approach to assessing, diagnosing, and treating stress during a daily situation that a parent has identified as repeatedly stressful was developed by Ohr and colleagues (discussed in Bailey, 2005). A brief videotape is made of a frequently occurring, stressful parent-child interaction during a home visit. This video is then used to provide insight into parental thinking and behaving and forms the basis for C-BASIIC (Cognitive-Behavioral Assessment of Stressful Interactions with Infants and Children), a cognitive-behavioral intervention aimed at reducing parental stress. Parental stress reduction techniques, such as C-BASIIC, can be applied alone or in conjunction with behavioral parent training, the most popular approach to teaching effective parent techniques (Kazdin, 2005). It is essential that behavioral parenting be taught to parents with very young children so that they can practice appropriate parenting strategies from the start of the child’s life and thus avoid errors in parenting. However, cultural beliefs affect attitudes toward parenting style and may affect a parent’s ability or willingness to perform positive parenting strategies. Many parent training programs are not culturally sensitive and are presented in a way that is not convenient to families.

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Vidair (2005) developed an approach to video-based behavioral parent training that is both culturally and family sensitive. In general, video-based programs include a video of actors demonstrating appropriate parenting techniques as a teaching device. In spite of the inclusion of culturally diverse models in the video for parents to emulate, parenting training is less effective with parents whose cultural backgrounds differ from the majority. Parents may learn best from viewing themselves perform targeted behaviors rather than a model that looks, talks, and gestures in ways that differ from their own idiosyncrasies; in fact, Pigott and Gonzales (1987) suggested that the self is the most culturally appropriate model. In Vidair’s program, termed ‘‘video self-modeling,’’ parents are videotaped while interacting with their child. Clips of them performing only appropriate parenting behaviors are then compiled onto a training DVD. For parents who demonstrate few effective parenting techniques during the interaction, appropriate behaving is staged using a script. Vidair demonstrated the effectiveness of video self-modeling for improving positive parenting behaviors of mothers with oppositional children. Interestingly, one mother from Jamaica initially noted that people from her culture do not focus on praising their children for everyday behaviors; however, after viewing the video of herself as the model, she increased positive reinforcement. Also of importance, anecdotal information suggested that mothers found the in-home intervention enjoyable, easy to understand, and convenient. A critical issue in the assessment of both the child and the family is language dominance and proficiency. Yansen and Shulman (1996) indicated that language fluency can be categorized along a five-level continuum: (1) nonspeaker, (2) very limited speaker, (3) limited speaker, (4) functional speaker, and (5) fluent and proficient speaker. In addition to language proficiency, language dominance of the home must also be assessed. Short and easily completed instruments, such as the Home Language Survey (Ortiz, 1992), may be administered to assess language learning history, language use with the child, language use by the child, and language use among adults in the household.

Assessing Young Children’s Developmental Competencies Objectives. The goal of this step is to develop a profile of the infant or toddler’s strengths and weaknesses in the domains of cognition, communication, motor, visual-motor, adaptive, social-interactive, and behavioral. A culturally competent assessment is sensitive to the impact of the multiple dimensions of a child’s environment when planning the assessment battery. The current functioning of any child must be understood in the context of the developmental path taken to reach this point. Therefore, it is essential that accurate developmental information be collected as the first stage of

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578 HANDBOOK OF MULTICULTURAL ASSESSMENT any diagnostic evaluation of a preschool child. The initial interview can be conceptualized as consisting of two components: a developmental phase and a sociocultural phase. Assessment of young children must include accurate information regarding the developmental trajectory of the child. In order to understand the context of development, information must be gathered regarding prenatal care and development, the course of perinatal development, and any pregnancy and birth complications. In addition, accurate information must be gathered with regard to developmental milestones including fine and gross motor development, language development, cognitive development and problem solving, social and emotional development, and a medical history. It is important to note that there are great individual differences found for these developmental milestones, and interpretation of a developmental history must be made in the light of these variations. Many factors are associated with this individual variability, including genetics, medical history, and life experiences. Therefore, it is important to interpret the developmental history in the light of familial and sociocultural histories. The sociocultural portion of the preassessment phase should include gathering information regarding the parent’s expectations of the child’s development degree of acculturation, language use and proficiency, and social support networks available to the parents. Methods: Infants and Toddlers. Choosing family-focused, culturally sensitive modes of assessment in the areas just mentioned is mandatory. Fortunately, within the past twenty-five years, such measures have been developed or revised to assess the broad range of development, including cognitive, language, motor, and social-emotional functioning of the young child. In fact, the early childhood practitioner can choose from numerous traditional measures (normative based) or alternative measures (curriculum based or criterion based), which differ regarding the degree of family focus and cultural sensitivity. Table 25.2 offers an overview of instruments addressing a child’s cognitive, language, motor, and social-emotional development that may be used as part of an early childhood evaluation. Bagnato (2005) who advocates early childhood evaluation models that link assessment and early intervention indicates that the measure that elicits perhaps the strongest family involvement is the Assessment Evaluation and Programming System for Infants and Children (Bricker et al., 2002). Also, the AEPS:E is a related measure endorsed by Bagnato. Other measures noted for strong reliance on parental input are the Battelle Developmental Inventory–Second Edition (BDI-2; Newborg et al., 1988), the Carolina Curriculum, HELP, and the Developmental Observation Checklist System (DOCS; Hresko, Miguel, Sherbenou, and Burton, 1994). Behavioral observations also may provide invaluable information regarding children’s problem solving and functioning within their natural environment.

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Table 25.2. Instruments for Evaluating Infants and Toddlers Instrument

Purpose

Brazelton Neonatal Assesses developmental Behavioral Assessment functioning of infants in Scale (NBAS; first month of life Brazelton, 1984)

Domain of Functioning

Measurement Category

Motor development, alertness, sensory processes, and emotional functioning

Norm referenced

Bayley Scale of Infant Assesses current Mental, motor, and Development— developmental status of behavior rating scales (Bayley, 2005) infants and children, early detection of developmental delay (1 month to 42 months)

Norm referenced

Screening instruments Ages and Stages Questionnaires (ASQ; Bricker, Squires, & Mounts, 1995)

Used to assess developmental status of at-risk infants 4 to 48 months

Battelle Developmental Inventory Screening Test (Newborg et al., 1988)

Assesses developmental Personal-social, functioning in children adaptive functioning, birth to 8 years (subset of motor development, items forms the Battelle cognition, and Developmental communication Inventory)

Motor, communication, personal-social, problem solving

Norm referenced

Criterion and norm referenced (for the full inventory)

Denver Developmental Screens infants at risk for Personal-social, Screening Test (DDST; developmental delay language, fine and Frankenburg, Dodds, (birth to 6 years) gross motor Archer, Shapiro, & Bresnick, 1990)

Norm referenced

Developmental Activities Screening Inventory (DASI-II; Fewell & Langley, 1984)

Criterion based

Early detection of developmental disabilities (1 to 60 months)

Cognition, academic, perceptual, motor, and foundational skills

Developmental Assesses child’s Physical, self-help, Profile—II (Alpern, functional developmental social, academic, Boll, & Shearer, 2000) age level (birth to 12 communication years)

Norm referenced

Curriculum-based measures Assessment, Evaluation, and Programming System (AEPS) for Infants and Young Children: Vol. 1. Measurement for Birth to Three Years (Bricker, 1993)

‘‘Designed for Fine and gross motor, assessment to determine self-care, social goals and objectives, communication intervention activities, monitor progress; also includes family forms’’ (birth to 3 years)

Curriculum based

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580 HANDBOOK OF MULTICULTURAL ASSESSMENT Table 25.2. (Continued) Instrument

Purpose

Domain of Functioning

Measurement Category

The Carolina Curriculum for Infants and Toddlers with Special Needs (2nd ed.)

Assesses children’s level Cognition, Curriculum based of development for entry communication, social, into the curriculum and fine and gross motor evaluates progress (birth to 24 months)

Hawaii Early Learning Profile

Assesses children’s strengths and weaknesses and evaluates progress

Cognition, language, Curriculum based social, emotional, gross motor, and self-help skills

Transdisciplinary Play-Based Assessment: A Functional Approach to Working with Young Children (Rev. ed.; Linder, 1993)

‘‘Designed to provide a comprehensive, integrated view of the child’s development, style, and interaction patterns’’ (6 months to 6 years)

Cognition, Curriculum based social-emotional, communication and language, sensorimotor

Ordinal Scales of Infant Development/Infant Psychological Development Scales (IPDS; Uzgiris & Hunt, 1975; Dunst, 1980)

Based on Piaget’s theory; assesses the development of cognitive schemas throughout sensory-motor stage

Six scales: Visual pursuit and object permanence Development of means for obtaining desired environmental events Vocal and gestural imitation Operational causality Construction of object relations in space Development of schemes related to objects

Criterion, curriculum based. Play-based (because of the Piagetian tasks) (and norm referenced—not originally, but Dunst 1980 published scoring system that includes age norms and an estimated developmental age

The process of assessing young children is somewhat different from that of older children. Younger children are less likely to attend for long periods of time, may be more active, and may be apprehensive in the company of strangers. Their level of language development may interfere with understanding what is required of them during some of the tasks. To maintain young children in a relaxed, attentive state, parents are typically asked to be present during the assessment, and it is important to determine the role that they will play during this time. Information obtained from step one of this model is integral to planning the best process for assessment and setting the stage for interaction with parents. Assessments for infants and toddlers may be done in either the home or center-based settings. Regardless of setting, making the child and parents comfortable is an important goal. Appointments should be scheduled at

FAMILY-ORIENTED, CULTURALLY SENSITIVE (FOCUS) ASSESSMENT OF YOUNG CHILDREN

convenient times, preferably when the child is in a state that maximizes attention. For these reasons, the traditional assessment process that involves multiple appointments with one professional at a time is not recommended. Assessors who are sensitive to the needs and interaction styles of parents and children are flexible in the process of assessment that they use and are more likely to use a less traditional approach. Sandall (1997) suggests that one way to provide an optimal environment for both child and parent is to use nontraditional approaches that allow flexibility and recommends a play-based, arena-style assessment. Arena assessment involves simultaneous assessment of the child across several developmental domains. Various professionals participate in the arena procedure, but typically one professional is the facilitator who guides the child through the tasks, with other professionals recording their observations. Parents are sometimes asked to be the facilitator if the professionals need help engaging the child. Parents are a vital part of the arena process and are asked to provide information and sometimes to comment on and validate their young child’s responses. This flexible approach also encourages parent-child interaction and interactions between the various professionals and the parent. Thus, this approach not only provides the child with an environment most likely to maximize performance but also provides the opportunity to learn more about the family’s attitudes, values, and behaviors; how members interact; family competencies; and family needs. Method: Preschool Children. Epstein, Schweinhart, DeBruin-Parecki, and Robin (2004) suggested that assessment of preschool children can yield four types of information: identifying children in need of services, planning for instruction or intervention for children, identifying program improvement and staff development needs, and evaluating the overall efficacy of a program. The selection of assessment techniques for evaluating culturally diverse children should be based on the referral question. A list of many of the formal evaluation instruments available for preschool children is given in Table 25.3. With young children, the referral question should contain two components. The first addresses the question of the child’s current level of functioning across developmental domains. This portion of the assessment should include a detailed analysis of the strengths and weakness demonstrated by the child. Analysis of the strengths and weaknesses drives the second portion of the referral question: how to help to increase the adaptiveness of this child. Hence, information about the child must be collected in such a way so as to allow the application of these results to the consultation process with the parents or guardian, as well as the generation of the individualized educational plan. In order to address both components of the referral question, it is often necessary to employ formal norm-referenced procedures, curriculum-based criterion-referenced procedures, and other informal processes.

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582 HANDBOOK OF MULTICULTURAL ASSESSMENT Table 25.3. Instruments for Assessing Preschool-Aged Children Instrument

Purpose

Domain of Functioning

Measurement Category

Preschool assessment instruments: Cognitive ability (verbal and nonverbal) Differential Ability Measures intellectual Verbal and nonverbal ability Norm referenced Scales—II (DAS; Elliot, ability and achievement (ages 3–6 to 6–11); verbal, 2007) (2–6 to 17 years of age; nonverbal, and spatial ability achievement tests only (5–0 to 17–11) for school-age children) Kaufman Assessment Battery for Children (KABC-II; Kaufman and Kaufman, 2006)

Measures intelligence and achievement in children 2 to 12 years of age

Sequential and simultaneous Norm referenced processing, achievement, nonverbal abilities

Stanford-Binet Intelligence Scales–Fifth Edition; (Roid, 2003)

Measures intellectual ability ages 2 to 24 years

Verbal, Abstract/Visual, Quantitative, and Short-term memory

Norm referenced

Verbal and performance scales

Norm referenced

Wechsler Preschool and Measures intellectual Primary Scale of ability ages 3 to 7-3 Intelligence–Revised (WPPSI-III; Wechsler, 2003)

Detroit Test of Learning Evaluates general Verbal aptitude, nonverbal Norm referenced Aptitude-P (DTLA-P3; cognitive ability in 3 to aptitude, attention-enhanced Bryant & Hammill, 9 year olds aptitude, motor-enhanced 2005) aptitude, and motor-reduced aptitude Merrill Palmer Revised Scales of Development (Roid & Samper, 2005)

Infant and preschool children

Assesses visual motor, learning, and problem-solving issues

Norm referenced

Preschool assessment instruments: Cognitive ability (nonverbal only) Leiter International Performance Scale–Revised (Roid & Miller, 2001)

A nonverbal assessment instrument that does not require the ability to speak or understand English; can be administered to individuals 2 years old to adult

Raven’s Progressive Measure of nonverbal Matrices (Raven, Court, intelligence & Raven, 2003) (Coloured Progressive Matrices-CPM is for 5 to 11 years)

Nonverbal intelligence

Norm referenced

Perceptual ability, deductive Norm referenced and analogical reasoning Measures ability to form comparisons, reason by analogy, and organize spatial perceptions into systematically related wholes

FAMILY-ORIENTED, CULTURALLY SENSITIVE (FOCUS) ASSESSMENT OF YOUNG CHILDREN

Table 25.3. (Continued) Instrument Goodenough-Harris Drawing Test/‘‘Draw-A-Man’’ Test (GHDT; Harris, 1963)

Domain of Functioning

Purpose Brief test of nonverbal intelligence for individuals 3 to 15-11 years

Nonverbal cognitive ability based on child’s drawing of a man, woman, or self

Measurement Category Norm referenced

Preschool assessment instruments: Adaptive behavior AAMD Adaptive Behavior Scale–School Edition (ABS-SE; Lambert, Nihara, & Leland, 1993)

Measure of adaptive behavior for children 3-3 to 17-2 years

Personal self-sufficiency, community self-sufficiency, personal-social responsibility, social adjustment, personal adjustment

Criterion and norm referenced

Adaptive Behavior Inventory for Children (ABIC; Mercer & Lewis, 1982)

Measure of adaptive behavior in children 5 to 11-11 years

Measures six areas of adaptive behavior: family, peers, community, school, earner/consumer, and self-maintenance

Norm referenced

Four areas: communication, daily living skills, socialization, and motor skills, and one general area of maladaptive behavior

Norm referenced

Personal-social, adaptive functioning, motor development, cognition, and communication

Criterion and norm referenced (may be linked to curriculum)

Vineland Adaptive Measure of adaptive Behavior Scales–II behavior newborn to (VABS; Balla, Cicchetti, adult & Sparrow, 2005) Preschoolers: Developmental functioning Battelle Developmental Assesses developmental Inventory (BDI; functioning in children Newborg, Stock, Wnek, birth to 8 years of age Guidubaldi, Svinicki, & Dickson, 1988) Brigance Diagnostic Inventory of Early Development (Brigance, 1978)

Developed for use with Contains 98 skill sequences children below the and lists objectives for the developmental age of 7 skills years

Criterion and norm referenced (can be linked to curriculum)

Developmental Activities Screening Inventory–II (DASI-II; Fewell & Langley, 1984)

Nonverbal screening May be used as a instrument designed for prescriptive tool for infants and classroom planning preschoolers (birth to 60 months) who are severely handicapped

Criterion and norm referenced (can be linked to curriculum)

Developmental Indicators for the Assessment of Learning–Revised (DIAL-R; Mardell-Czudnaiski & Goldenberg, 1983)

Screening test used to identify children 2 to 6 years with learning problems

Criterion and norm referenced (can be linked to curriculum)

Motor, conceptual, and language skills

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584 HANDBOOK OF MULTICULTURAL ASSESSMENT Norm-referenced assessment devices are assessment instruments that are administered in a standardized fashion, and the child’s performance is judged relative to the performance of other children of similar age. Norm-referenced instruments provide a standard and a general level of functioning, information necessary to address the first part of the referral question. Validity is always an issue with norm-referenced standardized tests. Before any instrument is employed, a thorough review of the manual and subsequent literature must be undertaken to ensure that there are no biases or sampling problems. Unlike the infant assessment instrument, there is fairly good predictive validity among many of the norm-referenced preschool instruments. Nevertheless, good psychometric properties should not give license to develop prognoses based on these test results. If prognostication is undertaken, the validity of the instrument may become a self-fulfilling prophecy. That is, if a child is thought to be moderately mentally retarded and a program and parental expectations are developed based on this information, the child’s development may be hindered by inappropriate distancing and presentation of new material to be learned. Rather than engage in prognosis, it is far more beneficial to the child to use the predictive nature of the instruments to determine the level of risk the child is at and develop an appropriate intervention to address the risk factors. Criterion-referenced instruments address the prescriptive portion of the referral question (Neisworth and Bagnato, 1986). Criterion-referenced assessment devices are often directly linked to the curriculum as with informal curriculum-based assessment, or systems such as the Carolina Curriculum and the Hawaii Early Learning Profile. Other forms of criterion-based assessment include theoretically based devices such as the Ordinal Scales of Infant Development, the Developmental Activities Screening Inventory— II (Fewell and Langley, 1984) and the Development Indicators for the Assessment of Learning—Revised (DIAL-R; Mardell-Czudnaiski and Goldberg, 1983), the Battelle Developmental Inventory (BDI; Newborg, Stock, Wnek, Guiduboldi, Svinicki, and Dickson 1988), and the Brigance Diagnostic Inventory of Early Development (Brigance, 1978). The advantages of these procedures of more formal norm-referenced approaches are the direct linkage of assessment to curriculum. In addition, the assessment is conducted in a more naturalistic environment, which can be used for formative and summative purposes. Informal Procedures. A number of informal procedures tat may provide a great deal of information regarding the development of culturally diverse preschool children. These procedures may be conceptualized as active or passive techniques. Passive techniques are assessment approaches in which the examiner does not actively engage the child during the assessment process. Rather, the

FAMILY-ORIENTED, CULTURALLY SENSITIVE (FOCUS) ASSESSMENT OF YOUNG CHILDREN

examiner gathers information through observation of the children in a variety of situations, structured and unstructured, with a variety of people. Passive techniques may be structured to some degree. For example, an examiner may ask a parent to teach a child to put together a puzzle in order to assess the dynamics of the parent-child interaction. Observations that help in understanding the preschool child within his or her multiple systems include classroom observations, observations during free play, observations of parent-child interactions, observations of mother-child interactions, and observations of peers. The quality and type of play often mirror a child’s developmental capabilities (Rubin, 1990). Observations of children’s play provide a window of opportunity to determine how cognitive, linguistic, fine and gross motor, social, and emotional development are integrated in the day-to-day reality of the child. Active informal assessment involves engaging a child in a task that will shed light on the child’s current level of development and the processes the child uses to learn. One of the most common forms of active informal assessment is dynamic assessment. Dynamic assessment refers to a set of assessment procedures that are characterized by (1) a test-teach-test sequence, (2) an emphasis on assessment of processes rather than outcomes, (3) assessment of generalizable skills, (4) identified strengths and weakness, and (5) differentiated performance and potential (Haywood, Brown, and Wingenfeld, 1990). The reauthorization of Individuals with Disabilities Education Act in 2004 brought response to interventions (RTI) to the forefront of informal procedures that need to be considered for used within the FOCUS framework. Response to treatment intervention is an assessment procedure in which a student’s learning is assessed in an ongoing fashion to determine the efficacy of treatments or curricular modifications. RTI is a highly behavioral approach focused on the direct measurement of academic skills. Despite the efficacy of the combination of RTIs and early literacy education (Hagans-Murillo, 2005), there is not widespread use of RTIs with preschool children.

Family Intervention Planning Objectives: Infant and Toddler. This step involves the determination of appropriate child and family interventions considering the infant or toddler’s developmental profile while remaining sensitive to the impact of multiple dimensions of the child’s environment. This culminates in the development of the IFSP. Methods. All professionals involved in the assessment of the child and family meet with the parents to generate the IFSP. This is an integration of the information obtained from the assessment regarding developmental competencies

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586 HANDBOOK OF MULTICULTURAL ASSESSMENT and needs as well as the evaluation of the family’s competencies and needs. In keeping with the aims of a FOCUS evaluation, the interaction between the professionals and the parents needs to be one of collaboration. Barrera (1996) suggests that ‘‘many times, the greatest bias lies not in the actual assessment but in how the data are reported’’ (p. 81). A professional who has adequately assessed parental competencies and has gained an understanding of the unique and sociocultural variables of that particular family would be in the best position to establish a collaborative relationship. If a collaborative relationship has been established that communicates respect and understanding of the family’s strengths and weaknesses, results can be discussed and interventions planned with a lesser degree of bias and stereotypical judgment.

Ongoing Evaluation and Planning Objectives: Infants and Toddlers. The assessment process does not end with intervention planning. In fact, the IFSP mandates six-month periodic reviews at a minimum. Young children change rapidly, and families are in a constant state of flux. As interventions are successful, there is a need to continually update the profile of the infant or toddler and family competencies and needs. Because other interventions may prove to be unsuccessful, review is essential. Methods: Infants and Toddlers. Review meetings, similar to the planning meetings, are collaborations between professionals and the family. Interview and observation yield important information regarding the progress of child and family. Many of the curriculum-based measures used in the initial evaluation are appropriate for evaluation. For example, the Assessment Evaluation and Programming System for Infants and Children requires periodic evaluations of child progress, along with strong family involvement. In addition, the Developmental Profile II (Alpern, Boll, and Shearer, 2000), Instrument for Measuring Progress (McAllister, 1994), and Developmental Programming for Infants and Young Children–Volume 2, Revised (Rogers et al., 1996) rely on family input and are good measures to check on progress. Method: Preschool Children. Kurt Lewin, the developmental psychologist, was credited with saying if you want to learn about the development of some phenomenon, you must try to change it. In FOCUS assessment, this translates into placing a child into a diagnostic placement to assess the child’s capabilities, as well as the most effective means of teaching the child. Barona and de Barona (2004) suggested that development placements should extend over a period of three to six months. This allows the child to acclimate to the classroom, the other children, and the educational professionals.

FAMILY-ORIENTED, CULTURALLY SENSITIVE (FOCUS) ASSESSMENT OF YOUNG CHILDREN

A significant period of assessment also allows educational professionals to engage in an ongoing series of classroom observations, curriculum-based assessment, and dynamic assessment. During the course of the diagnostic placement, educational professionals may be able to gather information regarding cultural background and degree of acculturation, parental expectations, language history, and parental involvement. All of these components are essential in developing an effective individual educational plan. In conjunction with formal assessment procedures, diagnostic placement provides educational professionals and parents the information that is essential for the development of an individual educational program that will help to maximally facilitate the child’s development.

SUMMARY There are great pressures for fair, reliable, and valid approaches to assessing young children, as testing requirements are being imposed on younger children through legislative and regulatory actions. The need for family-focused, culturally sensitive infant and toddler assessment and intervention is ever more apparent as the United States is becoming more culturally diverse and pluralistic. It is estimated that African Americans, Latinos, Native Americans, Asian Americans, and other people of color comprise more than one-third of the population of the United States. FOCUS is a five-component model of assessment of young children that aids early intervention professionals in working with a diverse array of families regardless of cultural similarity or disparity between the evaluator and the family.

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592 HANDBOOK OF MULTICULTURAL ASSESSMENT Raven, J., Court, R., & Raven, J. C. (2003). Raven’s Progressive Matrices. San Antonio, TX: Harcourt Assessment. Rogers, S. J., Donovan, C. M., D’Eugenio, D., Brown, S. L., Lynch, E. W., Moersch, M. S., et al. (Eds.). (1996). Developmental programming for infants and young children-Volume 2. Ann Arbor: University of Michigan Press Roid, G. H. (2003). The Stanford Binet Intelligence Scales-Fifth Edition. Chicago: Riverside. Roid, G. H., & Miller, L. (2001). Leiter International Performance Scale–Revised: Wood Dale, IL: Stoetling Company. Roid, G. H., & Samper, J. L. (2005). Merrill-Palmer Revised Scales Of Development. Lutz, FL: PAR. Rubin, K. H. (1990). New directions for child development: Children’s play. San Francisco: Jossey-Bass. Sanchez, M. T., & Brisk, M. E. (2004). Teachers’ assessment practices and understandings in a bilingual program. NABE Journal of Research and Practice, 2, 193–213. Sandall, S. R. (1997). Developmental assessment in early intervention. In A. H. Widerstrom, B. A. Mowder, & S. R. Sandall (Eds.), Infant development and risk (pp. 211–235). Baltimore, MD: Paul H. Brookes. Santos, R. M. (2004). Ensuring culturally and linguistically diverse families and communities. Remedial and Special Education, 20, 351–359. Spruill, J., Rozensky, R. H., Stigall, T. T., Vasquez, M., Bingham, R. P., & Olvey, C. D. (2004). Becoming a competent clinician: Basic competencies in intervention. Journal of Clinical Psychology, 60, 741–754. Stutsman, R. (1931). Merrill-Palmer Scale of Mental Tests. New York: World Book. Sue, D. W., Bingham, R. P., & Porch´e-Burke, L. (1999). The diversification of psychology: A multicultural revolution. American Psychologist, 54, 1061–1069. Sue, D. W., & Sue, D. (2004). Counseling the culturally diverse: Theory and practice (4th ed.). New York: Wiley. Uzgiris, I., & Hunt, J. M. (1975). Assessment in infancy: Ordinal scales of psychological development. Champaign: University of Illinois Press. Uzgiris, I., & Hunt, J. M. (1987). Infants performance and experience: New findings with the ordinal scales. Chicago: University of Illinois Press. Vidair, B. (2005). Video self-modeling as an intervention for mothers of oppositional children. (Unpublished dissertation). Wechsler, D. (1967). Wechsler preschool and primary scale of intelligence. San Antonio: Psychological Corporation. Wechsler, D. (2003). The Wechsler Preschool and Primary Scale of Intelligence: Third Edition. Orlando, FL: Harcourt.

FAMILY-ORIENTED, CULTURALLY SENSITIVE (FOCUS) ASSESSMENT OF YOUNG CHILDREN Yansen, E. A., & Shulman, E. L. (1996). Language assessment: Multicultural considerations. In L. A. Suzuki, P. J. Meller, & J. G. Ponterotto (Eds.), Handbook of multicultural assessment: Clinical, psychological, and educational applications. San Francisco: Jossey-Bass. Zimet, G. D., Dahlem, N. W., & Zimet, S. G. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52, 30–41.

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CHAPTER TWENTY-SIX

Assessment Issues for Working with Diverse Populations of Elderly Multiculturally Sensitive Perspectives Amanda L. Baden Grace Wong

T

he aging of the population of the United States, or the ‘‘graying of America’’ (Haley, Han, and Henderson, 1998), the extension of the average life span to seventy-seven years in 2004 (U.S. Census Bureau, 2006), and the retirement of the baby boom generation (born between 1946 and 1962; Eggebeen and Sturgeon, 2006) have led to an increase in elderly people requiring psychiatric care and psychological assessment. Among the aging population, the life expectancy for White females (80.3 years) in comparison to that of Black females (75.6 years) and of White males (75.1 years) in comparison to that of Black males (68.8 years) suggests that more information is needed on the issues that older adults of color must negotiate in seeking medical and mental health care. Furthermore, the ever-changing ethnic diversity of older adults whom psychologists assess has necessitated that psychologists better understand the issues in providing the geriatric population with accurate, appropriate, and comprehensive psychological assessments. As a result of the increase in the ethnic diversity of the elderly in America, the appropriate use of psychological assessment instruments for evaluating older adults has received increased empirical attention. Recent additions to the literature base in multicultural assessments of the elderly have primarily focused on intelligence testing issues across cultures, language and translation issues in assessment, norms for individuals across cultures, and neuropsychological assessments. The purpose of this chapter is to familiarize practitioners with research and clinical issues encountered when conducting psychological assessments

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ASSESSMENT ISSUES FOR WORKING WITH DIVERSE POPULATIONS OF ELDERLY

with the underserved and increasingly multiculturally diverse population of elderly in America. To familiarize clinicians with the issues affecting older adults of color and of various ethnic backgrounds, we contextualized the issues that can affect competent, ethical, unbiased, effective, and culturally sensitive assessments with older adults. This chapter addresses culturally biased assessment of the elderly, the features of culturally sensitive assessment of older adults, mental status exams with various ethnic groups, intelligence testing with various ethnic groups, and the assessment of depression and pseudodementia in geriatric populations. The literature addressing multicultural assessments with geriatric populations has enumerated many of the challenges found in assessing the elderly (Hays, 1996; Skinner, Teresi, Holmes, Stahl, and Stewart, 2002; Valle, 1998; Yeo and Gallagher-Thompson, 1996). To date, the research that has been conducted addresses five main themes. First, the literature cautions against potential cultural bias in many of the psychological instruments used in geriatric assessments (Teresi, Holmes, Ram´ırez, Gurland, and Lantigua, 2001; Young, 2003). Second, the literature contains comparisons between elderly from various ethnic groups and elderly Whites on mental status exams, tests of cognitive functioning, and neuropsychological measures of cognitive func¨ tioning (Hedden et al., 2002; Lowenstein, Arguelles, Barker, and Duara, 1993; Manly et al., 1998; Manly, Jacobs, Touradji, Small, and Stern, 2002; Pedraza et al., 2005). To remedy possible cultural biases, researchers have suggested adjustments to existing measures or endorsed specific measures found to be more suitable for various ethnic groups (Bohnstedt, Fox, and Kohatsu, 1994; Borson, Scanlan, Watanabe, Tu, and Lessig, 2005; Storey, Rowland, Basic, and Conforti, 2002). Third, studies have focused on the ability of psychological measures to detect such disorders as dementia within ethnic groups, especially when using instruments translated into the languages of other ethnic groups (Espino, Lichtenstein, Palmer, and Hazuda, 2001; Mast, Fitzgerald, Steinberg, MacNeill, and Lichtenberg, 2001; McCurry et al., 2001; Taussig, Mack, and Henderson, 1996). A fourth theme in the literature focused on the establishment of normative data for particular instruments with specific ethnic groups (Ferraro, Bercier, Holm, and McDonald, 2002; Fillenbaum, Heyman, Huber, Ganguli, and Unverzagt, 2001; Lucas et al., 2005; Patton et al., 2003). Finally, some researchers have sought to validate newly developed or revised instruments for use with multiculturally diverse elderly (Dick, Teng, Kempler, Davis, and Taussig, 2002; Glosser, Wolfe, Albert, and Lavine, 1993; Jorm, 2004; McCurry et al., 2001; Mungas, Marshall, Weldon, Haan, and Reed, 1996). The empirical research represented by this work reflects the growing interest in geriatric assessment with diverse populations. However, although substantial strides have been made in the past seven years since Wong and Baden (2001) reviewed the literature on multicultural assessments, many ethnic groups

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596 HANDBOOK OF MULTICULTURAL ASSESSMENT have yet to be adequately represented in the literature despite representing a substantial portion of older adults of color seeking treatment. For example, few studies have focused on the psychological assessment of the elderly from major ethnic subgroups such as Native Americans and South Asians. Furthermore, practitioners continue to face situations in which they are expected to perform assessments on ethnically diverse elderly with few culturally appropriate tools and with a dearth of norms for those over the age of seventy-five. Moreover, the vast majority of the studies that were conducted focused on African American or Spanish-speaking elderly populations. Although a strong body of research addressing geriatric assessment with Chinese-speaking older adults exists, many other Asian subgroups have yet to receive adequate attention. The result of these gaps in the literature is that information regarding assessments of multicultural geriatric populations is limited and skewed in its representation of the various ethnic groups. We have chosen to highlight a vitally important issue in the assessment of the elderly: the tendency to underdiagnose psychiatric conditions in this population. In particular, pseudodementia and its relationship to depression must be better understood and recognized by clinicians to ensure its proper diagnosis and treatment.

CULTURALLY BIASED ASSESSMENT Inherent in the field of assessment is concern regarding the appropriateness, accuracy, sensitivity, fairness, and equity in measurement. A natural by-product of these concerns for practitioners, researchers, test developers, and the public is attention to potential bias in assessment instruments and measures. Following a recent examination of a commonly used measure, Assets and Health Dynamics of the Oldest Old (AHEAD), to measure cognitive functioning, Zsembik and Peek (2001) concluded that ‘‘persistent race effects are, at this point, un-interpretable and need further examination’’ (p. S272). This sentiment has been shared regarding the impact of race and ethnicity on a variety of measures used with the diverse population of elderly in the United States. Similarly, the assessment of dementia, although extensively researched within White elderly Americans, continues to be problematic when elderly people of color are examined due to biased instruments, inappropriate norms, and a variety of other issues. In essence, one of the major difficulties in assessing ethnically diverse elderly in the United States is that the psychological measures used to assess them have generally been developed both by and for White elderly individuals, that is, normative data obtained from White geriatric populations (Hays, 1996; Mahurin, Espino, and Holifield, 1992).

ASSESSMENT ISSUES FOR WORKING WITH DIVERSE POPULATIONS OF ELDERLY

As a result, the most commonly used mental status examinations may ‘‘assume a particular education and cultural upbringing’’ (Hays, 1996, p. 192). Moreover, the constructs and abilities tested using the standardized measures may be culturally biased. Intelligence testing, for example, has com¨ ¨ monly been found to have inherent biases (Lowenstein, Arguelles, Arguelles, Linn-Fuentes, 1994). With respect to the Wechsler Adult Intelligence Scale-III, crystallized intelligence, which is heavily influenced by educational attainment, language, and one’s cultural body of information, is strongly emphasized because it is regarded as the aspect least susceptible to the effects of aging. Minority older adults are at a disadvantage when crystallized intelligence is assessed. They may not have been raised or educated in the United States. Furthermore, they may not have received formal education, a phenomenon that was common over half a century ago, particularly among women. Fluid intelligence is assessed using the performance measures and is more heavily related to daily living skills and daily functional ability. However, although fluid intelligence is the most susceptible to decline in aging, it is also influenced by education. The relationship between measured levels of intelligence on educational attainment demonstrates the difficulty in measuring cognitive decline when using a measure like the Wechsler Scales with individuals from various ethnic groups having qualitatively different and lower levels of educational attainment than the groups used in obtaining normative data for the instruments (Dana, 1993). Many of these instruments provide an underestimation of cognitive functioning of non-White populations (Mahurin et al., 1992). Cultural bias was also demonstrated on many of the other instruments that were used to assess elderly populations such as the Mini-Mental Status Examination (Folstein, Folstein, and McHugh, 1975). Generally a common cultural bias found in measures and assessment tools can be traced back to biases that are heavily influenced by educational attainment levels. Other factors often related to performance on assessment instruments were occupational status, depression level, residence, sex, physical health, premorbid history, and environment (Cohen and Carlin, 1993; Kaufman, McLean, and Reynolds, 1988; Manly et al., 1998; Stewart, Richards, Brayne, and Mann, 2001).

ELEMENTS OF CULTURALLY SENSITIVE, COMPREHENSIVE ASSESSMENTS OF OLDER ADULTS Several issues deserve attention for working with minority elderly. An important part of any assessment is a thorough interview of the patient. Unlike evaluating younger adults, testing of older adults often requires additional support in many areas.

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598 HANDBOOK OF MULTICULTURAL ASSESSMENT

Inviting Family Members Depending on the reason for referral, it can be useful to invite family members or home health aides to the interview. For example, the patient may need physical assistance with ambulating and travel, or because memory deficits are often an integral part of the referral question, an alternate source of reference is crucial in validating or correcting information obtained from the patient. Obtaining personal and medical history is critical, yet this information can be difficult to access. Medical information in particular may be challenging to gather given the immigration status or residence history of the clients, who may have lived many years in another country or in another part of the United States. The patient may not be capable of reliable reporting for reasons such as poor memory and lack of familiarity with Western medicine or medical terms. In addition, the person may be fearful of being in an environment where he or she cannot speak the language. The accompanying family members or home health aides are invaluable as providers of medical information about the patient, especially if they accompany the patient to clinic appointments. Family history of Alzheimer’s disease and medical conditions such as hypertension, diabetes, cerebral vascular accidents, and alcohol abuse can be important diagnostic information if the assessment is unclear or offers few clues about differential diagnosis. Other related areas about which clinicians should ascertain information include sensory loss and physical limitations; if possible, information about these areas of functionality should be gathered prior to the patient’s arrival. The patient may not be able to see or hear well enough to get to the clinician’s office independently or be tested fairly. For example, negotiating an unfamiliar setting can be confusing for elderly who have sensory loss or dementia. The clinician’s awareness of these issues can prevent unnecessary stress and frustration for patients.

Medications Medications can cause mental confusion and other side effects if they are not properly monitored. They should be brought along to the assessment because patients (as well as family) often struggle with the names and dosages of medication, both of which are hard to learn even if the patient speaks English fluently. Many elderly patients take multiple medications, and the effects of medication interaction can lead clinicians to conclude falsely that patients are less capable than their actual state. Certain medications, when mixed, can cause confusion and even be lethal.

ASSESSMENT ISSUES FOR WORKING WITH DIVERSE POPULATIONS OF ELDERLY

Educational History It is important to assess the patient’s educational history. Level of education is an important factor influencing the results of cognitive tests. Education is also helpful in providing a baseline for a patient’s premorbid functioning, since marked change is often a signal of something more serious, such as dementia. The significance of a former professor being unable to solve simple mathematics problems or write a simple sentence is markedly different from a former farmhand who cannot do the same tasks, regardless of language. In addition, test bias research shows that little formal education can lead to a patient’s appearing worse than he or she is, creating a ‘‘false positive.’’ Illiteracy too is more common than realized and must be explored early on, sensitively and supportively. Test selection is greatly affected by individuals’ level of literacy; thus, a test may have to be dropped or replaced. In the event of varying levels of literacy, clinicians should be prepared to administer test instructions in alternative ways or have an alternative test ready that meets the needs of the assessment.

Employment History Employment, an important measure of premorbid functioning, provides clinical information about the individual’s ability to persevere, maintain responsibility, attend and concentrate, and engage in social interaction. For those who have migrated or emigrated to the United States, employment history also provides information about the patient’s abilities in the homeland when he or she was able to speak in the original tongue, as well as about this person’s adaptive abilities in the United States. For the elderly, employment history provides a baseline to compare current functioning. This is particularly useful for those who have not had formal education or were educated in a schooling system unlike that in the United States. Ideally interviews should be conducted in the patient’s native language with clinicians fluent in that language. Unfortunately, this is not always possible. Steps should be taken to find an interpreter who has some clinical training rather than relying on untrained staff, family members, or home health aides. Sometimes a family member may want the patient to do well during an interview (even though the patient is brought in for dementia assessment) and may cue the patient by nodding or mouthing answers. The family member may be unfamiliar with terms and concepts being addressed or personal issues that may censor the patient’s true response to the clinician’s question. In addition, many dementia patients, unlike depressed patients, find ways of coping with memory loss by confabulation or by eliciting family members’ assistance with answering questions. It is important to instruct the attending collateral to

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600 HANDBOOK OF MULTICULTURAL ASSESSMENT refrain from cueing or answering questions on behalf of the patient during the clinician’s probe into the patient’s deficits. Translated versions of Mini-Mental Status Exam (MMSE), the Wechsler Adult Intelligence Scale-III (WAIS-III), or other researched neuropsychological instruments (for example, the Neuropsychological Assessment Battery of the Consortium to Establish a Registry for Alzheimer’s disease, CERAD) are often not commonly available at clinics. Unless the clinician or the clinic makes an effort to collect translated assessment instruments or tests developed especially for the minority elderly population, they may be unavailable. This chapter provides some references that might be helpful to further the reader’s investigation into how some of these instruments can be found. Much of the current research on assessment of minority elderly is in the area of dementia and depression given the status of these conditions as the primary areas of complaint and referral for the geriatric population in general. We recommend a text that, though published some years ago, continues to be a useful source of assessment instruments for Spanish speakers: Neuropsychological Evaluation of the Spanish Speaker (Ardila, Rosselli, and Puente, 1994). Ardila and colleagues studied several tests from classical neuropsychological literature (for example, the MMSE, the Boston Diagnostic Aphasia Examination, the Wechsler Memory Scale, and the Rey-Osterrieth Complex Figure), and ten additional tests were translated and prepared for use with Spanish speakers. These additional tests include the ‘‘A’’ Cancellation Test, Spanish Naming Test (adapted), Spanish Reading and Writing Test, Spanish Repetition Test, Spanish Phonemic Test (adapted), Spanish Grammar Test, Verbal Fluency Test (adapted), Calculation Ability Test, Verbal Serial Learning Curve, and Test of Memory for Unfamiliar Faces (adapted). Norms are available for patients seventy-five years and older; level of education is also accounted for. Additional components of a complete battery of tests are also needed for the various ethnic groups. Currently most of the validation studies are in individual journal articles, not all of which are easily accessible due to the international nature of this type of research.

DEMENTIA AND OLDER ADULT ASSESSMENT One of the primary tasks given to clinicians who work with older adults is dementia screening. Several elements are essential components of neuropsychological testing and the screening for dementia. Given that dementia is marked by initial memory changes and then more definitive cognitive decline, tools such as the MMSE, cognitive tests such as the Wechsler Adult Intelligence Scale-III, the Wide Range Achievement Test Revised, and screening batteries like the Mattis Dementia Rating Scale (DRS) formed by various tests designed

ASSESSMENT ISSUES FOR WORKING WITH DIVERSE POPULATIONS OF ELDERLY

to tap into different aspects of brain function are the basic tools psychologists use to ascertain the kind and degree of decline. While the field of medicine has made many advances in the area of brain imaging, specific functional deficits are still accessed through neuropsychological testing. Assessing intellectual functioning with ethnically diverse elderly requires normative samples for use with the elderly, as well as information regarding factors affecting intelligence tests. Without adequate norms and further research on factors affecting intelligence tests specific to minority groups, clinicians are left to make sense of ongoing conditions with little research support. The information that follows documents research findings for several common screening measures and the appropriateness of their use with various ethnic groups.

USE OF MENTAL STATUS EXAMINATIONS WITH MINORITY OLDER ADULTS The most commonly researched assessment instrument for ethnically diverse geriatric individuals is the Mini-Mental State Examination (MMSE; Folstein et al., 1975). It assesses short-term memory functioning, orientation to time and place, comprehension abilities, and attention and calculation skills (Valle, 1998). This instrument has been established as a screening tool that clinicians frequently use to determine the need for additional evaluation of cognitive impairment in the elderly. However, several empirical studies using the MMSE to screen ethnically diverse elderly have found it to be culturally biased and to result in high false-positive rates for dementia in African American elderly (Welsh, Fillenbaum, Wilkinson, and Heyman, 1995). Other cognitive evaluation instruments were also assessed as biased based on educational levels attained, age (for example, the very old), and cultural and language skills. Table 26.1 briefly reviews the literature and findings for the MMSE and other instruments developed to screen for dementia.

INTELLIGENCE TESTING WITH MINORITY OLDER ADULTS Intelligence tests have historically been plagued by problems of cultural bias and construct equivalence for all groups (Ram´ırez et al., 2002; Teresi, Holmes, Ram´ırez, Gurland, and Lantigua, 2002). Obtaining estimates of cognitive impairment and premorbid functioning are often the goals when assessing the elderly. The Wechsler Adult Intelligence Scale-Revised (WAIS-R) and the WAIS-III (updated in 1997) are frequently used for assessment of intelligence. WAIS-R provides age norms until age seventy-four, and WAIS III has extended its age norms to age eighty-nine. WAIS III made efforts to become more culture

601

Folstein et al. (1975)

Folstein et al. (1975)

Jia, Li, Chen, & Zhang (1999); Luo et al. (2002)

Mini-Mental Status Exam (MMSE)

MMSE Spanish version

MMSE Chinese version

Chinese speakers

Spanish speakers

English speakers

Language

Instrument

Source

Ethnicity or

Assessment

Effective for Alzheimer’s disease screening in Chinese elderly over age 70 regardless of education level

Used differential item functioning and created version with 15 items (Marshall, Mungas, Weldon, Reed, & Haan, 1997); scoring of serial sevens was the best predictor of dementia (Espino et al., 2004)

Widely available and studied; published in 57 languages; use cutoff score of 17 or 18 (versus 23) if educational attainment is eighth grade or less (Murden, McRae, Kaner, & Bucknam, 1991); use cutoff score of 19 when with African American or Hispanic elderly for best results (Bohnstedt et al., 1994); found to be effective for use with Native Americans (Weiner et al., 2003)

Strengths

Weaknesses

Education, age, gender, physical health, and daily life ability significantly affect scores

Scores affected by education levels; high risk of false positives for Latino elderly

Problematic use with ethnically diverse elderly including African American, Asian American, and Latino American; bias found for those having lower educational attainment

Table 26.1. Assessment Instruments for Use with Culturally Diverse Elderly

Hindi speakers

Ganguli, Ratcliff, Chandra, & Sharma (1995)

Mungas et al. (1996)

Royall, Cordes, & Polk (1998); Royall et al. (2003)

Fuld (1981)

MMSE Hindi version

MMSE Adjusted (MMSadj)

CLOX Spanish Version

Fuld Object Memory Evaluation (FOME)

African Americans, Hispanics, and Chinese

Spanish speakers

African and Hispanic Americans

Korean speakers

Park & Kwon (1990)

MMSE-K

Effective dementia screening for African Americans (Summers, Lichtenberg, & Vangel, 1995); Hispanics (Ortiz, La Rue, Romero, Sassaman, & Lindeman, 1997); and Chinese (Wu, Zhou, Como, Fan, & Qiao, 2002)

Initial findings suggest this modified clock drawing test is not affected by education or acculturation

Improved diagnostic accuracy across educational levels and ethnic groups over the MMSE

Designed to be used with those having little formal education or with the illiterate (for example, use of serial sevens, days of the week)

Altered the scoring method to improve validity

(continued overleaf)

Showed some limitations in specificity when diagnosing Alzheimer’s disease

No empirical review of the CLOX with other ethnic groups

More validation required; no validation conducted with Asian Americans

Scores still affected by lower levels of education

Scores are affected by educational levels of the Korean elderly

Asian, African, and Hispanic American White Americans and Chinese

Borson, Scanlan, Brush, Vitaliano, & Dokmak (2000)

Jorm & Jacomb (1989); Jorm (1994)

Mini Cog

Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)

English speakers

Morris et al. (1989)

Consortium to Establish a Registry for Alzheimer’s Disease (CERAD)

Language

Instrument

Source

Ethnicity or

Assessment

Translated into fifteen languages; high levels of reliability; low bias for education levels and dominant language proficiency; short form is sixteen items; seventeen-item version effective for Chinese elderly (Fuh, Teng, Lin, & Larson, 1995)

Three-minute cognitive screening evaluation; effective for use with multiethnic sample and most education levels

Translated into Bulgarian, Chinese, Dutch, Finnish, French, German, Italian, Japanese, Korean, Portuguese, and Spanish; effective for use with Native Americans (Whyte et al., 2005)

Strengths

Table 26.1. (continued)

Can be affected by the traits of the historian (for example, depression, anxiety) and by the relationship between the historian and the elderly patient (for example, caring, controlling)

Had a 27 percent false-positive rate (as opposed to 64 percent false-positive rate of the MMSE); need to do more validation

Bias found when used with African American elderly even after correcting for education and age differences (Fillenbaum et al., 2001; Welsh et al., 1995); cutoff scores not yet applicable to older adults at both younger and oldest ages (Beeri et al., 2006)

Weaknesses

Morales, GonzalezMontalvo, Bermejo, & Del-Ser (1995)

Mattis (1988)

Teng et al. (1994)

Hall, Hendrie, Britain, & Norton (1993)

S-IQCODE or SS-IQCODE

Dementia Rating Scale (DRS-2)

Cognitive Abilities Screening Instrument (CASI)

Community Screening Interview for Dementia (CSID)

American Indians, Cree speakers

Chinese and Japanese speakers

English and Spanish speakers

Spanish speakers

Ethnic bias for this test (Shadlen et al., 2001)

More empirical research needed to ensure lack of bias

Expands applicability and utility of a dementia screening instrument for American Indians

Some cultural bias possible when used with Chinese elderly (Chan, Chiu, Chien, Thompson, & Lam, 2006)

MMSE had high (but nonsignificant diagnostic power) (Del-Ser, Morales, Barquero, & Cant´on, 1997)

Created different cutoff scores for those having zero, one to five, and six and above years of formal education (Lin et al., 2002)

Developed norms for use with African Americans (Rilling et al., 2005) and Spanish Speakers (Arnold, Cuellar, & Guzman, 1998)

Improved accuracy for screening dementia over the MMSE

606 HANDBOOK OF MULTICULTURAL ASSESSMENT fair, removing items believed to be too culturally biased, and included an ethnically diverse population during efforts to establish a norm. Despite the improvements, the WAIS norms remain too broad for specific ethnic groups of elderly and are insufficiently precise.

African Americans A small number of studies addressing the measurement of intellectual functioning have been conducted with African American elderly. In 2005, Lucas and a multidisciplinary team at the Mayo Clinic collected normative data on the WAIS-R for the Older African-American Normative Studies (MOAANS) project (Lucas et al., 2005). African American (n = 309) clients living in the community from age fifty-five to eighty-nine participated in this study in an effort to establish reliable norms for African American elderly patients. Also at the Mayo Clinic, Pedraza and colleagues (2005) worked on norms for a core neuropsychological test battery that included the WAIS-R, Wechsler Memory Scale-Revised, and the Auditory Learning Test. Prior to this study, Kaufman et al. (1988) sought to determine the degree to which the WAIS-R subtests were related to race and education. In the study, the oldest age group ranged between fifty-five and seventy-four years of age. He and his colleagues found that Whites scored higher on all eleven subtests than did African Americans and that level of education attained accounted for 15 to 20 percent of the variance in WAIS-R scores on nine of the eleven subtests. Kaufman et al. did not attempt to interpret these findings for use in evaluations of cognitive impairment with the elderly, and the results did not extend to those over age seventy-four. Manly et al. (1998) found significant race effects and education effects for intelligence among African Americans. These studies reinforce the need for extreme caution when using intelligence tests to assess cognitive impairment in a population for which the test (in this case, the WAIS-R) was not developed. The hope is that the availability of new norms on the MOAANS will provide some degree of anchoring for cognitive and neuropsychological testing of older African Americans.

Latino/Hispanic Americans Measures of intellectual functioning with Latinos have been found to be culturally biased. The EIWA is a Spanish adaptation of the WAIS developed in 1965 and standardized with residents of Puerto Rico. L´opez and Romero (1988) encouraged practitioners to use the EIWA because it has fewer culturally biased items and because Spanish speakers were used for standardization. However, they found substantial differences from the WAIS (comparisons were made to the original WAIS rather than updated versions) in the conversion of raw scores to scale scores, especially on the Object Assembly and the Digit Span subtests

ASSESSMENT ISSUES FOR WORKING WITH DIVERSE POPULATIONS OF ELDERLY

of the EIWA (the two subtests most similar in content to the WAIS). As a result, determining the equivalency of the WAIS and the EIWA with respect to level of difficulty on the subtests was difficult. To account for this difficulty, L´opez and Romero suggested that given the standardization sample used for the EIWA, the EIWA is most appropriate for use with Spanish-speaking individuals from predominantly rural communities, with little educational background (less than nine years) and lower-status jobs. It is important to note that this study was not conducted using a U.S. mainland population, and the issue of whether these norms can be generalized without reservation remains for U.S. Latino/Hispanic populations. Lowenstein and colleagues (1993) studied the neuropsychological performance of Spanish-speaking (95 percent of whom were Cuban American) and English-speaking White (non-Hispanic) elderly patients with Alzheimer’s disease. In comparing the two groups on the WAIS-R, Lowenstein et al. chose to translate the WAIS-R into Spanish for their study rather than use the EIWA. They found lower educational attainment levels and lower scores on the Vocabulary, Digit Span, and Comprehension subtests of the WAIS-R for the Spanish-speaking elderly than for the White elderly. However, when they controlled for the effects of educational attainment, differences were seen only on the WAIS-R Digit Span subtest. Level of impairment due to Alzheimer’s disease also affected performance. After controlling for educational attainment, the mildly impaired Spanish speakers differed from the White elderly only on the WAIS-R Digit Span subtest, but the more moderately to severely impaired Spanish speakers had lower scores on the WAIS-R Digit Span and Comprehension subtests. These findings suggest that the following factors should be considered when assessing Spanish-speaking Latino elderly: the strong relationship between the Vocabulary subtest and educational attainment, the cultural bias found in the Comprehension subtest, and the low susceptibility to cultural bias and educational attainment of the Digit Span subtest. Cultural and test bias in tests of cognitive intellectual functioning with Spanish-speaking elderly have been documented in the use of both the WAIS-R and the EIWA (L´opez and Taussig, 1991). Furthermore, L´opez and Taussig caution that the WAIS-R can underestimate Spanish-speaking older adult intellectual functioning and the EIWA can overestimate their functioning. When conducting intellectual assessments with Spanish-speaking elderly, clinicians must use caution and consider bias.

Asian Americans The intellectual functioning of elderly Asian Americans has primarily centered around language issues and translated instruments for use with non-Englishspeaking Asians. In fact, few studies have examined Asian American elderly fluent in English. The WAIS was translated for Chinese-speaking populations

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608 HANDBOOK OF MULTICULTURAL ASSESSMENT (WAIS-RC; Gong, 1983), and research was conducted to compare results from mainland China with the WAIS-R standardization sample (Ryan, Dai, and Paolo, 1992). Findings indicated that cultural differences regarding value systems, educational approaches, and educational attainment explained differences in intersubtest scatter. A version of the WAIS was also translated for Japanese-speaking populations (Nakamura, Nakanishi, Furukawa, Hamanaka, and Tokudome, 2000). Interestingly, most of the existing studies on Asians have specifically addressed issues for Chinese and Japanese individuals in their countries of origin, and they rarely included information on the elderly. A 2001 study in Washington State (following the 1997 study in Honolulu) used the CERAD test battery with Japanese Americans (McCurry et al., 2001), including the WAIS-R Digit Span and Digit Symbol subtests. McCurry and colleagues recommended that appropriately corrected norms for use with Japanese Americans be used when interpreting the results of cognitive screening tests. The need for standardization samples that reflect the growing population of older Asian American adults in the United States reinforces the need for projects like the Mayo Clinic Older Americans Normative Studies (MOANS). Although some research (Geary et al., 1997) suggests that Asian American and White American elderly may experience comparable decline in computational and reasoning abilities in mathematics and may have similar levels of general intelligence among participants sixty to eighty years old, more research is needed to clarify and substantiate this finding. The MOANS is needed more than ever before as more ethnically diverse adults are aging. Cognitive assessment tools such as the WAIS-R and WAIS-III are often foundational in a neuropsychological battery. Without the specific language-translated tools and norms to work from, clinicians must resort to testing under conditions that are far from ideal and without established studies of reliability and validity. Although this should not prevent ethnically diverse older adults from accessing psychological testing, clinicians must use utmost caution when conducting and interpreting the results.

DEPRESSION AND PSEUDODEMENTIA Depression must also be included in this chapter given its status as the most common mental health problem found in those who are sixty-five or older (Epstein, 1976). Depression in the elderly is often underdiagnosed and thereby does not receive adequate, if any, treatment (Angel and Angel, 1995). Society often expects older adults to make somatic complaints, talk about the loss of loved ones, and be less physically active. However, the prevalence of depression among older adults is due to many factors. First,

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many minority elderly persons live near poverty level, have multiple chronic medical conditions, and experience a lack of acculturation to mainstream life. Social isolation is also common given that the family members of many older adults have little availability due to the need to work long hours to supplement low incomes and support school-age children. Other factors leading to depression can be the inability to speak English, difficulty traveling due to ambulatory problems or unsafe neighborhoods, physical limitations resulting from medical problems, and close friends who have moved away or died. Often travel to their countries of origin and maintaining telephone contact with those in their countries of origin may be beyond the family’s budget. Many elderly persons experience a loss of social status (for example, due to loss of professional identity and a sharp financial decline after retirement). They also may experience humiliations associated with being a person of color or may experience a loss of status by immigrating to a new country. The stressors related to aging are many, and ethnic minority groups have stressors that are particular to their groups. Padgett (1995) in her edited book on ethnicity and aging, provided clinicians and researchers a thorough comparison of depression among ethnic groups. More recently, researchers have examined a host of factors important to the accurate diagnosis and treatment of depression among the elderly, such as gender, race, and social class (Covinsky et al., 2003; Francoeur, 2006; Kales and Mellow, 2003; Kales, Neighbors, Blow et al., 2005; Kales, Neighbors, Valenstein et al., 2005; Lagan`a and Sosa, 2004; Lavretsky and Small, 2004; Van Gorp, Root, and Sackeim, 2004). Although psychotic depression is the most commonly seen variant in inpatient hospital units, less severe forms such as pseudodementia and masked depression, conditions in which where physical complaints are not found to have a physiological basis, are also commonly observed in inpatient as well as outpatient settings. In masked depression, somatic symptoms are often overlooked as potential depressive symptoms. Clinicians must attend to the possibility of depression in older adults given that many cultures tend to express depression by somatization of symptoms (Grau and Padgett, 1988). When individuals also have chronic medical conditions, differentiating masked depression is particularly difficult (Kales and Mellow, 2003). In addition, merely living with chronic medical conditions can be stressful. Neurovegetative signs can also be an indicator of the presence of depression. Many older adults may not seek treatment and instead withdraw or fail to recognize the presence of depressive symptomotology. They may attribute feeling poorly as being due to external circumstances such as losses or poverty rather than realizing that physiological changes due to age can also bring about depression in a way that makes coping more difficult.

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Pseudodementia A common assessment referral need is to make differential diagnoses between depression and dementia. In pseudodementia, or the ‘‘dementia syndrome of depression’’ (Spar and La Rue, 1990, 2006), patients can appear demented as a result of their cognitive impairment, poor grooming, declining activities of daily living, poor eye contact, and slumped posture, for example. When tested, their performance is not at the low levels that indicate organic impairment. Odd behaviors typically observed in patients having dementia such as leaving pants unzipped, wearing underclothes over outer clothing, wandering, or confabulating are not present. Because many minority elderly patients having low education levels tend to have low scores on the MMSE, other behaviors consistent with dementia should be observed before considering the possibility of dementia. It is often necessary to observe the patient’s response to treatment (such as medication and therapy) before a clearer picture can be seen. Individuals with pseudodementia, unlike dementia patients, can show improvement in cognitive functioning when treated with antidepressants (McNeil, 2001). Clinicians who normally do not work with the elderly and the syndrome of dementia should consult with geriatric specialists who are knowledgeable about issues of aging and aware of testing bias issues. Misdiagnosis can lead to treatment that may not be appropriate for the patient. Spar and LaRue (2006) offered useful observations regarding differences between dementia and pseudodementia in their book, Clinical Manual to Geriatric Psychiatry.

Depression Screening Scales Depression screening measures were originally designed for research. Although scoring within specified ranges on the various depression screening scales is not sufficient to make a diagnosis of depression, the scales can provide helpful information about the presence of depressive symptoms. While these scales were developed to assess depression based on the Western medical model of medicine, they continue to be used and translated into different languages because few other options are available. A few commonly used scales that have been used across cultures are the Beck Depression Scale (BDI; Beck, 1978), Geriatric Depression Scale (GDS; Yesavage, 1982), Hamilton Rating Scale for Depression (HRSD; Hamilton, 1980), and Zung Self-Rating Scale (Zung, 1965). With the exception of the Geriatric Depression Scale, many cross-cultural studies did not use a specific elderly population. The validity of the GDS was substantiated for use with a Japanese American population (Iwamasa, Hilliard, and Kost, 1998), a Chinese American population (Lee, 1992), a Mexican American/Spanish-speaking population (Baker and Espino, 1997),

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and an Iranian population (Malakouti, Fatollahi, Mirabzadeh, Salavati, and Zandi, 2006). Long and short forms of the Chinese GDS were also compared (Liu, Lu, Yu, and Yang, 1998). The GDS has also been translated into a variety of languages such as Spanish, Hindi, Vietnamese, Korean, Russian, and Romanian, and these versions are available on the Internet (Yesavage, 2006). The most common criticism of the depression screening scales is their failure to be adapted so that they are culturally appropriate for individuals of diverse cultural backgrounds. Although this limitation results in restricted cultural validity (Marsella, Sartorius, Jablensky, and Fenton, 1985), the scales are robust enough to differentiate within-group differences between the depressed and nondepressed. Despite their limited utility in non-Western populations, the scales are still being used in clinical settings because of the lack of other options and because they aid in quantifying depressive symptoms. However, scores must be interpreted with the utmost of caution and never in isolation from other clinical information.

CASE STUDY OF AN ELDERLY CHINESE CLIENT To contextualize the information presented in this chapter, the example that follows describes the case of an elderly Chinese immigrant to the United States.

Presenting Problem Mrs. Lan is a sixty-five-year-old Chinese woman from the People’s Republic of China. Her daughter and granddaughter have been worried about her because during the week, she leaves the stove on, runs water too hot for a bath, or leaves the door wide open when she ventures out of their city housing apartment in the projects. She often loses money and blames them for taking it. Her daughter leaves food cooked for her, but she fails to eat during the day. Her daughter reports she cries at home and leaves the apartment searching for them and subsequently gets lost. Thankfully, their neighbors have brought her home on more than one occasion. They do not understand why she does not pick up the phone or call them when she feels lonely. Background History Mrs. Lan grew up in rural China and is illiterate. Her family was poor, and her brother was selected to go to school. They were peasants who worked on a collective farm during the Maoist era. When she married, her husband moved the family to a small town and worked at a government-run factory. She assisted by cooking for the staff. She had two children. At present, she lives with her second daughter whose husband’s relatives sponsored them so they could immigrate to the United States when Mrs. Lan was fifty-five years of age. Her daughter works in a sewing factory in Chinatown, and her granddaughter is now in high school. She stays at home alone, as she is unable to do the simplest task of trimming thread at the sewing factory.

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612 HANDBOOK OF MULTICULTURAL ASSESSMENT Mrs. Lan’s mother lived with the family and died in her seventies in China after ‘‘a period of confusion,’’ according to her daughter. Despite her mental confusion, Mrs. Lan does not have any medical problems other than weight loss (from failure to eat when no one is supervising). She is not on any medications other than vitamins. Mrs. Lan does not drink alcohol or smoke. Presentation When she came to the session, her clothes were buttoned incorrectly. Her affect was flat, and she played with a button on her vest over and over. She reported having eggs for breakfast, yet she had not eaten. At times she did not answer questions addressed to her by the clinician as if she was not mentally present. Measures and Assessments The choice of assessment tools was based on those available at the clinic. Aside from the MMSE, portions of the Mattis Dementia Rating Scale were administered, minus aspects that were too language related. The Bender Gestalt was used to screen for signs of brain disruptions. Instructions during assessment were given in Chinese. Her scores on the MMSE were expected to be low given Mrs. Lan’s lack of formal education and unfamiliarity with information related to the United States. Since she does not speak any English, the language-related portions of the Mattis Dementia Rating Scales were omitted, but a number of subtests were presented and terminated when she was not making any progress and the task was beginning to agitate her. She was given the Bender Gestalt to screen for obvious organic signs. No further neuropsychological testing was administered because she did not have the attention and concentration to tolerate more than fifteen minutes per sitting. She came for four sessions, and testing was discontinued each time after fifteen minutes when the client was unable to go on. Despite the absence of normative data, the tools were selected because they were available at the clinic and could offer valuable information about Mrs. Lan’s functioning level. Mrs. Lan’s daughter and granddaughter were interviewed to gather information about the patient’s behavior and capabilities at home. They also provided some personal and medical background information and current medical history. Questions Considered During Testing To what degree is the poor performance on the MMSE, DRS, and Bender a culprit of having no formal education? How much of her poor performance was related to language? Can the diagnosis of dementia be comfortably concluded based on the information gathered? MMSE and Findings Mrs. Lan was oriented in person but not in time or place. She was unable to recall the day of the week or month, date, and year. She was able to report being in the United States but not the city or state. She could not report the name of the mayor

ASSESSMENT ISSUES FOR WORKING WITH DIVERSE POPULATIONS OF ELDERLY or governor. Although she was aware of being in the hospital, she did not know the hospital’s name or what floor she was on. Her overall scores were very low for all other categories, including subtracting by sevens from one hundred (and subtraction by twos) and copying pentagons. Words for recall were substituted with Chinese words. She barely repeated one word before losing concentration. Findings Lack of education, illiteracy, and lack of English aside, Mrs. Lan’s clinical picture supports a diagnosis of dementia. She presented with significant difficulty in memory, physical coordination, initiation of action, word production, and visual organization. Diagnosis. Dementia of the Alzheimer’s type Prognosis. Poor

As the case study indicates, the assessment tools selected were based on availability at the clinic. Unfortunately, limitations regarding the choice of assessments as well as availability of assessments often narrow clinicians’ range of options for assessment with the elderly. Although this is obviously not ideal, clinicians in the community are often challenged to understand the purpose and power of an assessment tool and how to use the instrument to make it work when other options are unavailable or have yet to be developed. In the absence of published norms, clinicians sometimes must turn to their own experience (or their consulting colleagues’) to provide some basis of comparison. Compared to other Chinese patients who are relatively free of medical conditions, Mrs. Lan’s missed items, such as name and location of the clinic or the name of reigning politicians, are fairly common. However, timeand date-related questions, subtracting by sevens, recall of Chinese words, and reproduction of shapes by drawing should be mostly intact. In her case, subtracting by sevens was supplemented by subtracting by twos, as her lack of education could interfere with her score. Consideration was given to the impact of education even when she had difficulty with subtracting twos. Yet Mrs. Lan also had difficulty naming two items when asked to identify food found at the marketplace. Many psychiatric patients show deterioration in their performance on the MMSE. Hence it is not sufficient to substantiate the diagnosis of dementia. Additional confirming information such as other testing data, current behavior and problems in functioning, family and personal medical history, and loss of functioning as documented in a psychological assessment can create a fuller picture supporting dementia. Mrs. Lan’s family reports that she was once able to count and complete simple shopping. She was able to manage basic addition and subtraction as she had to shop and cook for the factory staff. She maintained the role of cook for

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614 HANDBOOK OF MULTICULTURAL ASSESSMENT many years while managing her household and was a decent housekeeper. She was sociable and helped the family survive by growing a yard of vegetables. Due to the lack of history of hypertension or cerebral vascular accidents and the relative absence of medical problems, and no history of alcohol use, dementia related to strokes or alcohol is unlikely. Although dementia of the Alzheimer’s type is confirmed only at autopsy, Mrs. Lan’s overall picture suggests dementia of the Alzheimer’s type, most likely in the midstage. It is likely that Mrs. Lan is unable to make telephone calls to her daughter because her brain has declined to where she is no longer able to link information together. Dementia is a condition that often disrupts neuronal connections. Hence, clinicians who frequently work with geriatric clients need to know how assessment information translates to real life. Clinicians provide information for family and caretakers about the patient’s functioning capacity so as to avoid faulty expectations, blaming, or other unnecessary stressors. For example, Mrs. Lan is no longer able to dial a phone because her mind can no longer connect the sequence of behaviors required to do this seemingly simple task. Hence, she is unable to remember to eat, control the bath water temperature, and close the door behind her when she leaves the apartment. Fortunately for her safety, she has been unable to find her way out of the apartment building, allowing neighbors to bring her home. Although Mrs. Lan had some symptoms of mild depression, her overall picture is not suggestive of pseudodementia caused by depression. Pseudodementia patients are concerned about their loss of memory. Mrs. Lan is no longer aware of her memory loss. Knowledge about established research addressing the effects of education on the results of assessment tools such as the MMSE provides information about the dangers of overinterpretation of dysfunction, especially when working with ethnically diverse clients who are in good health and have limited education. The details of acceptable and unacceptable errors, however, require clinical experience or consultation about the population and the client’s background information (for example, education, knowledge of English, access to information), mental well-being, and intelligence. It might be helpful to track Mrs. Lan’s progression in the next few months or year to see if she shows further deterioration to confirm that her illness is progressive and not a reflection of a temporary state.

CONCLUSION The information presented in this chapter is intended to assist practitioners and researchers in providing culturally sensitive assessments to older adults. A relatively small number of studies have been conducted with culturally

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sensitive assessments of multiethnic elderly as a goal. However, researchers who have begun to contribute to the understanding of minority elderly have made substantial gains. Already, some assessment instruments have been translated into a variety of languages, and several have been validated with minority older adults in the United States. The instruments that have been translated tend to be the measures that are most commonly used. More specialized instruments such as assessments of memory, problem solving, and visual organization have yet to be prepared and validated for use with ethnically diverse elderly. Future researchers should begin to address these more specialized areas. Nonverbal tests of cognitive ability such as the Beta III (Kellogg and Morton, 1999) should also be validated for use with the elderly. Clinicians must be aware of the limitations of many of the currently available translated versions of measures. For example, the EIWA overestimates intelligence, whereas the WAIS-R underestimates intelligence (L´opez and Taussig, 1991). The MMSE and other dementia assessment measures are affected by education level, poverty, gender, and race, so caution must be exercised when using these tools (Espino, Lichtenstein, Palmer, and Hazuda, 2004; Wood, Giuliano, Bignell, and Pritham, 2006). As a result, such variables as the educational attainment of older adults and the ages used for normative data affect the validity of the instruments. Another area for future research is in studying geriatric patients who are representative of the vast array of cultures present in the United States. Given that virtually no information was available for geriatric assessments with Native American elderly, this is clearly an area that deserves priority. Similarly, many racial ethnic groups with large U.S. populations continue to be represented by only a handful of studies. Finally, accurate normative samples should be obtained for instruments used with minority elderly. Despite the important contributions of the researchers already identified in this chapter, a tremendous amount of work needs to be done to prepare clinicians for the steadily increasing geriatric population. We hope that this review will aid practitioners in their provision of culturally competent assessments of older adults and will encourage additional work in this area.

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616 HANDBOOK OF MULTICULTURAL ASSESSMENT Baker, F. M., & Espino, D. V. (1997). A Spanish version of the Geriatric Depression Scale in Mexican-American elders. International Journal of Geriatric Psychiatry, 12(1), 21–25. Beck, A. T. (1978). Beck Depression Inventory. Philadelphia: Philadelphia Center for Cognitive Therapy. Beeri, M. S., Schmeidler, J., Sano, M., Wang, J., Lally, R., Grossman, H., et al. (2006). Age, gender, and education norms on the CERAD neuropsychological battery in the oldest old. Neurology, 67(6), 1006–1010. Bohnstedt, M., Fox, P. J., & Kohatsu, N. D. (1994). Correlates of Mini-Mental Status Examination scores among elderly demented patients: The influence of race-ethnicity. Journal of Clinical Epidemiology, 47(12), 1381–1387. Borson, S., Scanlan, J., Brush, M., Vitaliano, P., & Dokmak, A. (2000). The Mini-Cog: A cognitive ‘‘vital signs’’ measure for dementia screening in multi-lingual elderly. International Journal of Geriatric Psychiatry, 15(11), 1021–1027. Borson, S., Scanlan, J. M., Watanabe, J., Tu, S. P., & Lessig, M. (2005). Simplifying detection of cognitive impairment: Comparison of the Mini-Cog and Mini-Mental state examination in a multiethnic sample. Journal of the American Geriatrics Society, 53(5), 871–874. Chan, S.W.C., Chiu, H.F.K., Chien, W. T., Thompson, D. R., & Lam, L. (2006). Quality of life in Chinese elderly people with depression. International Journal of Geriatric Psychiatry, 21(4), 312–318. Cohen, C. I., & Carlin, L. (1993). Racial differences in clinical and social variables among patients evaluated in a dementia assessment center. Journal of the National Medical Association, 85(5), 379–384. Covinsky, K. E., Newcomer, R., Fox, P., Wood, J., Sands, L., Dane, K., et al. (2003). Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. Journal of General Internal Medicine, 18(12), 1006–1014. Dana, R. H. (1993). Multicultural assessment perspectives for professional psychology. Needham Heights, MA: Allyn & Bacon. Del-Ser, T., Morales, J.-M., Barquero, M. S., & Cant´on, R. (1997). Application of a Spanish version of the ‘‘Informant Questionnaire on Cognitive Decline in the Elderly’’ in the clinical assessment of dementia. Alzheimer Disease and Associated Disorders, 11(1), 3–8. Dick, M. B., Teng, E. L., Kempler, D., Davis, D. S., & Taussig, I. M. (2002). The Cross-Cultural Neuropsychological Test Battery (CCNB): Effects of age, education, ethnicity, and cognitive status on performance. In F. R. Ferraro (Ed.), Minority and cross-cultural aspects of neuropsychological assessment (pp. 17–41). Lisse, Netherlands: Swets & Zeitlinger. Eggebeen, D. J., & Sturgeon, S. (2006). Demography of the baby boomers. In S. K. Whitbourne & S. L. Willis (Eds.), The baby boomers grow up: Contemporary perspectives on midlife (pp. 3–21). Mahwah, NJ: Erlbaum.

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618 HANDBOOK OF MULTICULTURAL ASSESSMENT Grau, L., & Padgett, D. (1988). Somatic depression among the elderly: A sociocultural perspective. International Journal of Geriatric Psychiatry, 3(3), 201–207. Haley, W. E., Han, B., & Henderson, J. N. (1998). Aging and ethnicity: Issues for clinical practice. Journal of Clinical Psychology in Medical Settings, 5(3), 393–409. Hall, K. S., Hendrie, H. C., Brittain, H. M., & Norton, J. A. (1993). The development of a dementia screening interview in two distinct languages. International Journal of Methods in Psychiatric Research, 3(1), 1–28. Hamilton, M. (1980). Rating depressive patients. Journal of Clinical Psychiatry, 41(12), 21–24. Hays, P. A. (1996). Culturally responsive assessment with diverse older clients. Professional Psychology: Research and Practice, 27(2), 188–193. Hedden, T., Park, D. C., Nisbett, R., Ji, L.-J., Jing, Q., & Jiao, S. (2002). Cultural variation in verbal versus spatial neuropsychological function across the life span. Neuropsychology, 16(1), 65–73. Iwamasa, G. Y., Hilliard, K. M., & Kost, C. R. (1998). The Geriatric Depression Scale and Japanese American older adults. Clinical Gerontologist, 19(3), 13–24. Jia, X., Li, S., Chen, C., & Zhang, W. (1999). Preliminary test of the Psychogeriatric Assessment Scales (PAS). Chinese Mental Health Journal, 13(4), 193–196. Jorm, A. F. (1994). A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): Development and cross-validation. Psychological Medicine, 24(1), 145–153. Jorm, A. F. (2004). The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): A review. International Psychogeriatrics, 16(3), 275–293. Jorm, A. F., & Jacomb, P. A. (1989). The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): Socio-demographic correlates, reliability, validity and some norms. Psychological Medicine, 19(4), 1015–1022. Kales, H. C., & Mellow, A. M. (2003). Psychiatric assessment and treatment of depression in dementia. In P. A. Lichtenberg, D. L. Murman, & A. M. Mellow (Eds.), Handbook of dementia: Psychological, neurological, and psychiatric perspectives (pp. 269–307). Hoboken, NJ: Wiley. Kales, H. C., Neighbors, H. W., Blow, F. C., Taylor, K.K.K., Gillon, L., Welsh, D. E., et al. (2005). Race, gender, and psychiatrists’ diagnosis and treatment of major depression among elderly patients. Psychiatric Services, 56(6), 721–728. Kales, H. C., Neighbors, H. W., Valenstein, M., Blow, F. C., McCarthy, J. F., Ignacio, R. V., et al. (2005). Effect of race and sex on primary care physicians’ diagnosis and treatment of late-life depression. Journal of the American Geriatrics Society, 53(5), 777–784. Kaufman, A. S., McLean, J. E., & Reynolds, C. R. (1988). Sex, race, residence, region, and education differences on the 11 WAIS—R subtests. Journal of Clinical Psychology, 44(2), 231–248. Kellogg, C. E., & Morton, N. W. (1999). Beta III. Odessa, FL: Psychological Corp.

ASSESSMENT ISSUES FOR WORKING WITH DIVERSE POPULATIONS OF ELDERLY Lagan`a, L., & Sosa, G. (2004). Depression among ethnically diverse older women: The role of demographic and cognitive factors. Educational Gerontology, 30(10), 801–820. Lavretsky, H., & Small, G. W. (2004). Mixed cognitive and depressive syndromes. In S. P. Roose & H. A. Sackeim (Eds.), Late-life depression (pp. 81–94). New York: Oxford University Press. Lee, H.C.B. (1992). Chinese translation of geriatric depression scale. Clinical Gerontologist, 12(1), 90–91. Lin, K.-N., Wang, P.-N., Liu, C.-Y., Chen, W.-T., Lee, Y.-C., & Liu, H.-C. (2002). Cutoff scores of the Cognitive Abilities Screening Instrument, Chinese version in screening of dementia. Dementia and Geriatric Cognitive Disorders, 14(4), 176–182. Liu, C.-Y., Lu, C.-H., Yu, S., & Yang, Y.-Y. (1998). Correlations between scores on Chinese versions of long and short forms of the Geriatric Depression Scale among elderly Chinese. Psychological Reports, 82(1), 211–214. L´opez, S., & Romero, A. (1988). Assessing the intellectual functioning of Spanishspeaking adults: Comparison of the EIWA and the WAIS. Professional Psychology: Research and Practice, 19(3), 263–270. L´opez, S. R., & Taussig, I. M. (1991). Cognitive-intellectual functioning of Spanishspeaking impaired and nonimpaired elderly: Implications for culturally sensitive assessment. Psychological Assessment, 3(3), 448–454. ¨ ¨ Lowenstein, D. A., Arguelles, T., Arguelles, S., Linn-Fuentes, P. (1994). Potential cultural bias in the neuropsychological assessment of the older adult. Journal of Clinical and Experimental Neuropsychology, 16(4), 623–629. ¨ Lowenstein, D. A., Arguelles, T., Barker, W. W., & Duara, R. (1993). A comparative analysis of neuropsychological test performance of Spanish-speaking and English-speaking patients with Alzheimer’s disease. Journals of Gerontology, 48(3), 142–149. Lucas, J. A., Ivnik, R. J., Smith, G. E., Ferman, T. J., Willis, F. B., Petersen, R. C., et al. (2005). A brief report on WAIS-R Normative data collection in Mayo’s older African Americans normative studies. Clinical Neuropsychologist, 19(2), 184–188. Luo, G., Han, J., Qu, Q., Qiao, J., Yang, J., Wu, C., et al. (2002). The suitable application of the MMSE in people aged over 55 in urban and rural areas. Chinese Journal of Clinical Psychology, 10(1), 10–13. Mahurin, R. K., Espino, D. V., & Holifield, E. B. (1992). Mental status testing in elderly Hispanic populations: Special concerns. Psychopharmacology Bulletin, 28(4), 391–399. Malakouti, S. K., Fatollahi, P., Mirabzadeh, A., Salavati, M., & Zandi, T. (2006). Reliability, validity and factor structure of the GDS-15 in Iranian elderly. International Journal of Geriatric Psychiatry, 21(6), 588–593. Manly, J. J., Jacobs, D. M., Sano, M., Bell, K., Merchant, C. A., Small, S. A., et al. (1998). Cognitive test performance among nondemented elderly African Americans and Whites. Neurology, 50(5), 1238–1245.

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620 HANDBOOK OF MULTICULTURAL ASSESSMENT Manly, J. J., Jacobs, D. M., Touradji, P., Small, S. A., & Stern, Y. (2002). Reading level attenuates differences in neuropsychological test performance between African American and White elders. Journal of the International Neuropsychological Society, 8(3), 341–348. Marsella, A. J., Sartorius, N., Jablensky, A., & Fenton, F. R. (1985). Cross-cultural studies of depressive disorders. In A. Kleinman & B. Good (Eds.), Culture and depression: Studies in the anthropology and cross-cultural psychiatry of affect and disorder (pp. 299–324). Berkeley: University of California Press. Marshall, S. C., Mungas, D., Weldon, M., Reed, B., & Haan, M. (1997). Differential item functioning in the Mini-Mental State Examination in English- and Spanish-speaking older adults. Psychology and Aging, 12(4), 718–725. Mast, B. T., Fitzgerald, J., Steinberg, J., MacNeill, S. E., & Lichtenberg, P. A. (2001). Effective screening for Alzheimer’s disease among older African Americans. Clinical Neuropsychologist, 15(2), 196–202. Mattis, S. (1988). Dementia Rating Scale. Odessa, FL: Psychological Assessment Resources. McCurry, S. M., Gibbons, L. E., Uomoto, J. M., Thompson, M. L., Graves, A. B., Edland, S. D., et al. (2001). Neuropsychological test performance in a cognitively intact sample of older Japanese American adults. Archives of Clinical Neuropsychology, 16(5), 447–459. McNeil, J. K. (2001). No mistaken identity: Pseudodementia is real and treatable. Journal of the American Geriatrics Society, 49(4), 492–493. Morales, J.-M., Gonzalez-Montalvo, J.-I., Bermejo, F. L., & Del-Ser, T. (1995). The screening of mild dementia with a shortened Spanish version of the ‘‘Informant Questionnaire on Cognitive Decline in the Elderly. Alzheimer Disease and Associated Disorders, 9(2), 105–111. Morris, J. C., Heyman, A., Mohs, R. C., Hughes, J. P., et al. (1989). The consortium to establish a registry for Alzheimer’s disease (CERAD): I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology, 39(9), 1159–1165. Mungas, D., Marshall, S. C., Weldon, M., Haan, M., & Reed, B. R. (1996). Age and education correction of Mini-Mental State Examination for English- and Spanish-speaking elderly. Neurology, 46(3), 700–706. Murden, R. A., McRae, T. D., Kaner, S., & Bucknam, M. E. (1991). Mini-Mental State exam scores vary with education in Blacks and Whites. Journal of the American Geriatrics Society, 39(2), 149–155. Nakamura, H., Nakanishi, M., Furukawa, T., Hamanaka, T., & Tokudome, S. (2000). Validity of brief intelligence tests for patients with Alzheimer’s disease. Psychiatry and Clinical Neurosciences, 54(4), 435–439. Ortiz, I. E., La Rue, A., Romero, L. J., Sassaman, M. F., & Lindeman, R. D. (1997). Comparison of cultural bias in two cognitive screening instruments in elderly Hispanic patients in New Mexico. American Journal of Geriatric Psychiatry, 5(4), 333–338.

ASSESSMENT ISSUES FOR WORKING WITH DIVERSE POPULATIONS OF ELDERLY Padgett, D. K. (Ed.). (1995). Handbook on ethnicity, aging, and mental health. Westwood, CT: Greenwood Press. Park, J. H., & Kwon, Y. C. (1990). Modification of the Mini-Mental State Examination for use in the elderly in a non-Western society: I. Development of Korean Version of Mini-Mental State Examination. International Journal of Geriatric Psychiatry, 5(6), 381–387. Patton, D. E., Duff, K., Schoenberg, M. R., Mold, J., Scott, J. G., & Adams, R. L. (2003). Performance of cognitively normal African Americans on the RBANS in community dwelling older adults. Clinical Neuropsychologist, 17(4), 515–530. Pedraza, O., Lucas, J. A., Smith, G. E., Willis, F. B., Graff-Radford, N. R., Ferman, T. J., et al. (2005). Mayo’s older African American normative studies: Confirmatory factor analysis of a core battery. Journal of the International Neuropsychological Society, 11(2), 184–191. Ram´ırez, M., Teresi, J. A., Silver, S., Holmes, D., Gurland, B., & Lantigua, R. (2002). Cognitive assessment among minority elderly: Possible test bias. In J. H. Skinner, J. A. Teresi, D. Holmes, S. M. Stahl, & A. L. Stewart (Eds.), Multicultural measurement in older populations (pp. 97–125). New York: Springer. Rilling, L. M., Lucas, J. A., Ivnik, R. J., Smith, G. E., Willis, F. B., Ferman, T. J., et al. (2005). Mayo’s Older African American Normative Studies: Norms for the Mattis Dementia Rating Scale. Clinical Neuropsychologist, 19(2), 229–242. Royall, D. R., Cordes, J. A., & Polk, M. (1998). CLOX: An executive clock drawing task. Journal of Neurology, Neurosurgery & Psychiatry, 64(5), 588–594. Royall, D. R., Espino, D. V., Polk, M. J., Verdeja, R., Vale, S., Gonzales, H., et al. (2003). Validation of a Spanish translation of the CLOX for use in Hispanic samples: The Hispanic EPESE study. International Journal of Geriatric Psychiatry, 18(2), 135–140. Ryan, J. J., Dai, X., & Paolo, A. M. (1992). Intersubtest scatter on the mainland Chinese version of the Wechsler Adult Intelligence Scale. Psychological Assessment, 4(1), 60–62. Shadlen, M.-F., Larson, E. B., Gibbons, L. E., Rice, M. M., McCormick, W. C., Bowen, J., et al. (2001). Ethnicity and cognitive performance among older African Americans, Japanese Americans, and Caucasians: The role of education. Journal of the American Geriatrics Society, 49(10), 1371–1378. Skinner, J. H., Teresi, J. A., Holmes, D., Stahl, S. M., & Stewart, A. L. (Eds.). (2002). Multicultural measurement in older populations. New York: Springer. Spar, J. E., & La Rue, A. (1990). Concise guide to geriatric psychiatry. Washington, DC: American Psychiatric Press. Spar, J. E., & La Rue, A. (2006). Clinical manual of geriatric psychiatry. Washington, DC: American Psychiatric Publishing. Stewart, R., Richards, M., Brayne, C., & Mann, A. (2001). Cognitive function in UK community-dwelling African Caribbean elders: Normative data for a test battery. International Journal of Geriatric Psychiatry, 16(5), 518–527.

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622 HANDBOOK OF MULTICULTURAL ASSESSMENT Storey, J. E., Rowland, J.T.J., Basic, D., & Conforti, D. A. (2002). Accuracy of the clock drawing test for detecting dementia in a multicultural sample of elderly Australian patients. International Psychogeriatrics, 14(3), 259–271. Summers, J. D., Lichtenberg, P. A., & Vangel, S. J. (1995). Fuld Object-Memory Evaluation in an urban geriatric population. Clinical Gerontologist, 15(4), 21–34. Taussig, I. M., Mack, W. J., & Henderson, V. W. (1996). Concurrent validity of Spanish-language versions of the Mini-Mental State Examination, Mental Status Questionnaire, Information-Memory-Concentration Test, and Orientation-MemoryConcentration Test: Alzheimer’s disease patients and nondemented elderly comparison subjects. Journal of the International Neuropsychological Society, 2(4), 286–298. Teng, E. L., Hasegawa, K., Homma, A., Imai, Y., et al. (1994). The Cognitive Abilities Screening Instrument (CASI): A practical test for cross-cultural epidemiological studies of dementia. International Psychogeriatrics, 6(1), 45–58. Teresi, J. A., Holmes, D., Ram´ırez, M., Gurland, B. J., & Lantigua, R. (2001). Performance of cognitive tests among different racial/ethnic and education groups: Findings of differential item functioning and possible item bias. Journal of Mental Health and Aging, 7(1), 79–89. Teresi, J. A., Holmes, D., Ram´ırez, M., Gurland, B. J., & Lantigua, R. (2002). Performance of cognitive tests among different racial/ethnic and education groups: Findings of differential item functioning and possible item bias. In J. H. Skinner, J. A. Teresi, D. Holmes, S. M. Stahl, & A. L. Stewart (Eds.), Multicultural measurement in older populations (pp. 85–96). New York: Springer. U.S. Census Bureau. (2006). 2006 statistical abstract: The national data book. Retrieved December 14, 2006, from http://www.census.gov/compendia/statab/ vital statistics/life expectancy/. Valle, R. (1998). Caregiving across cultures: Working with dementing illness and ethnically diverse populations. Philadelphia: Taylor & Francis. Van Gorp, W. G., Root, J. C., & Sackeim, H. A. (2004). Neuropsychological assessment of late-life depression. In S. P. Roose & H. A. Sackeim (Eds.), Late-life depression (pp. 117–128). New York: Oxford University Press. Weiner, M. F., Rosenberg, R. N., Svetlik, D., Hynan, L. S., Womack, K. B., White, C., III, et al. (2003). Comparison of Alzheimer’s disease in Native Americans and Whites. International Psychogeriatrics, 15(4), 367–375. Welsh, K. A., Fillenbaum, G., Wilkinson, W., & Heyman, A. (1995). Neuropsychological test performance in African-American and White patients with Alzheimer’s disease. Neurology, 45(12), 2207–2211. Whyte, S. R., Cullum, C. M., Hynan, L. S., Lacritz, L. H., Rosenberg, R. N., & Weiner, M. F. (2005). Performance of elderly Native Americans and Caucasians on the CERAD Neuropsychological Battery. Alzheimer Disease and Associated Disorders, 19(2), 74–78. Wong, G., & Baden, A. L. (2001). Multiculturally sensitive assessment with older adults: Recommendations and areas for additional study. In L. A. Suzuki, J. G. Ponterotto,

ASSESSMENT ISSUES FOR WORKING WITH DIVERSE POPULATIONS OF ELDERLY & P. J. Meller (Eds.), Handbook of multicultural assessment: Clinical, psychological, and educational applications (2nd ed., pp. 497–522). San Francisco: Jossey-Bass. Wood, R. Y., Giuliano, K. K., Bignell, C. U., & Pritham, W. W. (2006). Assessing cognitive ability in research: Use of MMSE with minority populations and elderly adults with low education levels. Journal of Gerontological Nursing, 32(4), 45–54. Wu, C., Zhou, D., Como, P., Fan, J., & Qiao, Y. (2002). Neuropsychological and functional test in an Alzheimer’s disease screening in rural area of Henan province, China. Chinese Mental Health Journal, 16(9), 587–589. Yeo, G., & Gallagher-Thompson, D. (Eds.). (1996). Ethnicity and the dementias. Philadelphia: Taylor & Francis. Yesavage, J. A. (1982). Development and validation of a Geriatric Depression Screening Scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37–49. Yesavage, J. A. (2006, December 15). Geriatric Depression Scale. Retrieved from http://www.stanford.edu/∼yesavage/GDS.html. Young, S. (2003). Minority and cross cultural aspects of neuropsychological assessment. Personality and Individual Differences, 35(3), 725–726. Zsembik, B. A., & Peek, M. K. (2001). Race differences in cognitive functioning among older adults. Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 56(5), 266–274. Zung, W. W. (1965). A self-rating depression scale. Archives of General Psychiatry, 12(1), 63–70.

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SECTION THREE

FORENSIC ASSESSMENT

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ection Three contains two chapters focusing on assessing child maltreatment and criminal competence. This section is an important new addition to the Handbook given the decisions that are made based on these evaluations. In Chapter Twenty-Seven, Lisa A. Fontes and Margarita R. O’Neill-Arana examine how bias can be reduced when assessing for child maltreatment among culturally diverse families. The authors examine racial disproportionality in the child welfare system, identification of false positives based on ethnocentrism, unfamiliar discipline methods, unfamiliar medical interventions, and linguistic misunderstandings. Cases illustrate various issues throughout the chapter. Chapter Twenty-Eight, by Sergei V. Tsytsarev and Amanda Landes, looks at cultural considerations in determining competency to stand trial. The authors provide information regarding the goals and objectives of competency evaluation and how these can potentially be addressed from a multicultural standpoint. They specifically highlight linkages among competency, intelligence, and diagnosis.

CHAPTER TWENTY-SEVEN

Assessing for Child Maltreatment in Culturally Diverse Families Lisa A. Fontes Margarita R. O’Neill-Arana

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his chapter provides information on how to reduce bias when assessing for child maltreatment among culturally diverse families.1 It describes some of the ways professionals commonly mistake cultural differences for child abuse or neglect, or overlook child abuse in families that differ from them culturally. It also helps readers determine whether the unfamiliar practices that they are seeing in a family constitute child maltreatment or whether they are simply cultural variations in child rearing. For individuals who are mandated reporters but not protective social workers, the most common question when thinking about assessing risk is: Do I have enough suspicion of child maltreatment to file a report? Those who work more closely with child welfare systems, including social workers, attorneys, detectives, judges, and guardians ad litem, address delicate questions: Is the evidence strong enough to substantiate or support a report that child maltreatment has occurred or a child is at risk? Is the family environment safe enough for the child to remain in the home or be reunited with his or her family? What kinds of changes or supports would ensure a child’s safety? Although their responsibilities differ, all people who work with children may get caught up in similar dilemmas involving cultural differences when assessing for child abuse.

This chapter contains material adapted with permission from Fontes, L. A. (2005). Child Abuse and Culture: Working with Diverse Families. New York: Guilford Press.

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628 HANDBOOK OF MULTICULTURAL ASSESSMENT In this chapter, we discuss ways to overcome some of the challenges that confront mandated reporters when the family under consideration is from a minority cultural group. We also describe common situations that occur when working with families from diverse cultural backgrounds that can lead to erroneously reporting abuse in a family or, conversely, failing to identify ongoing child abuse. Examples from clinical practice illustrate ways in which cultural practices may appear to be abuse. We present interventions that can help clarify concerns or suspicions of child abuse and assess whether a child is at risk while respecting the family’s culture. In addition, we share strategies that have helped us connect with families from different cultural backgrounds in protecting their children and reducing their risk for abuse. We hope this chapter will help readers avoid bias in their decision-making process—whether that bias is for or against members of a particular group. We are not assuming that readers are from the dominant group. Regardless of their own cultural background, most professionals in the United States have been schooled to see people from the dominant group as the norm and people from other groups as deviant.

RACIAL DISPROPORTIONALITY Discussing assessment raises a particularly urgent and contentious issue: ethnic, racial, and social class differences in ushering families into the child welfare system. While national incidence studies indicate that there are no significant differences in maltreatment rates between African Americans and Whites (U.S. Department of Health and Human Services, 1996), national, state, and municipal statistics reveal that African Americans and Native Americans are disproportionately caught up in the child welfare and foster care systems. For instance, ‘‘In most jurisdictions African Americans are more likely than Whites, Hispanics or Asians to have allegations of maltreatment substantiated and to have children placed in out-of-home care’’ (Baird, Ereth, and Wagner, 1999, p. 3). Another way of looking at the issue of disproportionality concerns the fact that while only 15 percent of children under age eighteen are non-Hispanic African Americans, 35 percent of the half-million children in foster care in the United States in September 2003 were from this group (Child Welfare Information Gateway, 2005). African American children’s removal from the home is more likely to become permanent: parental rights are more likely to be terminated and—with reduced possibilities for adoption—once removed, these African American children are permanently cut off from the only family they are likely ever to call their own. The situation is similarly dire for American Indian and Native Alaskan children, who are removed from their homes at approximately three times

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the rate of White children (Hill, 2006). The data on Latino children are less conclusive. National statistics indicate that Hispanic children make up 17 percent of the child population in the United States (U.S. Census Bureau, 2005) but only 13.5 percent of children in foster care. However, these statistics on Latinos vary by state and municipality, with overrepresentation in some areas and underrepresentation in others (Hill, 2006). Fairness and accuracy in the assessment of both abuse and neglect are clearly urgent priorities.

WHAT CONSTITUTES A SUSPICION, AND WHAT DOES CULTURE HAVE TO DO WITH IT? Assessing for child maltreatment is like trying to keep your balance on a seesaw. If you lean too much in one direction, you are in danger of disrupting family life unnecessarily to ‘‘protect’’ children who do not actually need the intervention. If you lean too much in the other direction, you may fail to protect children who are in dangerous situations. In less severe circumstances, a faulty assessment leads to a mismatch between services and client needs. In the most severe circumstances, a safe family may be permanently torn apart or a child may end up dead because of an incorrect assessment of the dangers. When there are cultural differences between the professionals and the families involved, maintaining equilibrium and providing quality services can be tricky (Fontes, 2005). Most mandated reporters experience ambivalence about how and when to follow up on suspicions of child maltreatment by contacting child protective services or the police. They worry that their reports will drive families away and that children will be ‘‘lost’’ in this way. Many have seen protective service interventions that inflicted harm rather than provided help despite the best intentions of everyone involved. Where there is a racial or ethnic difference between the professional and the child, the professional may also fear being perceived as discriminatory for filing a report. The professional may be concerned about lacking the necessary cultural information to distinguish between maltreatment and unfamiliar but harmless child rearing practices. In most states, people who work regularly with children are considered mandated reporters (ranging from school bus drivers to teachers, barbers, and psychotherapists) and are obligated to report suspected maltreatment when they encounter it while carrying out their professional duties. Most states require that a report be made to the police or child protective services when there is ‘‘cause to believe’’ or ‘‘reasonable cause to believe’’ that a child is at risk for maltreatment, or that such maltreatment is occurring or may have occurred (Zellman and Fair, 2002). Reporters are not required to investigate or be certain that the abuse has occurred, and people making reports are

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630 HANDBOOK OF MULTICULTURAL ASSESSMENT protected from prosecution for their reporting as long as their reports have been made in good faith. Well-meaning mandated reporters who make a lot of inquiries, trying to begin the investigation themselves rather than referring to child protective services, may put a child or a legal case at serious risk. Cultural issues can complicate this question of filing a report. Research is inconclusive as to whether people are more or less likely to report child abuse suspected in minority families (Ards, Chung and Myers, 1998; Charlow, 2001). It may be that professionals are more likely to screen for and then report child abuse in minority families because their biases lead them to suspect substandard parenting or to confuse cultural practices with substandard parenting (see Chipungu and Bent-Goodley, 2003). Some research supports this, including a 2002 hospital study that found that among children up to age three with similar injuries, Black and Hispanic children were far more likely than non-Hispanic White children to be screened by a skeletal survey for possible abuse (65 percent versus 31 percent) and reported to child protective services (53 percent versus 23 percent) (Lane, Rubin, Monteith and Christian, 2002). Interestingly, this study found both an overreporting of the Black and Hispanic children and an underuse of diagnostic tests that could detect abuse in the White children. Other researchers assert, however, that the problem lies not in reporting bias but rather in the different circumstances in which African American, Native American, and Latino children in the United States live, as compared to White and Asian American children. For example, neglect is more likely to be found among the poor, and Black and Native American children are more likely to be poor; therefore, members of these groups are more frequently reported for neglect (Myers, 2003). Children are more likely to be removed due to neglect than abuse, suggesting that poverty and its effects such as lack of access to safe housing, schools, day care, and health care partly determine why some children are removed from the home and others are not (Lewit, Terman, and Behrman, 1997). Researchers also wonder whether the problem is the overreporting of African American, Native American, and poor children, or the underreporting of White and economically advantaged children. Charlow (2001) claims that the key issue here is not the family’s ethnicity but rather its economic status. She reports on Daniel’s finding that ‘‘children of lower socio-economic parents were more likely to be reported as being abused even when they suffered the same injuries as children in better economic circumstances’’ (p. 773). It is difficult to tease out in research the interrelationships among race, ethnicity, socioeconomic status, the occurrence of child abuse and neglect, the relationship of the reporter to the family, and the investigation, reporting, and substantiation of maltreatment. Specific contexts may determine whether someone is fair, overly likely, or overly hesitant to report a suspicion. At times professionals belonging

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to the same culture as the family in question try to handle the abuse concerns on their own and are reluctant to report because of concern that if they report abuse in the family, it will foster even more discrimination or racism toward their cultural group. A Puerto Rican worker from a human services agency approached one of us after a presentation on sexual abuse in Puerto Rican families and said, ‘‘I am wondering if you should be doing a presentation about this. People already look down on our people, and now they are going to believe we are also sexual abusers.’’ It is often difficult for people from one culture to tell whether behaviors among people from a different culture justify suspicions of child abuse. An African American nurse who sees a Vietnamese mother shame her child for crying when he gets an inoculation might ask herself, for instance, ‘‘Is this mother acting in an aberrant way, or is there a cultural aspect to her behavior that I’m missing?’’ To compound this problem of cross-cultural ignorance, White teachers, guidance counselors, and neighbors sometimes report that they are less likely to approach a parent from a different culture with concerns about a child (such as poor hygiene or misbehavior) because they fear that they may be misunderstood and accused of prejudice. This kind of conversation should not be avoided. Often a tactful discussion alone allays suspicions and sets the stage for a helpful intervention— for instance:

A kindergarten teacher noticed that Regina arrived at school each day with unkempt hair, unlike the other Black children in the class who arrived well groomed. Also, although Regina was always clean and her clothes were neat, she wore flipflops and a light dress despite cool weather. Regina did not speak much. The teacher arranged to meet the child’s mother, who revealed to her that the family had recently emigrated from Jamaica with a very limited income, that the mother was allowing her daughter’s hair to form dreadlocks, and the family had not yet purchased winter clothes. The mother also confided that although Regina spoke freely at home, she was inhibited from speaking at school because some of the children had teased her about her Jamaican accent and words. The mother gratefully accepted the teacher’s offer to ‘‘round up’’ some winter clothes for her family, which the teacher sent home discreetly one day, along with a list of community resources that might interest the family. The teacher made a special effort to facilitate Regina’s friendships with other girls in the class. The teacher made international diversity a focus of the curriculum for several days, which gave Regina a kind of star status in the classroom. Regina continued to wear dreadlocks, which she tied up occasionally in a colorful scarf.

Because Regina seemed essentially well cared for, the teacher decided to contact the parents first and obviated the need to initiate a report of suspected neglect. This turned out to be an ideal decision all around. Nevertheless,

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632 HANDBOOK OF MULTICULTURAL ASSESSMENT mandated reporters should not fail to report reasonable suspicion of abuse simply because of a cultural difference:

Eddy, age ten, from El Salvador, was a skinny, fidgety child. He appeared to be ravenously hungry in school. His teacher noticed him asking his friends for what was left on their school breakfast and lunch trays and stuffing food into his pockets. As the year went on, his teacher noticed that he was increasingly dirty, and he developed a persistent cough. Eddy seemed to have bruises on his legs rather often. When asked about them, he said they were from playing soccer. Eddy seemed unable to concentrate in school. He was exceptionally fearful of the roughhousing of the other boys. The teacher felt great sympathy for Eddy’s family and suspected that they might be undocumented. She worried that a report of child maltreatment might get them deported, and so she did not share her concerns with anyone.

In this situation, the teacher ignored clear signs that a child might be at risk because of her sympathy for Eddy’s family and her concern about the vulnerability of their immigration status. Although her motivations are noble, in effect she is leaving Eddy (and possibly his siblings) at greater risk than she would leave children from the dominant group. At the very least, his teacher should have alerted the school’s student protection team to her concerns or requested an intervention from the school’s outreach worker. A call to child protective services might save Eddy’s life. Child protective services generally work with families regardless of their immigration status and do not share information with immigration authorities. Another approach when there is a reasonable suspicion of abuse is to attempt to involve the family in the reporting process. Many immigrant parents, especially if they are poor and isolated, face extreme stressors that may make them unintentionally react in ways that are abusive toward their children. These parents may welcome some of the services provided by the child protection agency, as in this case:

A Dominican girl told her therapist that her mother had been hitting her a lot. The therapist asked the mother into the office and explained her legal obligation to report the information her daughter had given to Child Protective Services (CPS). The therapist acknowledged all the stress the mother was facing as a single mother of three children away from her country, without a job, and not knowing English. The therapist told her that CPS might be able to help her find child care and after-school programs for her children, as well as economic support, access to medical care, and counseling. The therapist told her that parents who voluntarily requested services were viewed as concerned and collaborative. With some trepidation, the mother agreed to file a joint report. Together they called CPS from the therapist’s office and filed both reports simultaneously. CPS opened a

ASSESSING FOR CHILD MALTREATMENT IN CULTURALLY DIVERSE FAMILIES case for voluntary services, and the mother was referred to a Latina mothers’ support group that helped her feel less isolated. The mother was assigned a parent aide who helped her find a job and helped her get better housing, as well as after-school programs for her children. The mother’s depression and irritability decreased, as did her angry outbursts with her children.

In sum, in walking that tightrope between reporting or not reporting, we must make sure we protect all children. At the same time, we must also make sure our biases for or against members of a certain group, lack of familiarity with a given culture, or any discomfort we might feel with members of a certain group do not make us either too eager or too hesitant to report. If a behavior raises concern, we can discuss the concern with a cultural informant while protecting privacy, discuss the concern with a colleague, and screen the issue with protective services anonymously before making our decision. However, if a concern is a suspicion, it must be reported.

IS IT MALTREATMENT? IS THE CHILD AT RISK? Child abuse is defined in slightly different ways according to state statutes. The definition usually includes the concepts of harm, injury, or impairment or risk of these problems. Determining whether a given act constitutes child maltreatment may seem like a straightforward process, but often it is not. How much harm is too much? It can be argued that when a child is given a breakfast cereal she does not like one morning and therefore does not eat breakfast and is hungry in school until lunch, the child has been harmed. However, few would argue that this situation constitutes child neglect unless it occurs repeatedly. Exposure to many hours of television has been found to harm children’s cognitive achievement and contribute to obesity, yet few would argue that caretakers who allow their children to watch many hours of television are abusive. And how much risk is too much? Every year many children are severely injured, and some die while playing football, and yet few would argue that parents who allow their children to participate in contact sports are exposing them to abusive levels of risk. If a kindergartener breaks his arm while playing unsupervised in a stairwell, his parents may be subject to sanctions for neglect. However, if parents allow their child to ski alone on the slopes and he breaks his arm, this is not considered neglectful. Clearly cultural norms and social class shape how we evaluate abuse and risk. In many jurisdictions, the concept informally cited for judging whether a punishment constitutes physical abuse is ‘‘leaving a mark.’’ Even this concept is open for interpretation. If redness lasts only a few moments, does that

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634 HANDBOOK OF MULTICULTURAL ASSESSMENT constitute a ‘‘mark’’? If it lasts one hour? Six hours? If an adult twists a child’s arm up behind his back so it aches but leaves no sign of a bruise, is that child abuse? Does the decision depend on how long the arm is sore? Often assessments of harm and risk hinge on soft factors such as how articulate the parent might be and how comfortable the worker is with the parent rather than an objective evaluation of facts. We cannot address all possible dilemmas that arise. Here we discuss some of the most common issues that complicate the assessment process in working with immigrant and ethnic minority families. The section is divided into false positives, cases in which workers substantiate child abuse where none exists, and false negatives, where workers fail to substantiate child maltreatment—in both cases, because of cultural misunderstandings.

False Positives: Finding Abuse That Is Not Present False positives in child welfare often result from ethnocentrism, where the professional sees his or her own beliefs and practices as superior and misidentifies differing cultural practices as maltreatment even when there is no harm to children (Korbin and Spilsbury, 1999). Although the topics that follow certainly do not exhaust all the circumstances in which caretakers can be accused mistakenly of abusing or neglecting children, we hope this material orients readers to the kinds of issues that may crop up. Flexible Boundaries. People with a low income and people from many immigrant groups often have fluid boundaries around their selves and their households. Latino and some Asian cultures have been described as cultivating a familial self, which is ‘‘a sense of self that includes one’s close relationships as part of who one is’’ (Falicov, 1998, p. 163). When people have this extended sense of self, they may be more likely to share their homes, money, clothing, and even beds with relatives and family friends. Sharing resources in this way enables the survival of families that are stressed or near the poverty line. It can become virtually impossible to close the door to a relative, friend, or clan member who needs a place to stay or who has decided to make an extended visit. A nuclear family that has saved assiduously to change apartments or send their child to college may inexplicably (it seems to someone from the outside) give their savings to a relative who needs medical care, a funeral, or a ticket from their home country. Among traditional families, this sharing of resources is not subject to debate; it is just what one does. The fluidity of household boundaries can create dilemmas for people who have learned to view the presence of adults other than parents as a risk factor. For example, a family may give an investigator information about who lives in

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the home, but at the next visit, the investigator finds some new people—maybe even an entire family—in the household. An uncle may have called over the weekend saying he needed a place to stay. To refuse to take him in or to say that he could not come until he had been approved by a social service agency would be an unimaginable insult. As another example, a Korean family may fail to mention that every Saturday night, a cousin’s family from a nearby city stays with them so they can attend their Korean-language church services together. Household compositions may not be as fixed as they are in families from the dominant cultural group, and this may seem so ordinary to the family that they neglect to mention it. The issue of fluid household composition might emerge in a different way. A family may hesitate to tell professionals the full truth about who lives in their home. They might describe their nuclear family only, knowing that this is the norm in their new country; only after trust has been built will they reveal that an additional family, friend, or renters share the apartment. In some Somali families, a father maintains two households, with a wife and children in each, which is common in his culture. The father will hesitate to identify his relationship to his second wife and family to authorities because he has been told that polygamy is illegal in the United States. These families were established long before he emigrated to the United States, and he is unwilling to abandon either one. How can we handle these issues? If a family has failed to reveal the full truth or has lied, it would be important to try to find out the nature of the misrepresentation and the motivation behind it before approaching the family too harshly. Maybe they did not want to tell about every person who lives in the home because they have exceeded the limit allowed by their lease, or because the guest is undocumented, or because the additional person has a disability and is therefore stigmatized—not for any more nefarious reason. If the additional person or people who are staying in the home have been determined to put a child at risk or if the loose boundaries around the household seem to be a problem (for example, prostitution or drug dealing are bringing unrelated men into the household at all hours), then we must make absolutely clear to the family that the consequences of continuing this situation include the possibility of losing custody of their children. While the looser boundaries may be culturally normative, exposing children to risk is never acceptable. Misunderstandings with Schools. School is often the ‘‘first direct, sustained, and structured contact with an American institution’’ (Falicov, 1998, p. 224) for many immigrant families and cultural minority children. This contact presents numerous occasions for parents’ behaviors to be misinterpreted as abusive or neglectful. This section provides several examples.

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636 HANDBOOK OF MULTICULTURAL ASSESSMENT An immigrant family was reprimanded regularly over a period of months because of their failure to get their elementary-age children to school on time. The parents both worked two shifts and could not wake up to give their children breakfast. Finally a compassionate counselor figured out a solution: the parents began waking up the children at 6:00 A.M., when they returned from their night shift and before they lay down to sleep, and put the children on the earlier high school bus. The children were able to eat a free breakfast at the high school and walk down the block to their classes on time each day.

Such a simple solution by a conscientious counselor who took the time to think creatively spared this family from further traumatic and punishing encounters with child protection services and enabled the children to attend school appropriately and eat breakfast each day. Our point here is that children do need to attend school each day. We should work hard in conjunction with parents to make this happen rather than censoring them. Immigrant parents may be seen as neglectful for sending children to school when they are sick, even though they may have no reasonable alternative, and they may have been previously scolded for the child’s missing school. Also, less educated parents are often made to feel inadequate if they cannot help their children with their homework. Bilingual children and their parents frequently feel alienated and ashamed at school rather than applauded for having abilities in two or more languages. Immigrant children may have substantial work obligations at home that interfere with their attendance and progress at school. These may include family responsibilities such as caring for siblings, cousins, or infirm grandparents, and employment such as helping out in the family business. Concerned and understanding school personnel may be able to help families obtain the child or elder care or economic supports they need so the children can benefit more from their education. Most immigrant families will do what they can to ensure their children’s success in school if they learn that family pressures are interfering with the children’s achievement. Parents from countries that have relatively easy transportation to and from the United States, such as Jamaica and Puerto Rico, sometimes take their children out of school every winter for a month or two so the children can celebrate Christmas and stay with members of their extended family during this time. This visit means more than a simple vacation; it is a time to cement family and cultural bonds. For many parents, the children’s contact with the home country may seem more central to their education than the weeks missed in school. Education authorities should give some thought as to the best way to handle this—whether to provide children with schoolwork to bring with them on their journey, give parents clear reasons that their children should not miss this time in school, or simply unenroll the children officially during their

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weeks away and reenroll them on their return so the children will not have to be held back a grade for excessive absences. School staff frequently characterize immigrant parents as uncaring because they miss parent-teacher conferences, not realizing that some of these parents are unable to read the notices or speak English. Schools often schedule these conferences at times that are inconvenient for working parents. Parent-teacher association meetings and open houses are held in the evenings when public transportation may not be available or when it may be unsafe to walk in some neighborhoods. Sometimes parents cannot afford or do not have access to child care in order to attend the meetings. In Spanish there is an expression, La maestra es la segunda madre, meaning, ‘‘The teacher is the second mother.’’ Immigrant parents sometimes avoid schools out of a sense of respect for this second mother: they do not want to be seen as intruding on a teacher’s turf. In addition, refugee and undocumented parents may fear walking into a school because of the official authority it represents. It is often helpful to have other parents from the same ethnic group who are involved with the schools provide a personal invitation to parents from their group. Transportation to meetings and child care while the meetings are held can also greatly increase participation. Community potluck suppers where every family brings a dish from their country of origin can help parents feel that they have something to contribute to the community. Unfamiliar Discipline Methods. Those who are not familiar with a given culture’s disciplinary norms should seek consultation with professionals who come from the culture in question. A social worker recently described substantiating a charge of child abuse against Mexican parents who had forced their child to kneel on uncooked rice as a punishment. (This is a common disciplinary practice among many of the world’s peoples. In Spanish it is called hincar.) Although the mark from the rice on the bare knees vanished quickly and the parents made their children kneel for just a few minutes, the social worker said the practice seemed so bizarre that she thought it might have been a sign of the parents’ mental illness and inability to care for their children. A call to anyone familiar with Latino cultures or a consultation with a relevant text would have revealed that this disciplinary practice is common in many Latin American countries and should not be considered abusive unless it is used often, for long periods of time, or in unusual ways (Fontes, 2005). To determine whether a given disciplinary practice constitutes abuse, we encourage professionals to consider the following: • The age of the child. • How often the punishment is used.

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638 HANDBOOK OF MULTICULTURAL ASSESSMENT • The apparent physical and emotional effects of the punishment. Does it leave a mark? Is there lingering pain? Does the punishment upset or frighten the child? • The duration of the punishment. For instance, being made to stand with arms outstretched for five minutes is quite different from an hour. • The severity of the punishment. What is the degree of risk entailed? For instance, we consider abusive any punishment that involves burning or placing caustic substances into the mouth, eyes, genitals, or elsewhere on the body. • The invasiveness of the punishment. All punishments that interfere with natural processes such as eating, drinking, sleeping, moving the body, digesting food, and using the toilet when needed should be considered abusive.

Traditional Medical Interventions. Many traditional medical practices can be mistaken for abuse, including coining and cheut sah, Asian medical practices in which the edge of a coin or a hot spoon is rubbed on the skin; cupping, in which a flame is briefly placed inside a glass, creating a vacuum, and then the glass is placed on the skin, creating perfectly round bruises; and moxibustion, in which herbs are burned on or near the body to elicit healing (Krajewski-Jaime, 1991; Levesque, 2001; Lipson and Dibble, 2005). All of these practices leave marks on the skin. State protective agencies vary in how they handle these cases. Duong (2003) reports that in California, traditional medicine that leaves a mark, such as coining, is not considered a form of child abuse. However, when a child is found to have bruising caused by a caretaker, even if this is thought to stem from a traditional medical practice, an investigation must be undertaken every time. During the investigation, she explains this policy to parents; she says that by the second or third visit by protective social workers, most Vietnamese, Laotian, and Cambodian parents will forgo coining their children to avoid the hassle and suspicion engendered by the visit. Families from other cultures may not understand mainstream U.S. medical explanations and practices. Or in their efforts to provide the care they trust most for their children, they may forgo recommended Western procedures and rely instead on techniques and healers from their culture. It is not uncommon for Asian families to readjust the dosages of prescription medicine or stop taking medicine when the symptoms of an illness have disappeared, for instance (Chan and Lee, 2004). This fits their traditional view of how illnesses work: as being due to an imbalance of yin and yang. Antibiotics are seen as yang, and so Chinese patients frequently stop taking them when the symptoms vanish. They believe that taking them for too long could make the child overly yang and provoke further problems. If the child’s welfare depends on complying with a medical practice, then professionals may well have to enforce its use. But the questioning or rejection of Western medical care due to cultural beliefs should not be mistaken for simple neglect.

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Lack of Cooperation. Families are sometimes ‘‘punished’’ by having their children removed because they are seen as unmotivated or uncooperative. Conversely, some children are not afforded adequate protection because abusive parents know how to play the system. Clearly the more one knows about the workings of the system, the easier it is to follow the often unwritten rules, putting immigrant families and other families who are not from the dominant group at a disadvantage There are many reasons that a family might fail to ‘‘cooperate’’ or comply with a treatment plan. For example, a parent may lose custody for having failed to provide adequate housing when there simply is no adequate housing available for people at the parents’ income level. People who do not speak English well may not understand the treatment plan. Even if they understand the words, they may not understand some of the concepts—for example, ‘‘seek developmentally appropriate opportunities.’’ Chan (1992) describes a Vietnamese mother who attended only intermittently an early intervention program that was deemed essential for the development of her two-and-a-half-year-old autistic child. With sensitive inquiry, the professional was able to determine that the mother had not understood what autism was or the importance of the intervention program. (No written information had been provided for her in Vietnamese and the interpreter did not know the word for autism in Vietnamese.) In addition, the mother did not feel comfortable intensively stimulating her daughter verbally and socially in the way that was expected in the program. In her culture, such stimulation was considered ‘‘unnatural and inappropriate’’ relative to the child’s age and level of understanding (p. 227). And finally, the mother was uneasy in the class because of her poor English-speaking skills. Fortunately, she was later given the opportunity to participate in a similar program with other Vietnamese parents, where both she and her child flourished. Sometimes parents misinterpret CPS interventions and, in their efforts to comply, appear to be inadequate parents—for example:

A Puerto Rican mother became very passive regarding her adolescent sons’ inappropriate behaviors. When the family therapist explored the issue, the mother explained that when CPS took legal custody of her children, it had been explained to her as, ‘‘The agency will have authority over the children as parents.’’ The mother had understood that statement to mean that she could no longer enforce curfews or punish her children because she was no longer their mother. In a session, the CPS worker explained the custody issues to the mother and reassured her that she was still the mother and retained the authority to discipline her children.

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640 HANDBOOK OF MULTICULTURAL ASSESSMENT Lack of Information About a Child. Sometimes professionals are surprised that a parent may not remember a child’s age, birthday, or developmental milestones and interpret this as a lack of interest in the child. It is important to remember that what is considered a milestone in the dominant Canadian and U.S. culture may not be considered a milestone in the family’s culture. For example, Joe and Malach (2004) report that some Native American cultures may be delighted and throw a party when a child first laughs but not pay attention to the moment when he learns to sit up or walk. In addition, they write that talking is considered important somewhere between the child’s third and fourth birthday in some Native cultures, and parents may not notice or worry about a child who fails to talk earlier. In many immigrant and low-income families, children may be separated for long periods of time from their parents, who therefore may not be intimately familiar with their children’s histories. Again, this lack of information or contact should not be mistaken for a lack of caring or connection. And finally, a mother who has six children will have a harder time sorting out memories about individual children than a mother who has only two. Linguistic Misunderstandings. A girl from a Mexican Mixtec Indian family living in Tennessee was asked in class to describe what she eats at home. She said her family ‘‘just eats tortillas,’’ for breakfast, lunch, and dinner. The teacher reported her family to child protective services. It turns out that when the girl said ‘‘just tortillas,’’ she was referring to tortillas with meat, vegetables, eggs, and cheese, depending on the meal. The girl did not feel a need to explain this since it seemed self-evident to her (Samuels, 2006). Linguistic misunderstandings can lead to tragic outcomes, with parents signing papers they do not understand, professionals thinking they understand what a caretaker is saying but do not, children do the best they can interpreting for their parents but miss crucial information, and so on. We should assume that we are not going to obtain an accurate picture of risk in a family if we cannot speak with the family in its native language. At the very least, a trained professional interpreter should be brought in to help with the assessment. Calling in a bilingual professional or an interpreter when needed is not only the most professional and moral decision; it is also a legal obligation.2 Hairstyles and Clothing. Appearance influences how others see us and how we see them. From hairstyles and clothing, we make assumptions about a person’s gender, age, occupation, level of hygiene, marital status, sexual orientation, and socioeconomic status. These assumptions can prove problematic if they form part of a child maltreatment assessment and are made without awareness of cultural variations.

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Orthodox Jews first cut their children’s hair at a party on the child’s third birthday. Until this age, a child’s hair is allowed to grow freely, and it may look unkempt to the uninformed outsider. Some Muslims, Native Americans, Sikhs, Rastafarians, and members of other ethnic and religious groups have restrictions around the cutting of hair that may make outsiders believe the children are poorly groomed, when in fact they are groomed in the way their culture dictates. It is important not to penalize families for nonmajority choices in hairstyle. (Of course, dirty hair or lice are a different issue.) The influence of clothing on opinion formation becomes clear when working with refugees who have recently emigrated to the United States. Most of the African refugee families in our community are given huge piles of discarded clothing by U.S. families and congregations. The refugee families store heaps of this clothing in their closets and in the corners of their apartments. When getting dressed in the morning, the children grab clothes that appeal to them, and when the clothes are obviously dirty, they sometimes discard them to the same corner of the apartment. The refugees have never owned more than the clothes they could wear at one time; they had no idea how to manage this much clothing, how to use closets and dressers, or how to bring their clothes to a Laundromat and use the machines. The children’s schools call repeatedly about the inappropriateness of the children’s clothing: Mohamed was wearing pink and might get teased; Malyun was wearing her pants inside out or backward; Abshir was wearing pajama bottoms to school; Siyat was wearing girls’ sneakers with mermaids on them; and so on. In these situations, it can be helpful to provide practical information to the refugee family about customary dress and how to take care of the clothing, as well as educating teachers about the cultures of their students. Many religions require people, sometimes including children, to cover their heads at all times. Orthodox Jewish boys wear a kippah or skullcap on the back of their heads; male Hasidic Jews wear fur or fedora hats and heavy coats, even in hot weather, as well as distinctive sidelocks on boys that are never shorn (pais). Sikh men and women wear turbans to cover their hair. Many religions require girls and women to be modest in their dress. Some Muslim women and girls wear head scarves or body coverings (hijab). Girls and women of the Pentecostal faith typically do not wear pants, even on the coldest winter days. Although such practices may be unfamiliar to many professionals, they should not necessarily be regarded as signs of women’s oppression within a culture or a family. It is important to refrain from leaping to conclusions about forms of dress that may be unfamiliar. Sleeping Arrangements. Some families from traditional peasant cultures in Asia, Africa, and South America are incorrectly substantiated for neglect

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642 HANDBOOK OF MULTICULTURAL ASSESSMENT because their children sleep on the floor (Duong, 2003). Before substantiating such a claim, it is important to determine whether this practice is traditional in the family’s country of origin, whether the parents also sleep on the floor, and whether the sleeping space on the floor is clean and sanitary. Some Asian families have clean and comfortable mats for sleeping on the floor that they roll up each morning, leaving investigators scratching their heads as they search for beds. In most of the world’s cultures, children sleep in the same bed or at least the same room as their parents, and many respond in horror when they hear that children in the United States and Canada are often expected to sleep in a room alone, from birth or a very young age (Rogoff, 2003). Families may be incorrectly found to be negligent or suspected of sexual abuse because they share beds (cosleeping) (Falicov, 1998). (Of course, even if sharing a bed or a hammock may be customary, sexual abuse still could be occurring). Cosleeping itself may be problematic when children are beginning to mature physically and become aware of sexual urges or if the adults have poor boundaries. Under normal circumstances, cosleeping of mothers with their infants should not be seen as problematic and may enhance the mother’s ability to nurse and meet her child’s needs during the night. Cosleeping of infants with siblings or with other adults may pose risks, however. Research suggests cosleeping may contribute to deaths from sudden infant death syndrome (SIDS), particularly when the bedding is soft, infants are placed face down, and they are sleeping on something other than a bed, for instance, a sofa. The ratio of Black to White deaths from SIDS is more than two to one (Hauck et al., 2003). Economic factors appear to contribute, since some families cannot afford a bed for everyone in the household and may not be able to afford a crib that is appropriate for infants. To reduce the risk of SIDS, parents and other caretakers should learn to place children on their backs to sleep, should use firm bedding and avoid pillows with infants, and should avoid cosleeping on sofas or places other than beds. Cosleeping is problematic where the person or people in bed with the infant is obese, is impaired by drug or alcohol use, or is not the child’s parent. It may be worth noting that in countries where cosleeping is common, bedding is typically firmer and flatter, and has less excess covering such as blankets and pillows; it therefore poses less of a risk of SIDS and infant suffocation than the bedding used in Western countries. Except for the situations of infants sleeping on sofas, it would seem callous and ethnocentric for professionals to interfere with a family’s culturally based sleeping practices if no problem has been noted with the current arrangements. Cosleeping is not necessarily a sign of sexual abuse. However, if an investigation is conducted and there are other indicators of problems, if the children are expressing a desire to sleep separately, or if the children are

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beyond preschool age, professionals may want to discuss with caretakers the advantages of some independence at night. Here is an example of a family that engaged in cosleeping that was somewhat problematic although not abusive:

At age eight, Maryom emigrated along with her mother and three brothers from the Kenyan refugee camp where she was born. At school, she was asked to draw a picture of her room. She drew a picture of herself, her mother, and her three brothers sleeping together on the floor of one room. The teacher was concerned and filed a report with child protective services. The CPS worker discovered that although the family had been settled in an apartment with two bedrooms and had been given enough beds and mattresses for everyone to sleep alone, the family had barricaded the second bedroom, and all slept crowded together on mattresses on the floor in one room. The mother explained that first of all, she did not feel safe in the second bedroom because the window in it faced onto the fire escape and she was afraid of intruders. And second, in the refugee camps, she and her children had all slept on one mat together, and they felt safest this way. She said her children could not sleep without her. She said she would like for them to be able to go to sleep on their own but did not know how to make it happen. The CPS worker convinced the landlord to install window grates, which made the back room safer. Eventually the three boys moved into the back bedroom together, leaving Maryom and her mother on separate mattresses in one bedroom. The prior sleeping arrangements had not been abusive, but the social workers’ intervention allowed the family to use the entire space, which made it easier for all of them to sleep through the night.

One Father, Two Families. In many cultures, a man (and particularly a wealthy man) may have more than one family. When the former prime minister of France, Franc¸ois Mitterrand, died, both his wife and his mistress of many years attended the funeral, together with their respective offspring. In Latin America, the official household may be called the casa grande and the unofficial household the casa chica (Falicov, 1998). Although such an arrangement is not exactly socially accepted, it is not condemned with the same vehemence as such an arrangement might be in the United States (where people frequently have extramarital affairs of shorter duration). As long as both households are well cared for economically and the man is fairly discreet about his second family, all who know about this situation may wink and shrug their shoulders in much of Latin America and parts of Europe. This situation may present when you meet with a woman who describes her ‘‘husband,’’ the children’s father, and yet is vague about why he is not ‘‘home.’’ She may promise that he will show up for meetings, and yet he never does. One possibility, among many, is that he is her common-law husband who

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644 HANDBOOK OF MULTICULTURAL ASSESSMENT also maintains and lives with another family. Investigators need to explore this situation with some sensitivity; the children might not know about the father’s other family. In some Muslim cultures, including the Nation of Islam, men may take more than one wife. Although this is relatively rare, investigators may come across Muslim men with multiple wives and their children living in the same or separate households. The Quran restricts the circumstances in which polygamy can be practiced, but these edicts are interpreted differently in diverse Muslim communities. In some religious subgroups in the United States and Canada, such as some groups who call themselves Fundamentalist Mormons, a man may have more than one wife and multiple sets of children, either all living together or in nearby compounds. Investigators would be wise to seek counsel from their supervisors and district attorney as to whether these situations are considered problematic for children. It would also be important to determine whether any of the ‘‘wives’’ is underage. Care of Newborns. Many cultures have strict rules to protect children in the days and weeks immediately after their birth. Infants are often seen as unusually vulnerable during this period, requiring special talismans, protection, and prayers so they will not run the risk of being called back into the spirit world. Given the high rates of neonatal mortality that exist in much of the world, such precautions are understandable. In some cultures, children are not named until they have reached a certain age when they are considered ‘‘safe,’’ an age that varies according to the culture. Cultures as diverse as the Chinese, Sikkh, and Somali Bantus typically require that a mother stay at home with her infant for forty days after the birth, believing that taking such a young child outside would expose the child to unnecessary risks. Somalis believe that the smells of the world have the potential to make babies sick, and so they burn incense twice daily to protect children from these smells. These efforts to shelter newborns can come into conflict with the U.S. medical system, which often asks mothers to bring in their infants for a two-week checkup. When possible, an alternative means of meeting this medical requirement should be found, such as arranging for a visiting nurse to attend the mother and infant in their home. Western medicine currently recommends that the umbilical stump be left uncovered and allowed to dry in the days immediately following birth. In many cultures, women are taught to cover or tie their newborn’s umbilical stump with various materials or to rub the newborn’s stump with substances ranging from kohl to animal dung. Reasons commonly given for applying a substance to the cord are to keep bad spirits away, prevent bleeding from the stump, and promote its drying and separation from the baby. These materials can

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be dangerous if they are unclean or harbor tetanus spores. Parents’ concerns about their newborn’s well-being should be honored, but at the same time parents should be taught about standards of hygiene that will protect their babies’ health. Mongolian Spots. Mongolian spots are flat birthmarks that can be deep brown, gray, or blue-black in color. In some children, they look like bruises. They are usually found on the lower back and buttocks but can also be found on the legs, back, sides, and shoulders. They range from the size of a freckle to the size of an adult hand or larger. A child may have more than one of these marks. Ninety percent of Native Americans and people of African descent, 80 percent of Asians, 70 percent of Latinos, and just under 10 percent of White infants have one or more of these marks (Hurwitz, 1993). These spots are present at birth, and most fade by age two, with most disappearing entirely by age five. They can be distinguished from bruises because they are not sensitive to touch and therefore are not indicative of abuse. All too often people who are unfamiliar with Mongolian spots initiate child abuse investigations when they see these marks on young children. Parents who are considered at risk for other reasons, such as their young age or poverty, may be especially likely to have unnecessary reports filed against them.

False Negatives and the Use of Culture as a Justification Sometimes we fail to recognize a given practice as maltreatment because of cultural differences between ourselves and the family. The professional who holds an excessively relativist position may be inclined to accept as harmless all practices that have a cultural component or that a family claims have a cultural component. When we look at the many ways people raise children around the globe, we give up our ethnocentric lenses and discover that there is no one best way to raise children (Rogoff, 2003). Indeed, cultures successfully meet children’s basic needs such as food, shelter, education, and socialization into adulthood in myriad ways. However, this does not mean that anything goes, as long as it is ‘‘cultural.’’ Some cultural practices are indeed harmful. For example, in the United States, children watch an average of twenty-five hours of television each week—television that is full of violence and advertisements for unhealthful foods (Gentile and Walsh, 2002). It could be argued that watching enormous quantities of television is a cultural norm in the United States—and yet few would say this is desirable for children simply because it is cultural. The same could be said for the U.S. cultural practice of feeding large quantities of fatty foods to children, so that more than 20 percent of children are obese. The United States also allow minors to serve in the armed forces, a practice forbidden by the 1989 United Nation Convention on the Rights of the Child.

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646 HANDBOOK OF MULTICULTURAL ASSESSMENT Other cultures and nations also engage in cultural practices that are harmful to children; among them are genital cutting; cures involving contact with mercury, lead, or other toxic substances; punishments that involve ingesting pepper; washing children’s mouths out with soap or other irritating substances; child labor; child marriage, child sexual slavery, and prostitution; discrimination against girls that results in the underfeeding or infanticide of girl children; and denying girls access to school (Fontes, 2005). Understanding what is cultural is no easy task. Some instances of harm to a child may be defined and dismissed as cultural while in fact other risk factors may be present (Maiter, Alaggia, and Trocm´e, 2004). Examples of the way this might work are given below. Culture as a Mask or Smokescreen. A person who knowingly engages in a practice that is harmful to a child will sometimes use a justification that essentially boils down to, ‘‘My culture made me do it.’’ For example, Fontes (1993) worked with a Puerto Rican woman who counted her daughters’ pubic hair, had given them douches since they were infants, and inspected their underarms as she tested out various deodorants. She claimed these practices were common in Puerto Rico, where parents were ‘‘affectionate,’’ unlike U.S. parents who were cold and distant. In fact, this behavior would be considered as bizarre and invasive in Puerto Rico as it is on the mainland. In another example, a social worker was investigating physical abuse with a family from the Sicily region of Italy. The father had beaten his daughter, leaving bruises across her face, because she was out past curfew and he felt unable to control her in general. The father defended his behavior, claiming that in Sicily no girl would dare defy her parents as his daughter had done and that he was teaching her a lesson in a way that was appropriate in their culture. The social worker, who was quite knowledgeable about cross-cultural work, was not satisfied with this explanation. Instead she asked the father what his mother would think about his bruising his daughter’s face in that way. The father began weeping and admitted that while demanding obedience was culturally acceptable, beating one’s daughter in this way would be considered a disgrace (Sarah Maiter, personal communication, June 2002). When hearing about a problematic behavior that is rationalized as being based on culture, it is important to pay attention to who is defining what qualifies as cultural. Cultures are not homogeneous, and the person who is defining what is cultural may be the one who is benefiting from the behavior (Okin, 1999). Frequently, questionable behaviors that are explained away as cultural are behaviors that oppress or restrict the people who are least powerful in society: women and children (examples are the veil, genital cutting, wife beating, corporal punishment of children). So although it may be true that beating one’s children is somewhat more common in Portugal, say, than in the

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United States, a Portuguese family will nevertheless be required to conform to the law where it resides, and certainly not all families in Portugal beat their children. The family’s ethnic or national origin may be part of the story, but it is not always the whole story. ‘‘My Culture Made Me Do It’’ and Sexual Abuse. People who sexually offend are likely to use any and all excuses to justify their behavior, and cultural difference is no exception. Here are some examples: • ‘‘Someone put a curse [or a hex or an evil eye] on me and I didn’t know what I was doing. I was not myself. I was in a trance.’’ • ‘‘In my culture, all men break in their daughters. I was teaching her how to please her husband.’’ • ‘‘I was showing my son how to be a man; that’s what we do in my country.’’ • ‘‘Back home, it is not unusual for young girls to marry older men. That’s why I let my best friend have my daughter.’’ • ‘‘We are hot-blooded. You put a young girl like my stepdaughter in front of us, dressed the way she was dressed, and we can’t control ourselves.’’

Professionals who are accustomed to working with sex offenders will probably be able to determine the most egregious of these justifications. When in doubt, the professional should check with another person from the culture in question (while respecting confidentiality).

ONCE AGAIN: HOW CULTURE MATTERS IN ASSESSMENT There is a push among clinicians, investigators, and researchers who work in the field of child maltreatment to develop assessment checklists and structured decision-making processes to improve accuracy and formalize child maltreatment assessments. These instruments are adapted to the local communities where they are used and have become more sophisticated and accurate over time. They are truly able to distinguish among children in high-, medium-, and low-risk situations, so CPS departments can apportion their resources accordingly. This more structured process has some distinct advantages over the impressionistic methods many investigators use to make decisions about the future of children and families. These tools have been found to weed out bias and reduce racial disproportionality in child welfare caseloads, while improving child safety (Baird et al., 1999). Sometimes it does not matter whether a given practice is culturally based to determine whether abuse has occurred. When a practice is culturally acceptable in a country of origin but unacceptable in the United States or Canada, children

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648 HANDBOOK OF MULTICULTURAL ASSESSMENT still need to be protected according to the law where they live. Nevertheless, the notion that the practice was acceptable in the country of origin should be taken into account in assessing the family’s overall stability and the most appropriate intervention. For example, say a Korean family that recently emigrated uses physically abusive corporal punishment with their children, which is common in Korea (Hahm and Guterman, 2001). Maybe they strike the back of their children’s legs with a stick, leaving a mark. It would be entirely appropriate for the parents to have charges of physical abuse substantiated against them. However, if the parents seem amenable to change and did not seem to be aware of the different standards for child raising in their new country, if they do not have other risk factors such as substance abuse or domestic violence, and if the children are otherwise well cared for, the caretakers probably do not need parenting classes, which are likely to humiliate them and cause them to lose face; rather, they require careful instruction about discipline norms in their new country and an occasional contact to make sure they are conforming to the newly learned expectations. It would be important to establish a pathway for the children to seek assistance (from a school counselor, for instance) if the physical abuse recurs. In other words, the cultural roots of the behavior should be considered relevant in assessing a family and deciding which interventions are most appropriate, but it is less likely to be important in determining whether abuse has occurred.

CONCLUSION The power of the impression will never fully be weeded out of child maltreatment assessments, which opens up a space for cultural stereotypes and ignorance to exert their influence. We hope that attention to cultural issues, as discussed in this chapter, will ensure that decision making about children at risk will be based on fair and accurate culturally competent assessments without cultural bias or prejudice.

Notes 1. We use maltreatment here to refer to all forms of illegal child neglect and abuse: physical and emotional neglect and physical, sexual, and psychological abuse. 2. Title VI of the Civil Rights Act of 1964 forbids discrimination against any person on the basis of national origin in offering any services that receive federal financial assistance. This has been interpreted by the courts to include delivering adequate services to any individual who does not understand English, including arranging for interpreters, as well as informing clients or patients that interpreters are available. On August 11, 2000, President Clinton signed an executive order stating that all

ASSESSING FOR CHILD MALTREATMENT IN CULTURALLY DIVERSE FAMILIES agencies receiving federal assistance must provide services that are accessible to people with limited English proficiency. These stipulations apply to most health care, legal, criminal justice, education, and social welfare settings.

References Ards, S., Chung, C., & Myers, S. L. (1998). The effects of sample selection bias on racial differences in child abuse reporting. Child Abuse and Neglect, 22(2), 103–115. Baird, C., Ereth, J., & Wagner, D. (1999). Research-based risk assessment: Adding equity to CPS decision making. Madison, WI: Children’s Research Center, National Council on Crime and Delinquency. Chan, S. (1992). Families with Asian roots. In E. W. Lynch & M. J. Hanson (Eds.), Developing cross-cultural competence: A guide for working with young children and their families (pp. 181–257). Baltimore: Brookes. Chan, S., & Lee, E. (2004). Families with Asian roots. In E. W. Lynch & M. J. Hanson (Eds.), Developing cross-cultural competence: A guide for working with young children and their families (3rd ed., pp. 219–298). Baltimore: Brookes. Charlow, A. (2001). Race, poverty and neglect. William Mitchell Law Review, 28, 763–790. Child Welfare Information Gateway. (2005). Foster care: Numbers and trends. Washington, DC: United States Government Printing Office. Chipungu, S. S., & Bent-Goodley, T. B. (2003). Race, poverty and child maltreatment. APSAC Advisor, 15(2), 9–10. Duong, I. (2003). Traditional medicine and child abuse. Workshop presented at the American Professional Society on the Abuse of Children Colloquium, Orlando, FL. Falicov, C. J. (1998). Latino families in therapy. New York: Guilford Press. Fontes, L. A. (1993). Considering culture and oppression: Steps toward an ecology of sexual child abuse. Journal of Feminist Family Therapy, 5(1), 25–54. Fontes, L. A. (2005). Child abuse and culture: Working with diverse families. New York: Guilford Press. Gentile, D. A., & Walsh, D. A. (2002). A normative study of family media habits. Applied Developmental Psychology, 23, 157–178. Hahm, H. C., & Guterman, N. B. (2001). The emerging problem of physical child abuse in South Korea. Child Maltreatment, 6, 169–179. Hauck, F. R., Herman, S. M., Donovan, M., Iyasu, S., Merrick Moore, C. A., Donoghue, E. R., et al. (2003). Sleep environment and the risk of sudden infant death syndrome in an urban population: The Chicago Infant Mortality Study. Pediatrics, 111, 1207–1214. Hill, R. B. (2006). Synthesis of research on disproportionality in child welfare: An update. Washington, DC: Casey-Center for the Study of Social Policy Alliance for Racial Equity in the Welfare System.

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650 HANDBOOK OF MULTICULTURAL ASSESSMENT Hurwitz, S. (1993). Clinical pediatric dermatology (2nd ed.). Philadelphia: Saunders. Joe, J. R., & Malach, R. S. (2004). Families with Native American roots. In E. W. Lynch & M. J. Hanson (Eds.), Developing cross-cultural competence: A guide for working with young children and their families (pp. 89–115). Baltimore, MD: Brookes. Korbin, J. E., & Spilsbury, J. C. (1999). Cultural competence and child neglect. In H. Dubowitz (Ed.), Neglected children: Research, practice and policy (pp. 69–88). Thousand Oaks, CA: Sage. Krajewski-Jaime, E. R. (1991). Folk-healing among Mexican-American families as a consideration in the delivery of child welfare and child health care services. Child Welfare, 70, 157–167. Lane, W. G., Rubin, D. M., Monteith, R., & Christian, C. W. (2002). Racial differences in the evaluation of pediatric fractures for physical abuse. JAMA, 288, 1603–1609. Levesque, R.J.R. (2001). Culture and family violence: Fostering change through human rights law. Washington, DC: American Psychological Association. Lewit, E. M., Terman, D. L., & Behrman, R. E. (1997). Children and poverty: Analysis and recommendations. Future of Children, 7, 4–24. Lipson, J. G., & Dibble, S. L. (2005). Culture and clinical care. San Francisco: University of California, San Francisco, School of Nursing. Maiter, S., Alaggia, R., & Trocm´e, N. (2004). Perceptions of child maltreatment by parents from the Indian subcontinent: Challenging myths about culturally based abusive parenting practices. Child Maltreatment, 9, 309–324. Myers, S. L. (2003). Why are children of color overrepresented in reports to child protective services? APSAC Advisor, 15(2), 10–11. Okin, S. M. (1999). Is multiculturalism bad for women? Princeton, NJ: Princeton University Press. Rogoff, B. (2003). The cultural nature of human development. New York: Oxford University Press. Samuels, S. (2006). Do you have to speak English to raise your own child? Workshop at American Professional Society on the Abuse of Children Annual Colloquium, Nashville, TN. U.S. Census Bureau (2005). Statistical abstract of the United States, 2004–05. Washington, D.C. Retrieved November 18, 2006, from http://www.census.gov/prod/www/ statistical-abstract-2001 2005.html. U.S. Department of Health and Human Services, National Center on Child Abuse and Neglect. (1996). The third national incidence study on child abuse and neglect. Washington, DC: U.S. Government Printing Office. Zellman, G. L., & Fair, C. C. (2002). Preventing and reporting abuse. In J. Myers, L. Berliner, J. Briere, C. T. Hendrix, C. Jenny, & T. A. Reid (Eds.), The APSAC handbook on child maltreatment (2nd ed., pp. 449–475). Thousand Oaks, CA: Sage.

CHAPTER TWENTY-EIGHT

Competency to Stand Trial A Multicultural Perspective Sergei V. Tsytsarev Amanda Landes

D

espite a number of attempts to include courses on multicultural psychology in all psychology graduate training programs, many psychologists remain ethnocentric, and many may not even be willing to be involved in any multicultural assessment or therapy cases. Forensic psychology is no exception. For example, the American Academy of Forensic Psychology, which has been providing regular training for practicing forensic psychologists, has never offered courses on multicultural assessment. It is difficult to understand why education in this arena is lacking, considering the large role multiculturalism plays in psychology and the law. In this chapter we consider a few multicultural aspects of the assessment of competency to stand trial. This type of assessment is based on the fundamental principles of cross-cultural psychology and incorporates a number of aspects of clinical and forensic psychology, which ranges from the universal limitations of any forensic evaluation associated with both situational and dispositional characteristics typical for most defendants, to the impacts of the ethnic and cultural biases of evaluators and defendants on the content of the forensic evaluations. We present multicultural issues in forensic psychological assessments of competency. Although we realize that multicultural aspects of IQ and the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses are elucidated in other chapters of this book, it appeared important to add a forensic overtone to this analysis and emphasize reasonable skepticism with regard to the use of some tests in forensic settings due to their limited reliability

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652 HANDBOOK OF MULTICULTURAL ASSESSMENT and predictive validity. It is also critical to focus on the legal ramifications that follow the assessment of competency and the extent to which false negatives might affect defendants from the minority groups. Finally, we consider some practical recommendations regarding the development of multicultural competency in forensic psychologists. A cultural dimension has rarely been used in research on competency to stand trial. The biases involved in the evaluation of various competencies have been either totally denied or not taken into consideration due to the assumption that in any type of psychological assessment, objectivity is unlikely to be reached. Some of the reasons provided by skeptics of the evaluations include the limited cross-cultural validity of the assessment measures and the lack of interrater reliability of the evaluator’s interpretations of the obtained results. When the cultural context is an independent variable in our research, such limitations are almost inevitable. Indeed, this argumentation could be viewed as acceptable in some instances of multicultural assessment. However, it would be totally substandard in the assessment of competency to stand trial as well as in the evaluation of criminal responsibility. The future, and sometimes the entire life of a particular defendant, may depend on the conclusion made by forensic psychologists if the court decision is consistent with the forensic psychological report. Therefore, a focus within the field should aim to explore whether biased evaluation is a legitimate concern in order to standardize the process and ensure that those up for evaluation receive fair treatment.

THE GOALS AND OBJECTIVES OF THE ASSESSMENT OF COMPETENCY The first question that could be raised in this chapter is what the goals and objectives of competency evaluations are and how they can be addressed from a multicultural viewpoint. The standard for raising the issue of competency is that the trial court must take into account and weigh any factor suggestive of mental illness. In addition to the assessment of a mental state, there are many other reasons that a competency evaluation may be sought, including attorney ignorance, the defendant’s bizarre behavior, or strategic reasons unrelated to concern over the defendant’s competency, for example, to remove the defendant from the community or to competency evaluation as a means of discovery (Melton et al., 1997). For example, if the defendant is adjudicated incompetent, criminal proceedings are suspended. The Group for the Advancement of Psychiatry delineated a number of abilities of the defendant that must be assessed by a forensic psychologist

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during a competency evaluation (Melton, Petrila, Poythress, and Slobogin, 1997): • To understand his current legal situation • To understand the charges against him • To understand the facts relevant to his case • To understand the legal issues and procedures in his case • To understand legal defenses available in his behalf • To understand the dispositions, pleas, and penalties possible • To appraise the likely outcomes • To appraise the roles of defense counsel, the prosecuting attorney, the judge, the jury, the witnesses, and the defendant • To identify and locate witnesses • To relate to defense counsel • To trust and communicate relevantly with his counsel • To comprehend instructions and advice • To make decisions after receiving advice • To maintain a collaborative relationship with his attorney and to help plan legal strategy • To follow testimony for contradictions or errors • To testify relevantly and be cross-examined if necessary • To challenge prosecution witnesses • To tolerate stress at the trial and while awaiting trial • To refrain from irrational and unmanageable behavior during the trial • To disclose pertinent facts surrounding the alleged offense • To protect himself and to utilize the legal safeguards available to him The list of the abilities is both extensive and complex. In order to assess the level or magnitude of these abilities, professionals need to investigate the cognitive, emotional, and social components of intelligence, as well as several aspects of psychopathology. In addition, assessment must include the evaluation of some other competencies, such as interpersonal skills, ability to cope with stress, social perception, self-control, assertiveness, and a myriad of other personality characteristics that contribute to independent functioning. In other words, in most competency evaluations, professionals deal with two major constructs to be evaluated both quantitatively and qualitatively: IQ and DSM-IV diagnosis (American Psychiatric Association, 1994). Despite the fact that most forensic psychologists are quite aware of the limitations and

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654 HANDBOOK OF MULTICULTURAL ASSESSMENT problems associated with the use of these categories as a foundation for any kind of diagnosis or prognosis, they have little freedom of choice and must include interpretations of the defendant’s behavior and mental processes using both standardized evaluation of intelligence and formal psychiatric diagnosis.

MULTICULTURAL EVALUATION OF COMPETENCY AND THE RACIAL BIASES IN IQ TESTING Within Western (and more specifically, American) cultures where IQ tests and the DSM classification have been developed, there are reasonable doubts regarding the applicability of them to every member of the culture. However, the main problem is not associated with poorly constructed tests, the predictive validity of which is debatable. The main issue has to do with the cross-situational variability of people’s behavior and intellectual functioning, which is unlikely to be depicted by any existing test and, no doubt, any in the future. The situation becomes even more problematic when both IQ and DSM categories are applied in working with clients who belong to so-called minority groups: African Americans, non-African Blacks, various groups of Latinos, East Asians, Indians, Arabs, non-American Caucasians, Native Americans, and others. Compared to American Whites, some of those groups exhibit consistently lower scores on IQ tests, whereas others are likely to consistently exhibit similar or higher scores. The box contains an analysis of an infamous article by Arthur Jensen to remind readers that his argumentation continues to be widely used in professional circles. Psychologists should be trained to dispute Jensen’s seemingly statistically sound empirical results and particularly his interpretation of them.

Criticism of Jensen’s Perspective in Multicultural Diversity in IQ Scores In past decades, the idea of test bias was not a universally agreed-on concept. Early research in the field was aimed at defending the legitimacy of certain evaluative measures. In his controversial 1980 article, Arthur Jensen attempted to demonstrate that differing score ranges on standardized tests were due in part to intellectual differences between individuals of different racial backgrounds. Although Jensen’s 1980 article, Precis ´ of Bias in Mental Testing, is empirically sound, there are some flaws in its reasoning that make the information inappropriate to apply to society. Jensen’s position that standardized tests are not as biased as the popular notion suggests is built on faulty logic and drawn-out conclusions. Jensen begins by defining intelligence according to research conducted by Charles E. Spearman in the early 1900s, who labeled his perspective on the contents of intelligence as g: ‘‘Spearman concluded that g is manifested in most items that involve

COMPETENCY TO STAND TRIAL relation education, that is, seeing relationships between elements, grasping concepts, drawing inferences— in short, inductive and deductive reasoning and problem solving’’ (p. 326). Jensen uses this definition of intelligence to draw the conclusion that standardized tests, which measure IQ, and therefore g, are not biased and that score differences between Caucasians and African Americans result from a general lower intelligence in African American populations. He goes on to say that since African Americans are lower in their g abilities, they are less capable of higher-order processing: ‘‘In accordance with the Spearman hypothesis . . . blacks would perform less well (relative to whites and Asians) on multiple-choice test items than on true-false items, which are less complex, having fewer alternatives to choose among’’ (p. 331). Jensen states that his conclusion has been validated by two prior studies, although he fails to provide any information about the studies. It is not difficult to see the flawed line of reasoning in Jensen’s thinking about intelligence. He does not take into consideration that the whole concept of g that he is using to ground his conclusions is based on a cultural perspective of the important elements of thinking. The items emphasized in g may not be relevant for everyone. To strengthen his argument, Jensen provides several statistical examples that point to ethnic differences within IQ: ‘‘For example, an IQ of about 115 or above is needed for success in most highly selective colleges; about 15 percent of white as compared with less than 3 percent of the black population have IQs above 115, that is a ratio of about 5 to 1’’ (p. 326). This information is inaccurate for several reasons. First, Jensen does not provide data about where his statistics are from, such as which studies have proven this IQ discrepancy and what the target populations within the samples were. In addition, assuming that his ratio is correct (which does not seem likely), he does not consider any confounding variables that might account for score differences, such as socioeconomic status or cultural motivation to do well on IQ tests based on the assumed importance of college admissions. Major errors can be found in Jensen’s thinking about what constitutes bias and what does not. He provides readers with three distinct misconceptions individuals hold about test bias: the egalitarian fallacy, which posits that between-group differences are solely the result of bias; the culture-bound fallacy, which assumes that any sort of cultural material in a test makes it biased; and the standardization fallacy, which states that if a test is normed on a particular group of individuals, it is inappropriate for individuals not represented by the sample population. Jensen is correct about the egalitarian fallacy: it is incorrect to assume that group differences result from bias alone. However, his protests against the other two fallacies are less solid. Jensen’s argument against the culture-bound fallacy is highly subjective. He states, ‘‘To the extent that a test contains cultural content that is generally peculiar to the members of one group but not to the members of another group, it is liable to be culture biased with respect to comparisons of the test scores between groups’’ (p. 327). That would be valid if there were a scientific way to observe what is ‘‘peculiar’’ to everyone belonging to cultural subgroup. Including cultural material on standardized tests measures what a certain culture knows about the culture that the test was

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656 HANDBOOK OF MULTICULTURAL ASSESSMENT normed on, and therefore no longer is a measure of inherent intelligence. On a similar line, Jensen’s argument against the standardization fallacy assumes that it is okay to compare one group of people to a different standardization sample. Even if there is no empirical bias in doing so, as he states, these group comparisons may not be appropriate. Again, a test of this nature is measuring how culture A is similar to culture B, and not any unique characteristics of intelligence. Jensen deals with any counterarguments that opponents might offer by dismissing them. He instructs readers to assume that tests are unbiased until research shows otherwise: ‘‘Unless a test can be shown to be biased at some acceptable level of statistical significance, it is presumed to be unbiased’’ (p. 328). This line of thinking is in direct opposition to the scientific method applied in all modern psychological research. The current thinking remains that data are validated only through successive failed attempts to prove otherwise. Generally data are assumed to be flawed unless they can be upheld through various replication procedures. By stating the opposite, Jensen is making his unscientific argument even more so. In sum, the information Jensen proposes about test bias is not scientifically sound. He relies on broad generalizations based on a small number of studies, most of which he does not offer any information about within the article. His whole argument is based on the concept of Spearman’s g, a biased and culturally bound definition for intelligence that may be arbitrary in non-White cultures within and outside the United States. Finally, Jensen fails to consider individual differences and the various social, cultural, psychological, and biological factors that can contribute to varied levels of performance on standardized tests.

Overall, researchers find that bias does exist in competency evaluations; however, the issue may not be as simple as identifying one targeted minority group. Various factors intertwine, making it difficult to separate where the true bias lies from multiple confounding variables. In their research, Caldwell, et al. (2003) and Hicks (2004) concluded that African Americans are more likely to be found incompetent, but they acknowledge that statistically significant differences may be due to low socioeconomic status (SES) and not merely race. From his archival review of 288 mentally retarded defendants from a Florida hospital providing specific training on the legal system to mentally retarded patients with pending criminal cases, Ho (1999) concluded that race was not a statistically significant determinant of case outcome and directly attributed differences to SES. Although the above studies raise some doubt on the issue of racial bias in competency evaluations, it is premature to conclude that racial bias does not exist. Evidence supports that African Americans are more often diagnosed with mental illness, but that the dichotomy may result more from differences in SES than anything else; when the data controlled for SES differences, ethnic distinctions in diagnoses dissipate. African Americans tend to be diagnosed with more severe mental illnesses such as psychosis. Hicks (2004) puts forth that different ethnic groups demonstrate different ways of reporting their

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symptoms, such as attributing them to somatic or spiritual causes, which may lead to increased diagnoses for specific groups of people. Thus, evaluators may be erroneously comparing African American symptom manifestations to criteria based on the overt presentation of disorders in a Caucasian population.

INTELLIGENCE AS A CULTURAL CONSTRUCT The use of standardized IQ tests could be inappropriate because of an even more significant factor, which could be referred to as a cultural definition of intelligence and the cultural value of various components of it. Although many cultural definitions of intelligence have some similarities and are to some extent universal, the definition’s essence of intelligence in the European American culture is not fully consistent with the perspective on it in other cultures and subcultures. Whereas some cultures put emphasis on abstract thinking, verbal comprehension, memory, and competence in the rules governing behaviors, other cultures value creativity, social competence within a specific subculture, physical fitness, musical abilities, an ability to write poetry, and visual-motor coordination. Interestingly enough, a controversial issue of what constitutes a learning disability stems from the fundamental definitions of intelligence and the associated practices in education within various cultures. The diagnoses of learning disabilities can be established only within cultures that put emphasis on specific aspects of intelligence, whereas other cultures may have totally different perspectives on what is important in intellectual functioning. Therefore, a multicultural approach to assessment of competencies must incorporate the investigation of culture-specific, or emic, elements of IQ assessment. Moreover, in contrast to the assessment of criminal responsibility (mental state at the time of the offense), the assessment of competency to stand trial is present oriented and thus requires a form of functional analysis of the defendant’s behavior under specific circumstances such as a court trial. The perception and cognitive processing of various elements of a trial as well as subsequent behaviors are heavily affected by cultural factors. In fact, nearly every behavior could be viewed as a cultural construct. Therefore, professionals face an enormously difficult task of assessing not only the abilities listed above, but also the cultural environment of the defendant, which includes his own perspective, the cultural attitudes toward each of those abilities common among members of his culture, perception of the legal situation, understanding of legal procedures, cultural beliefs regarding the agents of assessment and intervention, and the value of both outcomes of competency evaluation: to be admitted either competent or incompetent to stand trial. If this analysis is provided, the formal IQ evaluation becomes an important, but not the only, source for the conclusions about the competency to stand trial.

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MULTICULTURAL ASSESSMENT OF COMPETENCY AND THE DSM DIAGNOSIS A formal DSM diagnosis needs to be provided. It must be admitted that validity and reliability were found to be greater in competency evaluations than in any other forensic evaluations. In Poythress and Stock’s examination of interclinician agreement (1980), 100 percent agreement was reached as to the ultimate opinion on competence, although diagnostic impressions varied greatly. In other words, the evaluators were able to reach a consensus on whether their clients were abnormal rather than on specific aspects of a mental disorder. This is exactly where cultural biases are likely to thrive. Several biases that are common toward Black Americans are well documented and are presented below. In fact, anyone with a ‘‘foreign’’ background has much higher chances of being diagnosed with nearly any mental disorder: learning disability, mental retardation, psychotic disorders, affective and mood disorders, personality disorders, and others. The literature is unambiguous about these findings, and it is only logical to view the practice of establishing a DSM diagnosis as a main condition for determining competency as completely outdated and unscientific. Indeed, one of the objectives of the evaluation of competency to stand trial is to assess the presence and degree of such psychological conditions as dementia, dissociative disorders, mental retardation, conduct disorders, certain personality disorders, anxiety disorders, and depression with psychotic features, but it is not the ultimate goal of evaluation. The goal is to establish whether the defendant’s cognitive abilities allow him to perceive, understand, and testify in court, that is, assist counsel and act with reasonable awareness within legal procedures. Therefore, psychological evaluation is functional and present oriented. Mental health professionals evaluate the psychological characteristics and behavioral manifestation that might prevent the defendant from standing trial within a specific sociocultural context. It is not exclusively focused on the search for the formal DSM diagnosis.

TYPES OF BIASES IN MULTICULTURAL ASSESSMENT OF COMPETENCY If the social context of the evaluation is multicultural, two types of problems emerge in the forensic evaluation conducted by a psychologist or another mental health professional. First are his or her own biases, both professional and cultural. These preconceived notions may prevent a professional from

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an objective assessment of the defendant’s characteristics. Second is cultural incompetency on the defendant’s side: his or her inability to function within a legal procedure due to his or her failure to respond adequately to specific cues (stimuli), the meaning of which in various subcultures may vary dramatically. The jury, the judge, the attorneys, and others participating in the criminal procedure are all perceived through cultural lenses, and the very presence of the defendant in such an environment as a courtroom may cause intense stress, anxiety, anger, and confusion that subsequently decreases their actual competency. To give an example of differences between Western and non-Western values regarding mental health, three culture-bound assumptions (Lewis-Fernandez and Kleinman, 1994) presented by Marsella and Pedersen (2004) could be considered: ‘‘(1) the egocentricity of the self, where individuals are seen as self-contained and autonomous units whose behavior is determined by a unique configuration of internal attributes; (2) the mind-body dualism, which separates psychological and physical problems; and (3) the assumption that culture is a vague and arbitrary superimposition on the otherwise ‘knowable biological reality’’’ (p. 416). All three assumptions could be proven wrong once they are perceived by members of non-Western cultures. Many of those cultures are collectivistic, have a monistic perspective on body-mind relationships, and believe in the power of their cultural traditions. Defendants with this kind of worldview are likely to perceive almost everything differently. Besides a legal system that remains foreign to them, they would interpret nearly every stimulus in a courtroom in their own way. Western mental health professionals who have been exposed to the courtroom environment by watching numerous movies are likely to perceive it as routine and not special. Subsequently they would be prone to interpret behavior of poorly acculturated defendants as deviant, abnormal, and bizarre and easily testify on their incompetency to stand trial. Instead of dealing with the actual mental competency, professionals might confuse the current level of functioning with the defendant’s ‘‘cultural incompetency.’’ In fact, cultural incompetency is a much broader phenomenon that manifests in a number of ways, including ‘‘distorted’’ perception of interpersonal behavior, ‘‘distorted’’ attribution of causes of people’s behavior, ‘‘inappropriate’’ emotional expressions, and ‘‘inadequate’’ communication with the legal counsel and other participants of a trial. At the same time, the types of incompetency could be situation bound; outside the courtroom, the behavior of a person from a dissimilar culture could be considered quite functional and consistent across many situations unless some extraordinary circumstances (such as an arrest, an investigation, a series of interrogations, or an isolation from the family and the community) become the key element of his or her social environment.

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THE IMPACT OF THE DEFENDANT’S SOCIAL ROLE ON COMPETENCY EVALUATION IN THE MULTICULTURAL CONTEXT In general, being a defendant is an unusual social role for most people regardless of whether they belong to the mainstream culture or a small subculture of immigrants. Forensic psychology research provides data on the dramatic behavioral, emotional, and cognitive changes experienced and exhibited by people who are under any kind of investigation. These include psychological and physiological symptoms of distress, elevated anxiety, outbursts of anger, feelings of helplessness, poor self-regulation, paranoid vigilance, distrust, malingering, dissimulation, endorsement of socially desirable answers on personality measures to make the best possible impression, and others. Therefore, the way of thinking, feeling, and behaving is likely to be substantially altered. All of these problems tend to be significantly more severe for defendants with a different cultural background because they are directly affected by the ‘‘inadequacies’’ described in a previous paragraph. The resulting combination of cultural and situational stressors may indeed lead to a disorganized and confusing behavior that is likely to be perceived by the evaluator as completely abnormal.

MULTICULTURAL ASPECTS OF RESTORED COMPETENCY The decision that is frequently made regarding multicultural defendants is to make medical efforts to restore their competency by any means so that the trial may be resumed. The resulting verdict might create a number of other multicultural issues. First, different ethnic groups respond differently to psychotropic medications. Second, even if there is a possibility of restoring competency by the use of medications, the question is whether the defendant is likely to act and think as himself or herself or the ‘‘competency’’ is artificial and totally induced by drugs (Melton et al., 1997). The third issue is the extent to which the use of medications is perceived as appropriate in the defendant’s community and thus whether he or she is likely to be compliant. And finally, there is an ethical concern as to whether the defendant has been taking medications voluntarily. From a rigorous multicultural standpoint, the ‘‘restored competency’’ is an intrusion in the privacy of the person’s cultural beliefs, values, and attitudes, and a superimposing of the mainstream perspective by means of medical technology in a form of psychopharmacological brainwashing. It is difficult to justify or defend this practice considering the psychological stressors experienced by defendants, particularly of those who do not belong to the mainstream culture.

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An example of a good empirical study consistent with these theoretical speculations is research conducted by Caldwell et al. (2003). The investigators looked at adult defendants in an outpatient setting over a three-year period. Results indicated that defendants suffering from psychotic disorders were more likely than those suffering from other Axis I disorders or substance abuse problems to have previously received inpatient psychiatric treatment. In addition, female defendants were more likely than males to receive recommendations for inpatient hospitalization. There was a greater chance of being found incompetent to stand trial if diagnosed with a psychotic disorder. Accordingly, more African Americans than Caucasians were diagnosed with psychotic disorders. Caldwell et al. noted the historical consistency between the high rates of forensic and nonforensic diagnoses of psychotic disorders among the African American community. The statistical data were explained by possible sociocultural weaknesses that adversely affect the lives of African Americans, therefore leading to the increased likelihood of a diagnosis of a psychotic disorder. Caldwell et al. also pointed out that many of the tools used for determining competency are not culturally sensitive, or from the biases of those in the clinical and legal professions that request competency evaluations for patients and clients.

CLINICIANS’ BIASES AND FEARS Besides the way in which symptoms are inappropriately interpreted, preconceived notions often find their way into forensic settings, thus decreasing the chances that certain individuals will be treated in an unbiased manner. Selection processes within jury pools, as well as clinicians willing to participate in competency evaluations, can greatly affect the outcomes of individual cases. Deitchman, Kennedy, and Beckham (1991) concluded that ethical concerns may influence a clinician’s decision to participate in a competency evaluation and thus creates a biased pool of willing examiners. Due to a self-selection process, the pool of psychiatrists who choose to participate in competency for execution evaluations may be biased. Since the issue is emotionally charged, it is difficult for examiners to remain neutral in their decisions. Many psychiatrists opt not to participate in such evaluations because of conflicts with their personal belief systems regarding the use of capital punishment. In addition, the jury pool becomes biased, as individuals in capital punishment cases who note that they are opposed to the death penalty are excused, leaving a group of more conservative and authoritarian individuals, according to research. The authors list several factors that can lead to bias in competency-to-execute cases, including an ambiguous definition of competency, the psychologists’ and psychiatrists’ personal beliefs toward the death penalty, the lack of agreement in diagnosis among psychologists, and clinically ambiguous case information.

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EXPLANATIONS FOR THE OVERREPRESENTATION OF MINORITY GROUPS: CULTURAL, ETHNIC, OR ECONOMIC? Thus, even when it cannot be explained by race categories alone, something is happening within the forensic system that allows an overrepresentation of minority groups. Even studies that determine that race is not a statistically significant factor have difficulty explaining the disproportionate number of African Americans incarcerated in jails or forensic mental health facilities. Ho (1999) outlines several factors that make determining competency for mentally retarded inmates difficult. For example, he points out that a large number of mentally retarded defendants are members of minority groups and are likely to have grown up in poor families. They are frequently given a secondary diagnosis of mental illness or brain injury. He points out that it is often difficult to distinguish mentally retarded inmates from illiterate individuals. In line with the disproportionate number of African Americans imprisoned as compared to Caucasians, there is an exceedingly high number of incarcerated mentally retarded African Americans. His study did not find a statistically significant difference between Black and White defendants who were found either competent to stand trial or incompetent to stand trial. Race did not appear to affect either the psychologists’ or the judges’ competency evaluations. IQ score was a statistically significant determinant of those found competent or incompetent and was positively correlated. Ho noted a substantially higher number of African Americans in his population than Caucasians and that the racial disparity within the prison system warrants further investigation. Overall the African American mentally retarded defendants came from an overall lower SES, had lower IQ scores, and had committed their first crime at an earlier age when compared to the Caucasian counterparts within the sample population. Hicks (2004) noted that non-White patients tend to show higher rates of psychiatric emergency room admission, but the differences may result from several factors, such as access to nonemergency room treatment, SES, and the type of diagnosis. For example, non-low-SES Whites may have limited options concerning preemergency psychiatric care. Clinicians need to be aware of the racial discrepancies that exist within forensic cases, as well as their own reactions to certain key issues that may obfuscate the decision making process. Hicks (2004) contends that the idea of approaching forensic cases in a color-blind manner is erroneous, because this overlooks key differences between groups that are important for understanding behavior. By ignoring ethnic differences, patients can be misdiagnosed and mistreated. As a result, biased forensic decisions may be made. The content of the evaluation of competency within the multicultural settings needs to include several elements to minimize the effects of the defendant’s

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limited acculturation and the evaluator’s cultural biases and limited bicultural sensitivity. In practice, it would require some multicultural training for forensic evaluators as well as some instruction for the defendants. The following instruments have been traditionally used to establish competency to stand trial, and they have been discussed in a number of books and articles (Barnard et al., 1991; Nicholson, Briggs, and Robertson, 1988; Melton et al., 1997): Competency Screening Test, Competency Assessment Instrument, Interdisciplinary Fitness Interview, Georgia Court Competency Test, Computer-Assisted Competence Assessment Tool, and CAST-MR. The most frequently used instrument is the MacArthur Competence Assessment Tool—Criminal Adjudication (Hoge et al., 1997), which measures two legal abilities (assisting counsel and decision making) and four psychological abilities (understanding, recognizing relevant information, thinking rationally, and appreciation). Although the latter has been proven to have better validity and reliability, there are no data to support its multicultural validity. Therefore, in addition to standardized measures, other instruments must be included in the initial evaluation of a competency. Among them a substantial role could be played by various acculturation scales, many of which (particularly designed for the Spanish speaking individuals) are reliable and valid instruments (Kang, 2006). The clinical interview with a multicultural component (Pedersen and Ivey, 1993) could be supplemented with specific instruction on how to tolerate stress and cooperate with counsel to prevent emotional distress in the courtroom. If some preparation is provided, the issue of competency in multicultural cases could be resolved before it is raised by the legal counsel.

CONCLUSION Some recommendations could be delineated to improve the quality and the objectivity of the multicultural assessment of the competency to stand trial. Any multicultural forensic evaluation requires some preparation. On the personal level, a professional needs a strong sense of identity and an understanding of his or her own cultural beliefs and attitudes. This person must also be ready to make an assumption that the defendant could have very different, if not opposite, perspectives on most of things that a professional could take for granted. Professionals need to be aware of the biases that exist in their own culture and the extent to which they share them. It is important for them to be honest with themselves and disclose these biases. In addition, they must be aware that certain characteristics of personality or symptoms of psychopathology are more likely than usual to be underestimated or overlooked when dealing with individuals from differing cultures. For example, our experience of providing

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664 HANDBOOK OF MULTICULTURAL ASSESSMENT training for working psychologists showed that even gender differences can be a powerful factor that distorts perception and assessment of certain behaviors, particularly behavior under stressful circumstances. Moreover, some experienced clinicians may develop a kind of professional perceptual distortion in their approach to criminal cases. Since forensic evaluators see a lot of clients over the years, the freshness of their perception could be replaced with a stereotypical vision of the cases—a tendency similar to the regression to the mean. The uniqueness of each case could be affected by professional biases multiplied by ethnic/racial biases, and this aberration in perception of certain minority groups might substantially undermine the quality of the forensic assessment. Much more research is needed to help mental health professionals provide objective and valid assessment on multicultural cases of competency to stand trial.

References American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (DSM-IV). Washington, DC: Author. Barnard, G. W., Thompson, J. W., Freeman, W. C., Robbins, L., et al. (1991). Competency to stand trial: Description and initial evaluation of a new computer-assisted assessment tool (CADCOMP). Bulletin of the American Academy of Psychiatry and Law, 19, 367–381. Caldwell, R. M., Mandracchia, S. A., & Ross, S. A. (2003). Competency to stand trial and criminal responsibility: An examination of racial and gender differences among African American and Caucasian pretrial defendants. American Journal of Forensic Psychology, 21(3), 5–19. Deitchman, M. A., Kennedy, W. A., Beckham, J. C. (1991). Self-selection factors in the participation of mental health professionals in competency for execution evaluations. Law and Human Behavior, 15(3), 287–303. Hicks, J. W. (2004). Ethnicity, race, and forensic psychiatry: Are we color-blind? Journal of the American Academy of Psychiatry and the Law, 32(1), 21–33. Ho, T. (1999). Examination of racial disparity in competency to stand trial between White and African American retarded defendants. Journal of Black Studies, 29(6), 771–789. Hoge, S. K., Polythress, N., Bonnie, R. J., Monahan, J., Eisenberg, M., & Feucht-Havar, T. (1997). The MacArthur adjudicative competency study: Diagnosis, psychopathology, and competence related abilities. Behavioral Science and the Law, 15, 329–345. Jensen, A. (1980). Precis of bias in mental testing. The Behavioral and Brain Sciences, 3, 325–371. Kang, S.-M. (2006). Measurement of acculturation, scale formats, and language competence. Their implications for adjustment. Journal of Cross-Cultural Psychology, 37, 669–693.

COMPETENCY TO STAND TRIAL Lewis-Fernandez, R., & Kleinman, A. (1994). Culture, personality and psychopathology. Journal of Abnormal Psychology. Special Issue: Personality and Psychopathology, 103(1), 67–71. Marsella, A. J., & Pedersen, P. (2004). Internationalizing the counseling psychology curriculum: Toward new values, competencies, and directions. Counseling Psychology Quarterly, 17, 413–423. Melton, G. B., Petrila, J., Poythress, N., & Slobogin, C. (1997). Psychological evaluations for the court: A handbook for mental health professionals and lawyers (2nd ed.). New York: Guilford Press. Nicholson, R. A, Briggs, S. R., & Robertson, H. C. (1988). Instruments for assessing competency to stand trial: How do they work? Professional Psychology: Research and Practice, 19, 383–390. Pedersen, P., & Ivey, A. (1993). Culture centered counseling and interviewing skills: A practical guide. Westport, CT: Praeger. Poythress, N. G., & Stock, H. L. (1980). Competency to stand trial: A historical review and some new data. Journal of Psychiatry and Law, 8, 131–146.

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CHAPTER TWENTY-NINE

Multicultural Assessment Trends and Future Directions Lisa A. Suzuki Joseph G. Ponterotto

T

he preparation of the third edition of this Handbook required us to once again examine the purposes and process of assessment, traditional measures in psychology, culturally related constructs, and the diverse populations in relation to current testing practices. In the final chapter to the 2001 edition, we noted: Issues related to multicultural assessment have changed very little since the publication of the first edition. The concerns we raised hold true today. In the political and economic arena, assessment practices are in large part still dictated by test development companies, and educational and institutional systems. What is permissible in terms of appropriate practice is still narrowly defined. Test instruments look similar to earlier versions, and little has been done to shake up the assessment community despite the development of alternative practices [Suzuki, Ponterotto, and Meller, 2001, p. 569].

Examining the overall content of this edition leads us to a much more optimistic outlook. The acknowledgment of the salience of culture has become more a part of mainstream thinking psychology. The American Psychological Association adopted The Guidelines on Multicultural Education, Training, Research, Practice and Organizational Change for Psychologists as policy in 2002. This landmark event solidified a commitment of the organization to promote cultural understanding throughout the profession. As one colleague put it, ‘‘We no longer have to spend time convincing other mental health professionals that multiculturalism is important.’’ Since the adoption of the

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Guidelines, the literature in the area has exponentially increased with directives on integrating the guidelines into training and professional practice. Assessment issues are clearly identified with respect to culture-centered and ethical psychological research with individuals from ethnic, linguistic, and racial minority backgrounds (Guideline 4). In addition, assessment is a focus in terms of applying culturally appropriate skills in applied psychological practice (Guideline 5). Assessment was one of the major domains addressed in the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology in 2002. A psychological assessment group was charged with identifying (1) major core competencies in assessment, (2) central training experiences, (3) strategies in evaluation, and (4) future directions. The report of the task group specifies the importance of incorporating models of culturally competent assessment (Krishnamurthy et al., 2004). A number of seminal texts focusing on particular areas of psychological assessment with attention from a multicultural perspective have been published and are frequently cited (Dana, 2000, 2005; Paniagua, 2005; Rhodes, Ochoa, and Ortiz, 2005; Valencia and Suzuki, 2001; Lim, 2006). In addition, testing manuals and general assessment texts contain references to the importance of cultural context. We are optimistic about the growing attention to multicultural issues in psychology, yet we are also aware that the demands placed on clinicians, researchers, and educators to address the ever expanding issues of the diverse communities we serve are facing exponential growth. As noted in the Preface to this book, the landscape of assessment is dynamic and continues to evolve as the complexities of cultural understanding expand. The challenges to the field are evidenced in the broadening of areas and topics related to assessment presented in this edition. The most popular measures in each domain of assessment have withstood challenges over time. The testing enterprise has also expanded to encompass global and international audiences. A number of tests have been translated and renormed in other countries. For example, the WISC-III, one of the cornerstones of assessing children’s intelligence, has been transported to a number of other countries, including Canada, France, Belgium, Germany, Austria, Switzerland, South Korea, Japan, Taiwan, and the United Kingdom (Georges, Weiss, van de Vivjer, and Saklofske, 2003).

MULTICULTURAL ASSESSMENT IN PRACTICE Despite the increased availability of information available regarding the use of various measures with diverse populations, concerns continue to be raised with respect to the gatekeeping functions of tests, limited availability of assessment

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Tests as Gatekeepers The gatekeeping function of tests is most apparent in high-stakes testing practices in the schools. Tests are mandated to determine grade promotion and high school graduation. School averages on various achievement measures are used to keep teachers and school administrators accountable. The movement toward high-stakes testing has proven detrimental to many racial and ethnic minority communities. Madaus and Clark (2001) made the following conclusions based on their review of one hundred years of data collected on high-stakes testing from research conducted at Boston College: • High stakes, high standard tests do not have a markedly positive effect on testing or learning • High stakes tests do not motivate the unmotivated • Authentic high stakes assessments are not a more equitable way to assess the progress of students who differ in race, culture, native language or gender • High stakes tests have been shown to increase high school drop out rates, particularly among minority populations [p. 1].

Madaus and Clark note that given these findings, the use of high-stakes testing must be vigilantly monitored for detrimental effects within communities. The SAT is a gatekeeper in terms of opportunities for higher education. As noted in Chapter 22 some schools have made this test optional for applicants to reduce reliance on test scores as the determining factor for admission.

Limited Availability of Appropriate Assessment Tools Despite better test development procedures and statistical means of estimating potential bias, there remains a dearth of measures for assessing the multiple intersecting identities and contexts of a given individual. The section of this Handbook focusing on immigrants and refugees highlights the complexity of the assessment process. Adapting measures for diverse populations (Chapter 9) and working with translators and interpreters (Chapter 10) are possible ways of managing these complexities, but translating effectively and interpreting appropriately is difficult and requires extensive training and associated costs.

Problems in the Application of Best Practices in Assessment The chapters of this Handbook highlight best practices (Chapter 1) and focus on various domains of assessment in psychology in the remainder of the

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text. It has been clearly easier to write about these topics than to see them implemented in practice. Anecdotal cases are used in various chapters to highlight best practices as well as illustrate the problems that can arise when multicultural issues are not attended to in the assessment process. Examples include formulating inaccurate and insensitive conclusions and acting on inappropriate judgments of the client.

FUTURE DIRECTIONS The future directions outlined in the second edition continue to be relevant (Suzuki et al., 2001) to our current work in assessment. Here we expand on them. • Infusing multicultural issues into all assessment courses in education and psychology training programs. Attention to multicultural issues in assessment training courses is uneven across academic programs. Given the increasing globalization of our profession and society, it is imperative for students to be trained to understand the complex overt as well as subtle impact of culture in all assessment practices. • Continuing development of alternative measures and procedures. As noted in various chapters in this edition, the use of standardized measures can be combined with more qualitative type indicators such as behavioral observations. Findings of self-report measures may be limited, and therefore inclusion of alternative measures or methods addressing a related construct can be helpful. • Increasing sensitivity to issues of equivalence as well as cultural divergence in understanding psychological and educational constructs. As noted in many chapters of this book, attending to cultural equivalence is imperative in assessment practice. Recognizing that psychological constructs, testing formats, and item meanings can vary for different groups should lead professionals to raise questions in determining whether an evaluation is necessary and what methods or instruments are most appropriate. • Increasing collaboration with members of racial and ethnic communities such as bilingual and bicultural professionals, indigenous healers, spiritual leaders, and cultural informants. As noted in Chapters 9 and 10 of the Handbook, establishing relationships with members of the diverse communities we serve can be invaluable in the assessment process. From translating measures to serving as potential interpreters and cultural brokers, knowing the communities in which we work can yield many benefits to professionals and members of the communities who will be better served.

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670 HANDBOOK OF MULTICULTURAL ASSESSMENT • Increasing attention in the literature to use of particular instruments with diverse populations (for example, reliability and validity studies). Integrating the latest developments in research and practice will enable professionals to provide the most informed services to diverse clients. Test developers provide seminal information regarding steps taken in the creation of new and revised measures. Indeed, the best-established tests may have entire texts devoted to their appropriate use, often citing seminal articles in the field and not just those conducted by members of the testing industry. Continually updating reliability and validity data is critical to examine how a test functions with respect to different population samples. Efforts have been made in these areas identified as future directions, but much more needs to be done to ensure our capacity to achieve multicultural competence in assessment practices. Professionals must be vigilant in advocating for better traditional tests, creation of new and innovative measures, and ways of integrating areas of assessments into useful documents that will benefit all those served.

References American Psychological Association. (2002). The guidelines on multicultural education, training, research, practice, and organizational change for psychologists. Washington, DC: Author. Dana, R. H. (Ed.). (2000). Handbook of cross-cultural and multicultural personality assessment. Mahwah, NJ: Erlbaum. Dana, R. H. (2005). Multicultural assessment: Principles, applications, and examples. Mahwah, NJ: Erlbaum. Georgas, J., Weiss, L. G., van de Vijver, F.J.R., & Saklofske, D. H. (Eds.). (2003). Culture and children’s intelligence: Cross-cultural analysis of the WISC-III. Orlando, FL: Academic Press. Krishnamurthy, R., VandeCreek, L., Kaslow, N. J., Tazeau, Y. N., Miville, M. L., Kerns, R., et al. (2004). Achieving competency in psychological assessment: Directions for training and education. Journal of Clinical Psychology, 60(7), 725–739. Lim, R. F. (Ed.). (2006). Clinical manual of cultural psychiatry. Washington, DC: American Psychiatric Publishing. Madaus, G., & Clark, M. (2001). The adverse impact of high stakes testing on minority students: Evidence from 100 years of test data. http://eric.ed.gove/ERICWebPortal (ED 450 183). Paniagua, F. A. (2005). Assessing and treating culturally diverse clients: A practical guide (3rd ed.). Thousand Oaks, CA: Sage. Rhodes, R. L., Ochoa, S. H., & Ortiz, S. O. (2005). Assessing culturally and linguistically diverse students: A practical guide. New York: Guilford Press.

MULTICULTURAL ASSESSMENT Suzuki, L. A., Ponterotto, J. G., & Meller, P. J. (Eds.). (2001). Handbook of multicultural assessment: Clinical, psychological, and educational applications (2nd edition). San Francisco: Jossey-Bass. Valencia, R. R., & Suzuki, L. A. (2001). Intelligence testing and minority students: Foundations, performance factors, and assessment issues. Thousand Oaks, CA: Sage.

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NAME INDEX

A Abedi, J., 8–10, 483–485, 535–537 Abe-Kim, J. S., 117 Abidin, R. R., 576 Able-Boone, H., 572 Abrahams, F., 379 Abrams, D., 358, 359 Abrams, R., 482 Abreu, J. M., 74, 75, 78, 82–84, 140, 391 Achenback, T. M., 331, 333 Ackerman, D. S., 508 Acosta, F. X., 221, 224 Adam, B., 306 Adams, R. L., 553, 555 Adamson, W. S., 388 Adler, A., 403 Afroz, N., 379 Agani, F., 207 Aguiar, L. J., 111 Aguilar-Kitibutr, A., 108 Ahluwalia, M. K., 92 Ahmed, L., 300 Aiken, L. R., 375, 378, 379, 382, 385 Aklin, W. M., 172, 180 Akutsu, P. D., 3, 73, 74, 84 Alaggia, R., 646 Alarcon, R. D., 107 Albaugh, B., 430, 438 Albee, G. W., 109

672

Albert, M. L., 595 Aldarondo, F., 375, 388, 389 Alden, L. E., 74 Alegria, M., 113 Aleva, A., 349 Alexander, C. M., 110 Alexander, J. F., 32 Alland, A., Jr., 350, 351 Allden, K., 199 Allen, J., 108, 110, 116–118, 139, 362, 364, 365, 391–393, 429, 437 Alonso, A., 504 Alpern, G., 579, 586 Altarriba, J., 116 Amante, D., 550 Ambady, N., 505 Amelang, M., 506 Anastasi, A., 7, 442, 455 Anastos, K., 206 Ancis, J. R., 134, 139, 144 Anderson, H., 249, 250, 264 Anderson, M., 299–301 Anderson, S., 284–285 Andersson, I., 350, 351 Andersson, S. B., 350, 351 Angel, J. L., 608 Angel, R. J., 608

NAME INDEX Angleitner, A., 403 Ani, M., 304–306 Anthony, W. A., 114 Anton, B. S., 113 Aponte, J. F., 392 Aragon, M., 119 Arana, G. W., 437 Araya, M., 197 Arbisi, P. A., 425, 426, 428, 437, 441 Arbona, C., 273–275 Archer, P., 579 Archer, R. P., 347 Ardila, A., 553, 600 Ards, S., 630 Arguelles, S., 556, 595, 597 Arguelles, T., 556, 597 Armour-Thomas, E., 7, 11, 12 Armstrong, P. I., 280 Arnheim, R., 350, 384 Arnold, B. R., 75, 605 Aronson, J., 13, 14, 514, 515 Arrendondo, P., 137–139 Arrindell, W. A., 301 Artiles, A. J., 12, 473, 507, 552 Artiola i Fortuny, L., 550, 551, 556 Asner-Self, K. K., 73 Atkinson, D. R., 118, 143, 146, 155n1 258, 365 Atkinson, M. J., 309 Atkinson, R., 13 Atran, S., 450 Atsma, N., 93 Attermeier, S. M., 571 August, D., 481, 482 Auld, F., 324 Austin, R., 63 Avila-Espada, A., 359, 360 Axelson, J. A., 305 Aylesworth, R., 15 Azuma, H., 459 B Ba, P., 179–180 Bachman, L. F., 473, 485, 552 Bachrach, J., 323 Baden, A. L., 594, 595 Bader, S. B., 550 Bagnato, J. T., 567, 570, 578 Bagnato, S. J., 572, 575, 584 Bailey, B. E., 359 Bailey, D. B., 575 Bailey, D. S., 576 Baird, C., 628, 647 Bakeman, R., 172

Baker, C., 479 Baker, E. L., 535 Baker, F. M., 610–611 Baker, N., 221 Baker, S. B., 275, 276 Balla, D. A., 583 Ballinger, T., 349 Bamaca-Gomez, M., 55 Bancroft, M., 223 Bandura, A., 273, 277, 283–284, 288, 324, 325 Banks, J. A., 59, 64 Banks, K., 95 Banks, R. W., 273 Bansal, A., 431 Barbaranelli, C., 273 Barclay, A., 387 Bardos, A. N., 350 Bargar, J. R., 414 Bargar, R. R., 414 Barger, N. J., 408, 417–419 Barker, W. W., 595 Barnard, G. W., 663 Barnett, R. W., 380 Barona, A., 572, 586 Barquero, M. S., 605 Barrera, I., 569, 586 Barrett, K. H., 190 Barron, K. E., 64 Barron, R. M., 64 Barton, K., 376 Basic, D., 595 Basoglu, M., 167–168 Bathurst, J., 418 Batolva, J., 165 Bayley, N., 565, 579 Beard, J., 22 Beatty, A., 473, 474, 484 Beavin, J. H., 27 Beck, A. T., 610 Beck, S., 362 Beck, S. E., 275 Beckham, J. C., 661 Beeri, M. S., 604 Behrens, J. T., 54 Behrman, R. E., 630 Belizaire, L., 63 Bell, C. C., 24 Bellak, L., 359 Bellak, S. S., 358, 359 Benhamida, L., 221 Bennett, J. A., 452 Bennett, R. W., 96, 97 Benoit, W. A., 334

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674 NAME INDEX Ben-Porath, Y. S., 221, 425–427, 437 Bent-Goodley, T. B., 630 Benton, A. L., 543, 554 Bercier, B. J., 595 Berg, E. A., 549 Berg, I. K., 250, 251 Berg-Cross, L., 140, 145 Berger, R., 170, 183, 185, 188 Bergman, L. R., 114 Bermejo, F. L., 605 Bernal, G., 116–117 Bernard, L. C., 553, 555, 556 Bernat, J. A., 437 Bernstein, M., 457 Berry, J. W., 74, 75, 77, 79, 145, 389–391, 449, 451, 452, 457, 512, 550, 551 Betancourt, H., 75, 83, 550, 553 Betz, N. E., 277, 283–285 Beuke, C., 418 Bhui, K., 180, 181, 184, 300 Bhullar, N., 512 Bieber, S., 364, 436 Bieber, S. L., 439 Bieschke, K. J., 132 Biesheuvel, S., 452 Bigelow, J. H., 11 Bignell, C. U., 615 Bikos, L. H., 281 Bilukha, O. O., 207 Binet, A., 94 Bingham, R. P., 568 Birman, D., 73, 74, 78, 79, 81, 83 Blackman, M. C., 376 Blair, G., 438 Blane, H. T., 387 Bledsoe, M., 289 Bleich, A. B., 207 Bloom, J. D., 199 Blow, F. C., 609 Blustein, D. L., 274, 275, 289 Boake, C., 553 Boehnlein, J. K., 199 Bogdan, R., 310–312 Bohnstedt, M., 595, 602 Boland, M. G., 512 Bolden, M. A., 139, 299 Boll, T., 525, 579, 586 Bolt, S. E., 9, 10 Bolton, P., 177, 182, 183, 188, 201, 203, 205, 207 Bond, M. H., 301 Borgen, F. H., 279, 284, 285 Borges, N. J., 376, 379, 382 Boring, E. G., 113, 457

Bornstein, B. T., 524 Bornstein, R. F., 342 Borsato, G. N., 5, 471 Borson, S., 595, 604 Boscardin, M. L., 97 Boskailo, E., 213 Bouchard, T. J., Jr., 403 Bowen, M., 254, 255 Bowman, P. T., 358 Bowser, B. P., 64 Boyce, J. C., 83 Boyce, W. T., 83 Boyd-Franklin 258 Boyer, J. I., 556–557 Boyer, L. B., 364 Boykin, A., 554 Bracero, W., 324 Bradley, P., 382–385 Bradley, R., 575 Brady, C., 428, 437 Brady, K. L., 428, 437 Brady, W., 197 Braithwaite, V., 458 Brayne, C., 597 Brazelton, T. B., 579 Breckenridge, A., 199 Brekken, L. J., 574 Bresnick, B., 579 Bricker, D., 570, 571, 578, 579 Bridgeman, B., 98 Bridges, W., 417 Brigance, A. H., 583, 584 Briggs, K. C., 405 Brisk, M. E., 568 Britain, H. M., 605 Broadhead, J. K., 309 Brobst, K. A., 280 Broca, P., 543 Brockway, D., 531 Brodbeck, F., 59 Bronfbrenner, U., 27 Brooks, R. D., 334 Brown, A. L., 139, 455, 569, 585 Brown, B. B., 288 Brown, C., 284–285, 285 Brown, C. R., 97 Brown, K. W., 306 Brown, M., 347 Brown, M. T., 274 Brown, S. D., 273, 276, 277 Brown, W., 569, 585 Brummett, B. R., 65 Bruner, J., 324, 325, 357, 459, 553–554 Brunner, T. M., 178

NAME INDEX Brush, M., 604 Bryan-Davis, T., 139 Bryant, B. R., 582 Buck, J. N., 348 Buckley, T. R., 111 Bucknam, M. E., 602 Budoff, M., 455 Buhr, D. C., 101 Buki, L.P., 73 Bulhan, H. A., 109 Burck, H. D., 275, 276 Burger, G. K., 386, 387 Burkard, A. W., 52, 65, 144 Burns, R. C., 348, 354 Burton, S., 578 Busby, R. M., 435, 439 Bush, L. D., 15 Butcher, J. N., 102, 103, 223, 225–227, 363, 425–427 Butler, F. A., 478 Butler, Y. G., 480 Byabagamba, H., 213 Byars-Winston, A. M., 276, 277, 281, 283, 285–287, 289 Byrd, D., 550 Byrne, N. O., 249 C Cabassa, L. J., 7, 74, 79, 83–85 Cahalan, C., 98 Cai, Z., 359 Cain, T. R., 172 Cairns, R. B., 114 Caldwell, A., 430, 438 Caldwell, B., 575 Caldwell, L. D., 135 Caldwell, R. M., 656, 661 Callahan, C. M., 510 Callum, C. M., 556 Calsyn, D. A., 435, 439 Camara, W. J., 347 Cameron, S. C., 135 Campbell, A. L., 550, 554, 555 Campbell, T. W., 362 Campione, J. C., 455 Camras, L. A., 172, 181 Canale, M., 552 Canivez, G. L., 524 Cano, J. M., 414 Cant´on, R., 605 Capps, R., 472 Caprara, G. V., 273 Capt, B., 571 Caraballo, A., 145, 147, 148, 197

Caramelli, P., 313 Cardalda, E., 323, 326 Cardozo, B. L., 207 Cardozo, M., 201, 207, 213 Carlin, L., 597 Carlson, J. E., 535 Carlson, J. F., 16 Carlson, J. S., 455 Carney, C. G., 283 Carney, J. V., 275 Carraher, D., 453 Carraher, T. N 453 Carrasquillo, A., 482 Carson, A., 534 Carter, R. T., 55, 109–110, 138, 139, 276, 288 Caruth, M., 225–226 Casas, J. M., 109–110 Castaneda, A., 364 Castellon-Wellington, M., 480 Castillo, A., 360 Casullo, M. M., 360 Catte, M., 349, 357 Cattell, A. K., 462 Cattell, H. E., 375, 376, 378, 379, 394 Cattell, R. B., 375, 376, 379, 462 Ceci, S. J., 453 Ceja, M., 101 Chambers, J. W., 299–301 Chan, K. Y., 378 Chan, S., 574, 638, 639 Chan, S.W.C., 605 Chandra, V., 603 Chang, J., 183 Chang, R., 113 Chao, R., 429, 438 Chapman, M., 414, 415 Chappell, P. A., 349 Charlow, A., 630 Chartrand, J. M., 630 Chauhan, R. V., 86, 140 Chauncey, H., 406–407 Chaves, A. P., 274 Chavez, E. L., 392–393 Chavous, T., 54 Chen, C., 602 Chen, D., 574 Chen, H. C., 458 Chen, M. J., 458 Chen, Y., 172, 189 Chen, Y. R., 53 Chen, Z., 359 Chernyshenko, O. S., 378 Cheung, F. K., 24 Chieh, L., 354

675

676 NAME INDEX Chien, W. T., 605 Chipungu, S. S., 630 Chiu, H.F.K., 605 Choca, J., 425, 431, 435 Choi, I., 175 Choney, S. K., 54, 57, 438 Christensen, B., 550 Christian, D., 471 Christian, C. W., 630 Chuah, V., 354 Chudowsky, N., 483 Chun, K. M., 73, 74, 83, 84 Chung, C., 630 Chung, R.H.G., 78, 79, 84 Church, A. T., 429, 438 Cicchetti, D. V., 583 Claire, T., 103 Claney, D., 57 Clark, M., 668 Clark, M. L., 381 Clewell, B. C., 474 Clifford, R. M., 575 Close, W., 274 Cloud, J., 13 Cobb, C. D., 504 Coehlo, E., 482–483 Cohen, C. I., 597 Cohen, J., 50 Cohen, M. H., 206 Cokely, K. O., 54, 55 Colapinto, J 265 Colby, A., 452 Cole, M., 177, 452, 462, 463, 553–554 Coleman, H.L.C., 117 Coleman, H.L.K., 59, 74, 138 Coleman, H.L.R., 551 Coley, J. D., 450 Collier, C., 365 Collier, V. P., 471, 479 Collinge, A., 300, 307 Comas-D´ıaz, L., 139, 148 Combs, G., 324 Como, P., 603 Conforti, D. A., 595 Conn, S. R., 376–378 Conner, M. G., 112 Connolly, H., 459 Connor, D. J., 12 Conoley, J. C., 44 Constantine, M. G., 135, 138, 139, 273, 274, 288 Conte, J. M., 504 Conti, D., 347 Conway, B. E., 457

Cook, D. A., 54, 55, 64, 133, 137, 143, 146, 148, 155n1 Coolidge, F. L., 389–390 Cordes, J. A., 603 Cort´es, D. E., 73, 109, 365, 442, 550 Cosentino de Cohen, C., 474 Cossette, S., 504 Costa, C. I., 59, 60, 62, 65 Costa, L., 554 Costa, P. T., 408, 409 Costantino, E., 323 Costantino, G., 42, 44, 108, 112, 116–118, 120, 123, 323, 324, 326, 327, 329, 334, 337, 341, 359, 360, 364 Cottingham, J., 379, 382 Cottone, R. R., 24 Court, E., 351 Court, R., 582 Covinsky, K. E., 609 Cox, D. S., 204 Cox, M. V., 349, 350, 357 Craig, R. J., 377, 425, 426, 428, 435, 437 Craig, T. J., 180 Craik, F.I.M., 457 Crain, C., 553 Crais, E. R., 572 Cramer, P., 357, 359, 360 Cristo, M., 221, 224 Crites, J. O., 283, 284 Crnic, K. A., 576 Croizet, J., 13 Cronbach, L. J., 34, 35 Croog, S. H., 299 Cross, D. T., 376, 387 Cross, K., 386 Cross, W. E., Jr., 52–54, 56–58, 66, 138, 146 Crossley, N., 357 Croteau, J. M., 132 Crothers, M., 285 Crowther, M. R., 388, 390–394 Cryer, D., 575 Csikszentmihalyi, M., 114 Csordas, T. J., 306 Cu´ellar, I., 7, 74, 76, 77, 82–85, 87, 605 Cullar, I., 551 Cullen, M. J., 514 Cullum, C. M., 556 Cummings, J. A., 223, 347 Cummins, J., 478, 479 Cundick, B., 364, 365 D d’Adesky, A. C., 206 Dahl, T. I., 506

NAME INDEX Dahlem, N. W., 576 Dahlstrom, L. E., 427 Dahlstrom, W. G., 427 Dai, X., 608 Daisy, F., 435, 439 Dalenberg, C., 227 Dana, R. H., 58, 74, 85, 87, 107–121, 133, 134, 139, 143–145, 147, 150, 323, 324, 326, 327, 347, 358, 360, 362, 364–366, 388, 391, 393, 428, 437, 442, 443, 597, 667 Daoud, F. S., 352 Darden, E. E., 285 Darling-Hammond, L., 5, 12 Das, J. P., 449, 458 Dasen, P. R., 451, 452, 459 D’Augelli, A. R., 379 Davey, T., 92 Davidov, B. J., 171 Davies, P., 97–98 Davies, R. D., 426 Davis, D. S., 595 Davis, G. L., 386 Davison Aviles, R. M., 281 Davison, L. A., 543 Dawes, M. E., 285 Day, J. D., 506 Day, R., 364 de Arellano, M. A., 428, 437 de Barona, M. S., 572, 586 de Beer, J., 418 De Goede, M., 349 de Jong, J.T.V.M., 197 de Marneffe, D., 205 de Shazer, S., 249–251 de Valle, P., 354 De Vries, J., 309, 310 Dean, B. L., 274 Dean, M. A., 504 Dean, R., 230 Deary, I. J., 523 DeBlassie, R. R., 381 DeBruin-Parecki, A., 581 DeGrande, G., 551 Deitchman, M. A., 661 Deitsch, S. E., 376, 379 DeLamatre, J. E., 376 Delgado-Romero, E. A., 74–75 Delphin, M., 119 Del-Ser, T., 605 Dennis, W., 348, 349, 352, 353 Der-Karabetian, A., 112, 118 Des Forges, A., 207 Deterding, N., 474 Detterman, D. K., 457

Detweiler, J. B., 114 DeVos, G., 385 Devos, G. A., 364 Dewaraja, R., 353 Diaz, N., 108 Diaz-Vivar, N., 108 Dibble, S. L., 638 Dick, M. B., 595 Diemer, M. A., 289 Diener, E., 299, 301 Diener, M., 299, 301 DiGiuseppe, R., 323 Digman, J. M., 408 Dion, G., 531 Dipoto, M. C., 285 DiTiberio, J. K., 414 Dodds, J., 579 Dodge, K. A., 119 Dohrenwend, B. P., 552–553 Dohrenwend, B. S., 552–553 Dokmak, A., 604 Donahue, P. L., 525–526 Dong, Y., 429, 438 Donnay, D.A.C., 279, 382–386 Doris, J., 451 Dornbusch, S. M., 288 Douglas, G., 100 Draguns, J. G., 25, 107, 425 Drasgow, F., 42 Dreger, R. M. k. 376 Duara, R., 556, 595 Dukstein, R. D., 283 Dumenci, L. 331 Dumont, F., 349 Dunaway, M. H., 375 Dunst, C. J., 576 Duong, I., 638, 641–642 Duran, R. P., 9, 16, 551 Durlak, J. A., 113, 117 Durojaiye, M.O.A., 459 Durvasula, R. S., 429, 438 Dwight, S. A., 94 E Earles, J. A., 521 Eaves, R. C., 494 Eber, H. W., 378 Eccles, J. S., 273, 276 Eggebeen, D. J., 594 Egli, E., 221 Ehrman, M. E., 414 El Masri, M., 197 Elfant, A., 111 Elfenbein, A. E., 505

677

678 NAME INDEX Elhai, J. D., 428, 437 Elliot, C. D., 582 Elliott, T. R., 382–385 Embretson, S. E., 94, 533 Emo, A. K., 504 Enochs, L., 285 Enomoto, K., 429, 438 Ephirim-Donkor, A., 305, 306 Epstein, A. S., 581 Epstein, L. J., 608 Epston, D., 249, 250 Ereth, J., 628 Erickson, C. D., 273 Erikson, E. H., 53 Erikson, J., 571 Espino, D. V., 595, 596, 602, 610–611, 615 Espinosa, L. M., 568, 570 Esquivel, G. B., 346, 347, 357, 361 Evans, A. C., Jr., 119, 275, 276 Evans, F. B., 190 Exner, J., 323, 331, 334, 361–363 Exner, J. E., 326 Eysenck, H. J., 503 F Fabrega, H., 107 Fabri, M., 195, 201 Fair, C. C., 629 Fairhurst, A. M., 414 Fairhurst, L. L., 414 Falanga, S., 379 Falicov, C. J., 258, 634, 635, 642, 643 Fan, J., 603 Farber, N., 554 Fatollahi, P., 610–611 Feigelson, M. E., 94 Feldt, K., 506 Fenton, F. R., 611 Ferguson, R. F., 532 Fernandes, C., 523 Fernandez, T., 82–83 Fernando, G. A., 180, 181, 183 Fernando, S., 111 Ferrara, R. A., 455 Ferraro, F. R., 557, 595 Ferri, B. A., 12 Ferriss, A. L., 300 Feuerstein, R., 455 Fewell, R. R., 579, 583 Fhagen-Smith, P., 53 Figley, C. R., 213 Figueroa, R., 473, 551 Fillenbaum, G., 595, 601, 604 Finch, C. S., III 305

First, M. B., 136 Fischer, A. R., 54, 55, 58, 74–75, 140 Fish, J. M., 25 Fisher, C. B., 135 Fishman, H. C., 255, 256, 259, 266 Fitzgerald, J., 595 Flaherty, J. A., 182–185 Flanagan, D. P., 328, 493, 494 Flanagan, R., 323, 324, 333, 335, 341, 342, 357, 361 Fleenor, J. W., 417 Fleischman, H. L., 535 Fletcher-Janzen, E., 542 Flores, J., 75, 78, 83 Flores, L. Y., 275, 286, 289, 388, 389, 391, 392, 394 Flourens, M.J.P., 544 Foley, G. M., 569 Folstein, M. F., 597, 601, 602 Folstein, S. E., 597 Fontes, L. A., 627, 637, 646 Foos, P. W., 394–395 Ford, L., 568 Ford-Booker, P., 550, 555 Forsyth, J. M., 139 Fortes, M., 452 Fouad, N. A., 110, 273, 275–277, 280, 282, 283, 285–287, 289 Foulks, E. F., 107 Fowers, B. J., 171 Fox, P., 595 Fradd, S. H., 222 Fraenkel, P., 249 Franceour, R. B., 609 Francis, D. J., 481 Franco, F., 356 Franco, J. N., 381 Frank, E. M., 505 Frank, J. D., 204 Frank, L. K., 346 Frankenburg, W. K., 578 Franklin-Jackson, D. C., 111 Frazier, P. A., 64 Freed, D., 190 Freedle, R., 501 Freedman, J., 324 Freeman, D., 418 Freeman, N. H., 350 Freire, P., 302 Friedel, D., 195 Friedman, M. J., 201, 225 Friere, P., 302 Frisby, C. L., 6, 520 Fritzsche, B. A., 279

NAME INDEX Frueh, B. C., 428, 437 Fuertes, J. N., 53, 55 Fuh, J. L., 604 Fujii, D. E., 557 Fujino, D. C., 134 Fu-Kiau, K.K.B., 304, 305, 307 Fukuyama, M.A.K., 139 Fuld, P. A., 603 Furukawa, T., 608 Furuya, K., 304 G Gainor, K. A., 138, 274, 277, 284–287 Gallagher, A., 98, 101 Gallagher-Thompson, D., 595 Galson, S., 197 Galvan, N., 74–75 Gamba, R. J., 73, 76, 77, 82–85, 365 Gamst, G., 73, 75, 112, 118 Gandara, P., 474, 484 Ganguli, M., 595, 603 Garb, H. N., 114, 346–348, 362, 364, 365 Garci´a, G. E., 480–482 Garcia-Peltoniemi, R., 221 Garcia-Preto, N., 257 Gardner, H., 510 Gardner, J. L., 276 Garfield, N. J., 275 Garrett, B. A., 430, 438 Garrett, M. T., 365 Gasquoine, P. G., 558 Gass, S., 477 Gastenveld, P. M., 286 Gastorf, J. W., 430, 438 Gay, J., 177, 452 Geary, D. C., 608 Geisinger, K. F., 7, 9, 14, 16, 181–184, 186, 388, 390 Gelkopf, M., 207 Gelso, C. J., 80 Genesee, F., 472, 478, 481 Gentile, D. A., 645 Georgas, J., 667 Gerrity, E., 168, 201 Gerstein, L., 110 Gerton, J., 551 Gerzina, H. A., 379, 382 Gesell, A., 565 Gettinger, M., 522 Gibbon, M., 136 Gick, M., 453 Gill, L. J., 387 Gill, M., 362 Gill, R., 458

Giordano, J., 257 Giuliano, K. K., 615 Gladwin, T., 452, 453 Glanville, D. N., 505 Glaser, R., 483 Glass, G. V., 480 Glass, M. H., 436, 439, 440 Glazer, R., 35 Glick, J., 177, 452 Glosser, G., 595 Goh, M., 117 Gold, J. R., 363, 437 Gold, P. B., 428 Goldberg, D., 584 Golden, C. J., 543 Golden, J. C., 381 Goldenberg, D., 583 Goldman, D., 430, 438 Goldman, L., 113–114 Goldstein, K., 544 Goleman, D., 503, 505 Golomb, C., 350 Gong, Y. X., 607–608 Gonzales, E., 355, 390, 391 Gonzales, F. P., 577 Gonzalez, G. M., 103 Gonzalez, R. C., 274, 276 Gonzalez-Montalvo, J.-I., 605 Gonzalez-Singh, F., 392–393 Gonzalez-Wippler, M., 304 Good, B. J., 107 Good, C., 14 Goodenough, F. L., 25, 26, 347–349, 352, 565 Goodnow, J. J., 350, 459 Goolishian, H. A., 249, 250, 264 Gopaul-McNicol, S., 7, 11, 12 Gordon, E. W., 96 Gordon, M. M., 74, 76, 364 Gotay, C. C., 300 Gottfredson, L. S., 275, 277, 521, 524, 525, 532 Gotway, C. A., 207, 213 Gough, H. G., 382, 383, 385 Gould, M., 384 Gowda, K. K., 110 Graf, M. H., 354 Graham, J. R., 427, 437 Graham, S., 288 Grant, D. A., 549 Grant, I., 555 Grant, S., 143 Grau, L., 609 Graybill, D., 429, 438 Gray-Little, B., 14, 552–553

679

680 NAME INDEX Green, J., III 359 Greenberg, M. T., 576 Greene, R. L., 427, 430, 438 Greenfeld, R., 323 Greenfield, P. M., 177, 187, 300, 312, 313, 449, 451, 452, 462 Greenspan, S. I., 570, 571 Gregory, R. J., 375, 382, 384, 385 Gregory, S., 5 Greniuk, C., 535 Gretchen, D., 55, 57, 86, 140 Grieger, I., 132–134, 136, 138, 143–145 Grieve, J., 550 Griffith, J. L., 252 Griffith, M. E., 252 Grigg, W., 525–526, 531, 534 Grigorenko, E. L., 449, 452–456, 459–461, 502, 512 Grossman, S., 426 Groth-Marnat, G. G., 347, 349, 375, 378, 379, 382, 384, 385, 391 Grove, W. M., 362 Guarino, A. J., 118 Guarnaccia, P. J., 108 Guerrero, M. D., 479 Guidubaldi, J., 583 Guillen, A., 288 Gunsalus, A. C., 436, 439, 440 Gunther, M. K., 348, 349 Gurland, B., 595, 601 Gushue, G. V., 258 Gustke, C., 535 Guterman, N. B., 648 Guthke, J., 455 Gutter, P. B., 568–569 Guzman, N., 605 Gysbers, N. C., 275, 276, 286 H Haan, M., 595, 602 Haase, R. F., 275 Habenicht, D., 354 Hacker, B. J., 571 Hackett, G., 276, 277, 283–285 Haenel, F., 225–227 Hagans-Murillo, K. S., 585 Hahm, H. C., 648 Hahn, J., 102 Hakuta, K., 473, 474, 478, 479, 482, 484 Haley, J., 254, 255 Haley, W. E., 594 Hall, E. T., 302, 304, 306 Hall, G.C.N., 113, 118, 165, 425–427, 431, 440

Hall, K. S., 605 Halstead, W., 547 Hamanaka, T., 608 Hamberger, L. K., 435, 439, 440 Hambleton, R. K., 182, 184–186 Hamilton, M., 610 Hammer, A. I., 279 Hammer, A. L., 405, 408, 409 Hammer, M. B., 437 Hammill, D. D., 582 Hamsher, K., 550, 554, 555 Han, B., 594 Hancock, R. A., 380 Handel, R. W., 425 Handler, L., 334, 348, 354 Hansen, J. C., 279 Hanson, M., 567, 568 Hardison, C. M., 514 Hargreaves, M., 100 Harkness, S., 459 Harmon, L. W., 279, 284 Harms, T., 575 Harris, D., 583 Harris, D. B., 347–349, r25 Harris, J. G., 551, 556 Harris, L., 77 Hartung, P. J., 376, 378 Hastings, J. E., 435, 439, 440 Hauck, F. R., 642 Hauff, E., 110, 139 Havighurst, R. J., 348, 349 Hays, P. A., 221, 223, 226, 595–597 Haywood, H. C., 585 Hazuda, H. P., 595, 615 Heaton, R., 555–558 Heaton, R. K., 555–558 Hedden, T., 595 Helms, J. E., 52–53, 54, 55, 57, 63, 64, 74–75, 80, 81, 95, 118, 133, 137–139, 143, 146, 148, 155n1, 276, 288, 391, 428, 441, 542, 550, 552–554, r17 Helms-Lorenz, M., 450 Henderson, J. N., 594 Henderson, V. W., 595 Hendrie, H. C., 605 Herdt, G., 451 Herman, J., 226 Hermosillo, D., 556 Hernandez, A., 323 Herrnstein, R. J., 456, 491, 521, 524 Herskovits, M., 74 Hesbacher, P. T., 204 Heubert, J. P., 12, 15 Heverly, L., 554

NAME INDEX Heyman, A., 595, 601 Hicks, J. W., 656, 662 Higareda, I., 12, 473 Higginbotham, H. N., 113 Hill, C. L., 24, 28, 118, 133, 278, 289, r8 Hill, J. S., 438 Hill, R. B., 629 Hilliard, K. M., 610 Hilsenroth, M. J., 346, 363 Hines, A. M., 83, 365 Hinton, D., 179–180 Hinton, D. E., 108 Hippisley, J., 100 Ho, T., 656, 662 Hochman, J. D., 569 Hock, H. R., 361 Hoefnagel-Hohle, M., 478 Hofer, S. M., 378 Hoffman, M. B., 455 Hoffman, R. G., 386 Hofstetter, C., 535 Hofstetter, C. H., 8, 483 Hoge, S. K., 663 Hojnoski, R. L., 347, 348 Holder, A.M.B., 273 Holiday, B. G., 109–110 Holifield, E. B., 596 Holland, J. L., 279–281 Hollifield, M., 182, 189 Holm, J., 595 Holmes, A. L., 109–110 Holmes, D., 595, 601 Holmes, K. Y., 386, 394 Holtz, T. H., 213 Holyoak, K., 453 Hooper, H., 554 Hopkins, N., 281 Hopstock, P. J., 535 Horan, J. J., 285 Horikoshi, W. C., 419 Horn, W. F., 576 Horton, A. M., Jr., 542–547, 549 Hoshmand, L. T., 358 Houghton, S., 100 Howard, G. S., 45, 48, 113–114, 324–326, 358 Howard, K., 274 Howard, K.A.S., 275 Hresko, W., 578 Hsu, H.-Y., 481 Hu, L., 134 Huang, J. S., 113 Huang, J. T., 458 Huang, L., 119

Huber, M. S., 595 Hubert, L., 280 Hudelson, P., 300 Hudley, C., 288 Huff, R. M., 390–391 Hughey, K. F., 285 Hulse, W. C., 348, 354 Hunt, J. M., 565, 580 Hunt, R. G., 64 Hunter, C. D., 133, 144 Hur, Y.-M., 403 Hurwitz, S., 645 Hynd, G., 554 I Iacopino, V., 190 Ialongo, N. S., 576 Ibanez, G. E., 73 Ibrahim, F. A., 112, 134, 135 Inhelder, B., 324, 325 Inzlicht, M., 14 Irvine, J. T., 459 Isaac, W., 554 Israel, T., 110, 118 Ivey, A. E., 134–135, 663 Iwamasa, G. Y., 610 J Jablensky, A., 611 Jackson, D. D., 27 Jackson, J., 275 Jackson, L. C., 108 Jackson, M. A., 59, 273–275, 280–282, 285, 287–289 Jackson, S. L., 283 Jackson, T. H., 544 Jacobs, D. M., 555, 595 Jacobs, P., 326 Jacobs, U., 190 Jacobsen, F. M., 139, 148 Jacomb, P. A., 604 Jahn, J., 305 James, S., 201 Jang, K. L., 403 Jaranson, J. M., 167–168, 225 Jasso, R., 77, 551 Jefferys, K., 165 Jeffreys, K., 196 Jenaro, C., 301, 308 Jenkins, J. H., 166 Jenkinson, C., 300 Jensen, A. R., 450, 502, 503, 520–523, 534, 535, 654–656 Jensen, G. H., 414

681

682 NAME INDEX Jessor, R., 452 Ji, L. J., 170, 173, 175, 176, 185 Jia, X., 602 Joe, J. R., 640 Johnson, A., 65 Johnson, A. J., 144 Johnson, L. R., 392 Johnson, R. C., 381 Johnson, S. M., 255–257 Johnson, V., 73 Johnson-Martin, N. M., 571 Jones, B. J., 281, 286, 376 Jones, E. E., 387 Jones, R. L., 112 Jordaan, J. P., 283 Jorgensen, M. A., 537–539 Jorm, A. F., 595, 604 Jung, C. G., 402–406, 408, 418 Juntunen, C. L., 274 Jurkovic, G., 73 K Kacanski, J. M., 275, 281, 282, 288 Kaemmer, B., 427 Kagame, A., 452 Kagan, J., 331 Kagawa-Singer, M., 300, 302, 308 Kainz, R. I., 415 Kaiser, R., 207 Kales, H. C., 609 Kalohn, J. C., 92 Kamatuka, N. A., 283 Kamphaus, R. W., 338 Kaner, S., 602 Kang, S. -M., 663 Kaplan, D. A., 14 Karasawa, M., 176 Karasek, R., 273 Karls, J., 109 Karlsson, R., 118 Karni, E. S., 385 Karol, D., 375, 376, 379 Karoly, L. A., 11 Karon, B. P., 347 Karp, S. A., 356 Kashiwagi, K., 459 Kastrup, M., 167–168 Katz, R., 304 Kaufman, A. S., 328, 512, 513, 523, 582, 597, 606 Kaufman, J. C., 452 Kaufman, N. L., 582 Kaufman, S. F., 348, 354 Kazdin, A., 310, 576 Kazin, C., 96

Kealey, D. J., 61 Keane, E., 437 Keane, T. M., 168, 436 Kearins, J. M., 452 Kearney, P., 249 Keats, D. M., 458 Keefe, K., 429, 438 Keitel, M. A., 388 Keith, K., 302, 307–309, 311, 414 Keller, A., 166 Kellogg, C. E., 615 Kellogg, R., 350 Kelly, K. R., 436, 440 Kelman, H. C., 204 Kempler, D., 595 Kendall, E., 418 Kennedy, W. A., 661 Kenny, D. A., 64 Kenny, M. E., 275, 289 Kerr, B., 286 Kerr, M. E., 255 Ketron, J. L., 457 Khaled, N., 197 Kheper, S., 306–307 Khoun, F., 205 Kilbride, P. L., 459 Kim, B.S.K., 74, 75, 78, 82–84, 140, 365, 391 Kim, K. S., 113 Kim, N., 342 Kimweli, D.M.S., 301, 305 King, J., 436 King, L. A., 300, 301 Kinzey, J., 221 Kinzie, J. C., 199 Kirby, L. K., 408, 417–419 Kirkman, M., 324, 325 Kirmayer, L. J., 107 Kise, J.A.G., 414 Kitayama, S., 449–450 Klein, K. L., 284, 285 Kleinman, A., 107, 201, 659 Kline, M. V., 390–391 Klinetob, N., 428, 437 Klonoff, E. A., 83, 364, 365 Klopfer, B., 349 Kluckhohn, C., 302 Knauss, L. K., 97 Knesting, K., 15 Knight, B. G., 380 Knox, S., 144 Knuckle, E., 554 Koenig, J. A., 473, 484, 485 Koestner, R., 342

NAME INDEX Kohatsu, E. L., 74, 80, 82, 391, 595 Kohn, S. W., 347 Kohout, J. L., 108 Komproe, I. H., 197 Kong, B. W., 299–301 Kopala, M., 388 Koppitz, E. M., 349, 350, 355, 357 Korbin, J. E., 630 Koschier, M., 283 Kost, C. R., 610 Kostin, I., 501 Kovacs, M., 334, 335 Krajewski-Jaime, E. R., 638 Kramer, J. J., 44 Kramer, T., 118, 119 Kraus, L. J., 285 Krieshok, T. S., 275 Krishnamurthy, R., 275, 276, 289, 667 Kristjansson, E., 15 Kroeber, A. L., 302 Krueger, R. F., 403 Kucer, S. B., 482 Kugler, J. F., 111 Kummerow, J. M., 415, 416 Kuo, P. Y., 389, 392 Kuperminc, G. P., 73 Kurasaki, K., 73 Kurpius, S.E.R., 286 Kurtines, W. M., 82–83 Kuyken, W., 300, 302, 307, 308, 310 Kwan, K.L.K., 375, 388, 389, 425, 429, 438, 441 Kwan, V.S.Y., 301, 302, 305 Kwon, Y C., 603 L La Rue, A., 603, 610 La Voy, S. K., 352 Labarta, M. M., 419 Lacelle-Peterson, M., 483, 484 Lacey, K., 438 Lachar, D., 427 Ladany, N., 135 LaFromboise, T., 74, 77, 81, 551 Lagan´a, L., 609 Lam, L., 605 Lam, T.C.M., 11, 16, 17 Lambert, N., 583 Landes, A., 651 Landrine, H., 83, 364 Lane, W. G., 630 Langley, M. B., 579, 583 Lanier, Y., 139 Lanning, K., 385

Lanphier, C. M., 199 Lantigua, R., 595, 601 Lapan, R. T., 273–277, 286 Lark, J. S., 132 Larsen, A. S., 576 Larson, E. B., 604 Lasoff, D. L., 273 Lauko, M., 531 Lauver, P. J., 281 Lavelle, J., 205 Lavine, L., 595 Lavretsky, H., 609 Lawrence, G., 414 Lazar´ın, M., 473, 483, 484 Lazarus, S. S., 9 Leach, M. M., 54 Lee, A., 139 Lee, C. D., 96 Lee, E., 139, 147, 233, 638 Lee, H.C.B., 610 Lee, R. E., 380 Lee, R. M., 274 Lee, S., 5 Lee, S. M., 55, 56, 58, 66 Lee, W.-Y., 248, 263 Legg, S., 101 Lei, P., 524 Leichtman, M., 346 Leland, H., 583 Lent, R. W., 273, 276–278, 282–284, 286–288 Leong, F.T.L., 274 Lesser, G., 553 Lessig, M., 595 Leung, K., 451 Levesque, R.J.R., 638 Levin, J., 385 LeVine, R. A., 45 Levine, S., 299 Levita, E., 554 Levitt, M., 394–395 Levy, B. S., 197 Lew, S., 77, 551 Lewin, K., 586 Lewis, C., 65 Lewis, J. F., 583 Lewis-Fernandez, R., 107, 108, 201, 659 Lewis-Jack, O., 554 Lewit, E. M., 630 Lherold, L., 364 Li, L., 289 Li, L. C., 24, 28, 133 Li, S., 602 Libet, J. M., 428, 437 Lichtenberg, P. A., 550, 595, 603

683

684 NAME INDEX Lichtenstein, M. J., 595, 615 Liddle, M. C., 24 Lidz, C. S., 455 Liebkind, K., 74–75, 80 Lilienfeld, S. O., 114, 346–348, 362, 363 Lim, R. F., 134, 136, 139, 143, 144, 148 Lin, K., 221 Lin, K.-M., 113 Lin, K.-N., 604, 605 Linde, C., 325 Lindeman, R. D., 603 Lindeman, R. H., 283 Linder, T., 580 Lingiardi, V., 379 Linn-Fuentes, P., 597 Linquanti, R., 474 Linton, R., 74 Linzey, G., 362 Lipson, J. G., 638 Liu, C.-Y., 611 Liu, W., 117 Livesley, W. J., 403 Lizardi, D., 108 Loe, S. A., 568 Loewenstein, D. A., 595, 596, 607 Loiselle, C. G., 504 Lone, R. F., 61 Longman, T., 207 Lonner, W. J., 112, 134 Lopes Cardozo, B., 201, 213 Lopez, D., 225–226 L´opez, I. R., 431 L´opez, S., 606, 607 Lopez, S. J., 114 L´opez, S. R., 83, 443, 550, 553, 607, 615 Lord, C., 8, 483, 535, 536 Lord, F., 39 Lord, W., 379 Losapio, G., 323 Losen, D. J., 11 Loveless, T., 12 Low, J. M., 379, 382 Lowe, S. M., 133, 144 Lowenstein, D. A., 556 Lowenthal, B., 569 Lu, C.-H., 611 Lu, F. G., 139 Lubin, N. M., 323 Lubinski, D., 280 Lucas, J. A., 595, 606 Lukin, L. E., 286 Lundberg, D. J., 283 Luo, G., 602 Luria, A. R., 463, 544–545

Lusebrink, V. B., 354 Lutz, C., 459 Luzzo, D. A., 283 Lynch, E., 226, 450, 567, 568 M Maass, A., 176 Macdaid, G. P., 415 Machover, K., 347, 349 Mack, W. J., 595 Mack-Allen, J., 379, 382, 394 MacNeill, S. E., 595 MacSwan, J., 478, 480 Macy, M., 570, 571 Madaus, G., 668 Maestas, M. V., 74, 75, 80, 81, 83, 425 Magar, V., 197 Magnum, M. E., 354 Magnuson, K. A., 11 Magruder, K. M., 428, 437 Mahurin, R. K., 596 Maiter, S., 646 Majors, M. S., 409 Mak, W., 74, 78, 82–85 Malach, R. S., 640 Malakouti, S. K., 610–611 Maldonado, R., 76 Malgady, R. G., 41, 42, 44, 50, 73, 108, 109, 115, 116, 323, 324, 327, 334, 341, 359, 360, 365, 442, 550, 552 Mallach, R. S., 574 Malouff, J. M., 512 Mamchur, C. M., 414 Mancuso, J. C., 324, 325, 357 Manly, J. J., 550–552, 555, 558, 559, 595, 597, 606 Mann, A., 597 Manson, S. M., 117 Manuel, R. S., 379, 382 Maramba, G. G., 118 Marcia, J., 54 Marcos, L., 221, 225 Marcus, R., 567 Mardell-Czudnaiski, C., 583, 584 Margules, P., 550 Marin, G., 73, 74, 76, 77, 82–85, 365 Markon, K. E., 403 Markus, H. R., 449–450 Marsella, A. J., 182–184, 186, 201, 611, 659 Marshall, S. C., 595, 602 Martell, Z., 225–226 Martin, C., 416 Martinussen, M., 506 Mascher, J., 133, 144

NAME INDEX Maschino, P., 74–75 Mason, E. P., 387 Mason, S., 350 Massagli, M. P., 207 Mast, B. T., 595 Masuda, T., 176 Matthews, G., 503–505 Matthews, M., 347 Matthews, W. J., 362 Mattis, S., 605 Matto, H. C., 350, 355, 356 Mau, W., 281 Mauer, K. F., 379 Maxwell, S. E., 506 Mayer, J. D., 504, 505 Mazzula, S. L., 139 Mbiti, J. S., 304, 307 McAdams, D. P., 324–326, 346, 347, 357 McAllister, J., 586 McAllister, L., 383–385 McBlaine, D. D., 431, 438 McCallum, T. J., 380 McCarthy, D. A., 565 McCarthy, I., 249 McCaulley, M. H., 402, 405, 407, 408, 416 McCaulley, M. Y., 415 McClelland, D. C., 342 McCormick, K., 414 McCrae, R. R., 60, 62, 408, 409 McCreary, M. L., 110 McCubbin, H. I., 576 McCubbin, L., 138 McCullough, C. S., 92, 95 McCurry, S. M., 595, 608 McDonald, J. D., 595 McDonald, L. S., 207–208 McDowell, I., 15 McEachern, A. G., 354 McFarlane, S., 226 McGoldrick, M., 257, 258, 264 McGue, M., 403 McHugh, P. R., 597 McIntosh, P., 137 McKoon, G., 480–482 McLean, J. E., 597 McNeil, J. K., 610 McNeish, T. J., 350 McNulty, J., 425–427, 437 McRae, T. D., 602 McWhirter, E. H., 274, 285, 287 Meara, N. M., 506 Mease, A. L., 32 Medin, D. L., 450 Medina, A., 6

Mehta, H., 24 Meier, M. J., 542 Meisels, S. J., 570, 571 Meller, P. J., 134, 426, 565, 567, 568, 571, 666 Mellow, A. M., 609 Melton, G. B., 652–653, 660, 663 Mendelsohn, J., 63 Mendendall, M., 61 Menken, K., 474 Mensh, E., 5 Mensh, H., 5 Mercer, J. R., 16, 583 Meredith, G. M., 381 Merenda, P. F., 182 Meronek, J. S., 376, 378 Mertens, D. M., 308, 311, 312 Meyer, G. J., 334, 347, 364, 379 Meyer, R. G., 376 Meyers, L. S., 118 Meyers, M. K., 11 Mezzich, J. E., 107, 111, 139 Michalsen, A., 306 Mickelson, R. A., 12 Milcenzon, S., 452 Milectic, T., 222, 224 Miller, D. C., 92, 95 Miller, G., 250, 251 Miller, K., 225–228, 235 Miller, L., 582 Miller, S. W., 555 Miller-Jones, D., 553–554 Millon, C., 426 Millon, T., 426, 431, 432 Miner, C. U., 283 Miner, H., 364 Minuchin, P., 265 Minuchin, S., 248, 255, 256, 259, 263, 265, 266 Mirabzadeh, A., 610–611 Miranda, A. H., 568, 569 Miranda, G. E., 138 Miranda, J., 113, 116–117 Misra, G., 459 Mittra, R., 379 Miville, M. L., 55, 60, 61 Mizushima, K., 385 Mobley, M., 27 Mohamud, S., 180 Mol, S., 61 Mollen, D., 118 Mollica, R., 167–168, 201, 205–208, 213 Monnier, J., 428, 437 Monteith, R., 630

685

686 NAME INDEX Moody R. A., 402 Moon, T. I., 364, 365 Moore, J., 378 Moradi, B., 54, 55, 58, 74–75, 140 Morales, J. -M., 605 Morris, J. C., 604 Morris, M. L., 279, 386 Morris, R. J., 204 Morrison, R., 347 Morse, A. B., 9 Morten, G., 146, 258 Morton, N. W., 615 Moscoso, M. S., 178 Moshinsky, A., 96 Mounts, L., 579 Mukarurama, D., 452 Mullaney, H. A., 550–552, 556 Multon, K. D., 286 Mundy-Castle, A. C., 459 Mungas, D., 595, 602, 603 Munley, P. H., 435, 439–441 Munson, S. M., 575 Murden, R. A., 602 Murray, C., 456, 491, 524 Murray, H. A., 358 Murstein, B. I., 323 Myers, I. B., 402, 404–410, 413 Myers, P. B., 405, 407, 413 Myers, R. A., 283 Myers, S. L., 630 N Nackerud, L., 207 Naglieri, J. A., 349, 350, 355, 356, 524 Nakamura, H., 608 Nakanishi, M., 608 Napa, C. K., 300, 301 Nathan, J. S., 347 Natriello, G., 14 Navarrette, C., 535 Ndogoni, L., 203 Neighbors, H. W., 609 Neisworth, J. T., 570, 572, 575, 584 Nelsen, D. E., 276 Nelson, K. S., 386 Nerukar, A., 197 Neugebauer, R., 203 Nevill, D. D., 282 Neville, H. A., 27, 288 Newborg, J., 578, 583, 584 Newman, H., 204 Newman, K. S., 274 Newsome, P., 473 Nezami, J. S., 363

Nezworski, M. T., 114, 348, 362 Ng, J., 113 Nichols, M. P., 261–263, 266 Nicholson, R. A., 663 Nielson, L. G., 114 Nieto, S., 59 Nihara, K., 583 Niles, S. G., 275 Nisbett, R. E., 170, 175, 176, 182, 188, 450, 458 Nishiyama, T., 385 Nitrini, R., 313 Nobles, W., 300–302, 304–306 Norcross, J. C., 108 Norenzayan, A., 175 Norris, K., 172 Norton, J. A., 605 Norton, R. A., 138 Novelli, M.M.R.C., 313 Nowicki, S., 505 ˜ Nunes, T., 453 Nutini, C. D., 59, 274, 275, 287–289 Nuttall, E., 354 Nuttall, R., 354 Nystedt, L., 114 O Oades-Sese, G. V., 346 Oakes, J., 12, 474 Oakland, T., 8 Obasi, E. M., 289, 388, 389, 391, 392, 394 O’Boyle, G. A., 300, 301, 308, 309 O’Brien, G., 479 O’Brien, K. M., 275, 283, 285, 286 Ocampo, C., 139 Ochberg, R. L., 358 Ochoa, S., 233, 473, 514 Ochoa, S. H., 568, 667 O’Connell, K. A., 309 O’Connor, M., 491 Oddou, G., 61 Ogawa, T., 353 Ogbu, J. U., 288 O’Hanlon, N., 100, 101 Ohr, P. S., 565, 567, 568, 571, 576 Oishi, S., 301 Okagaki, L., 461 Okawa, J. B., 165 Okazaki, S., 389–394 Oken, B. S., 306 Okin, S. M., 646 Olitzky, S. L., 346 Oliver, L. W., 273 Oliver, R., 477

NAME INDEX Olmedo, E. L., 551 Olson, D. H., 576 Olson, R. E., 425, 428, 435, 437 Omar, G., 119 O’Neill-Arana, M. R., 627 Ong, A. D., 55, 58, 66 Onyet, L. P., 167, 179 Orfield, G., 11 Organista, K., 73 Organista, P. B., 73 Orley, J., 300 Ornstein, R. O., 304, 306 Orozco, S., 380, 394 Ortiz, A. A., 577 Ortiz, D., 168, 190 Ortiz, I. E., 603 Ortiz, S., 233 Ortiz, S. O., 514, 667 Osborn, D. S., 280 Osborne, W. L., 283 Osipow, S. H., 283 P Pace, T. M., 430, 438 Pack-Brown, S. P., 135 Padgett, D., 609 Padilla, A. M., 5, 6, 8, 11, 171, 174, 180, 183, 278, 471 Padilla, G., 300, 302, 308 Paget, G. W., 350 Paivio, A., 324 Pallas, A. M., 14 Palmer, A. S., 552 Palmer, L., 353 Palmer, R. F., 595, 615 Palmeri, S., 571 Pals, J. L., 324–326 Pancheri, P., 427 Paniagua, F. A., 107, 134, 139, 140, 145, 667 Paolo, A., 608 Par´e, D. A., 249 Parham, T. A., 52–53, 54, 429 Paris, K. A., 430, 438 Park, D. C., 603 Park, J., 100 Parker, J.D.A., 503–505 Parker, W. M., 57 Parkin, C., 350 Parks, S., 571 Parloff, M., 204 Parron, D. L., 107 Parshall, C. G., 92, 93 Parsons, O., 553 Pascoe, J. M., 576

Pastorelli, C., 273 Patel, S., 108 Patsalides, B., 190 Patton, D. E., 595 Patton, J. M., 510 Paul, B. D., 435, 439 Paulhus, D. L., 74 Payne, D., 414 Pazdirek, L., 225–226 Pearman, R. R., 417 Pearn, J., 197 Pedersen, P. B., 56, 59, 134, 135, 140, 550, 659, 663 Pedraza, O., 595, 606 Peek, M. K., 596 Peel, M., 190 Pellegrino, J. W., 482 Peng, K., 175, 182, 188, 189 Pennington, D., 306 Perie, M., 525–526, 531 Perilla, J., 73 Perradatto, D., 576 Perry, J., 102 Perry, J. C., 274, 275 Perry, S. M., 381 Persky, I., 74, 78, 79, 81, 83 Persson Benbow, C., 280 Peterson, F., 220 Peterson, N., 274, 276 Petrila, J., 652–653 Pfeiffer, S. J., 349 Phalet, K., 15, 16, 112 Pham, P. N., 207 Phillips, J. C., 132 Phinney, J. S., 53, 55, 57, 58, 66, 74–75, 78–81, 83, 288 Phung, A. H., 425–427, 440 Piaget, J., 324, 325, 462 Pich, V., 108 Pichette, E. F., 365 Piekstra, J., 61 Piers, E. V., 334, 338 Pigott, H. E., 577 Pike, P. L., 429, 438 Piotrowski, C., 435 Pitariu, H., 385 Pizarro, D. A., 503 Plucker, J. A., 510 Plummer, J., 535–536 Politi, F., 176 Polk, M., 603 Polkinghorne, D., 113–114 Pollack, M. H., 108 Pollard, R., Jr., 230

687

688 NAME INDEX Pollio, H., 45 Ponterotto, J. G., 52–57, 59, 60, 62–65, 86, 87, 109–110, 133, 134, 138, 140, 143–145, 426, 666 Poole, F.J.P., 459 Poortinga, Y. H., 182, 188, 450, 451 Pope, K., 324, 325 Pope, K. S., 388 Pope-Davis, D. B., 54, 117 Popkin, M. K., 168 Porche-Burke, L., 568 Potere, J. C., 280, 285 Powell, A. B., 279 Powell, D. F., 283 Poythress, N., 652–653, 658 Pratt, I. E., 348, 349 Pray, L., 479, 480 Prediger, D. J., 135 Prendes-Lintel, M., 139, 147, 220, 225 Presley, G., 363 Pretti-Frontczak, K., 571 Prevost, L., 490 Price, J., 225 Price-Williams, D., 550, 553 Prigatano, G., 553 Prilleltensky, I., 201 Pritham, W. W., 615 Proffitt, J. B., 450 Protheroe, D. R., 61 Provence, W., 571 Pruitt-Stephens, L., 22 Puente, A. E., 347, 542, 543, 556, 600 Pumariega, A. J., 119 Putnam, D. B., 459 Q Qiao, Y., 603 Quenck, N. L., 405, 409, 410, 416 Quinn, D. M., 13 R Raajpoot, U. A., 425 Rainer, K. L., 110 Ramage, M. T., 273 Raminez, M., 550, 553 Ramirez, M., 364, 595, 601 Ramirez, M. III. 59–61 Ramsay, M. C., 523, 524 Rand, Y., 455 Rasch, B., 39 Rasheed, S., 285 Raskin, P. M., 273 Ratcliff, G., 603 Raven, J., 582 Raven, J. C., 462, 582

Reardon, R. C., 280 Redfield, D., 483 Redfield, R., 74, 76 Ree, M. J., 521 Reed, B. R., 595, 602 Reinhart, M. A., 576 Reise, S. P., 94, 533 Reitan, R. M., 542, 543, 546–548, 554, 557 Repapi, M., 385 Rescorla, L. A., 333 Reuter, E. K., 380 Reynolds, C. R., 338, 523, 524, 533, 534, 542, 546, 549, 553, 558, 597 Rhodes, R., 233 Rhodes, R. L., 473, 514, 667 Richard-Figueroa, K., 551 Richards, M., 597 Richards, P. S., 139 Richardson, M. S., 274 Richardson, T. Q., 391 Riches, C., 472, 481 Rickard-Figueroa, K., 77 Rickels, K., 204 Ridley, C. R., 22, 24, 28, 64, 118, 133–135, 137, 140, 143, 145, 147, 278, 289 Riemann, R., 403 Rietmiller, R. J., 334, 348 Rilling, L. M., 605 Ritzler, B. A., 323, 324, 347, 360–363, 366 Rivera, B., 568 Rivera, L. M., 73 Roazzi, A., 453 Robbins, R. R., 438 Roberts, C. R., 55, 58 Roberts, L., 349 Roberts, M. C., 119 Roberts, R., 503 Roberts, R. D., 504 Roberts, R. J., 550, 555 Robin, K. B., 581 Robin, R. W., 430, 438 Robinson, J., 299–301, 309 Rodriguez, O., 552 Rogers, K., 119 Rogers, S. J., 586 Rogler, L. H., 41, 42, 73, 109, 117–118, 323, 324, 334, 359, 365, 442, 550, 552 Rogoff, B., 642, 645 Rohde, T. E. 524 Roid, G. H., 582 Rojewski, J. W., 283 Rolstad, K., 478, 480 Romero, A., 603

NAME INDEX Romero, L. J., 606, 607 Rooke, S. E., 512 Root, J. C., 609 Root, M.P.P., 118, 391 Rorschach, H., 361–366 Rosas, P., 553 Rose, M. L., 274 Rosenberg, R. N., 336 Rosenfeld, H., 204 Rosenthal, K. S., 286 Rosenwald, G. C., 358 Ross, T., 550 Rosselli, M., 553, 600 Rothe, E., 119 Rothman, A., 114 Rotton, J., 394–395 Rounds, J., 280 Rovere, H.H.D., 313 Rowe, D. C., 450 Rowe, W., 54, 57 Rowland, J.T.J., 595 Rowland, M., 74–75 Rowley, S.A.J., 54 Royall, D. R., 603 Roysircar, G., 110 Roysircar-Sodowsky, G., 74, 75, 80, 81, 83, 389, 392 Rubin, D. M., 630 Rubin, K. H., 585 Rudell, K., 300 Rueda R., 12, 473 Ruhm, C. J., 11 Ruiz, P., 107 Rumberger, R. W., 474, 484 Rushton, J. P., 450, 502, 503, 521 Russell, E. W., 554 Russell, M., 375, 376, 379 Rust, J. P., 275 Rutledge, J. H., 380 Rutledge, P. C., 380 Ruzgis, P. M., 459 Ryan, J. J., 608 Ryan, R. M., 306 Ryan-Finn, K. D., 109 Ryder, A. G., 74, 77, 78, 84 Ryff, C. D., 65 S Sabin, M., 207 Sabina, M. Q., 354 Sackeim, H. A., 609 Sackett, P. R., 514 Saklofske, D. H., 667 Salama, P., 213

Salazar, J. J., 12, 473 Salovey, P., 114, 503, 505 Salvati, M., 610–611 Sam, D., 75, 77 Samper, J. L., 582 Samuda, R. J., 12–13 Samuels, S., 640 Sanchez, G. I., 8 Sanchez, M. T., 568 Sandall, S. R., 581 Sandhu, H. S., 382, 385 Sandler, I. N., 113 Sandoval, J., 9, 16, 551, 552 Sanoff, A. P., 491 Santiago-Rivera, A. L., 116 Santos, R. M., 570 Sarbin, T. R., 324, 325 Sartorius, N., 300, 611 Sassaman, M. F., 603 Sato, H., 353 Saunders, F. W., 407–409 Saunders, W. M., 479 Sauvageot, J. A., 428, 437 Savickas, M., 273 Savickas, M. L., 283 Sax, L. J., 101 Saxena, S., 302, 304, 305 Saxon, A. J., 435, 439 Saya, R., Jr., 57 Scanlan, J., 595, 604 Schalock, R., 301 Scharron-Del-Rio, M. R., 116–117 Schaubhut, N. A., 279, 386 Scherdin, M. J., 416 Scheuneman, J. D., 8 Schlemer, L., 500 Schliemann, A. D., 453 Schmidt, D. B., 280 Schmidt, F. L., 524 Schnipke, D. L., 98 Scholte, W. F., 207 Schottenbauer, M. A., 356 Schuerger, J. M., 376–379, 382 Schulenberg, S. E., 375 Schutte, N., 512 Schwartz, R. C., 261, 262 Schweinhart, L. J., 581 Sciarra, D. T., 247, 258 Scogin, F., 388, 390–394 Scrams, D. J., 98 Scribner, S., 553–554 Scurfield, R. M., 201 Segal, D. L., 389–390 Segall, M. H., 451

689

690 NAME INDEX Seibel, H. P., 380 Seidenberg, M., 553 Seligman, M.E.P., 114 Selinker, L., 477 Sellers, R. M., 54 Serpell, R., 459 Sevig, T. D., 139 Sexton, T. L., 32, 273, 276 Shadlen, M.-F., 605 Shanping, W., 418 Shapiro, H., 579 Sharma, S., 603 Sharp, D. W., 177, 452 Shaughnessy, M. F., 378 Shearer, M., 579, 586 Shelton, J. N., 54 Shelton, M. L., 285 Sherbenou, R., 578 Shorrocks-Taylor, D., 100 Short, E. L., 490 Shulman, E. L., 577 Shweder, R., 451, 452 Sidel, V. W., 197 Siegel, C., 378 Signer, B. R., 99 Silove, D. M., 207 Silvera, D. H., 506 Simcox, A. G., 341–342 Simeonsson, R. J., 575 Simmons, R., 111, 119 Simon, G. M., 94, 247, 248, 251, 252, 257, 265, 266 Singer, J. L., 324, 325 Sireci, S. G., 7, 8, 14, 97, 485, 533, 534 Skevington, S. M., 309 Skiba, R. J., 15 Skinner, J. H., 595 Sklar, J. C., 13 Skodol, A. E., 136 Slavin, L. A., 110 Slobogin, C., 652–653 Small, G. W., 609 Small, S. A., 555, 595 Smith A., 554 Smith, A. E., 276 Smith, C., 363 Smith, D., 349 Smith, D. W., 428, 437 Smith Fawzi, M. C., 207 Smith, M. A., 54, 113 Smith, P., 523 Smith, P. L., 273, 285 Smith, T. B., 139 Snow, C., 478, 481

Snow, C. E., 482 Snowden, L. R., 24, 83, 109, 117, 365 Snyder, C. P., 114 Sobel, H. J., 324 Sohn, W. J., 379, 394 Solano-Flores, G., 473 Solberg, V.S.H., 274, 275 Sosa, G., 609 Spangler, W. D., 331 Spanierman, L. B., 137, 289 Spar, J. E., 610 Sparrow, S., 583 Spearman, C. E., 654, 655 Speight, J. D., 286 Speight, S. L., 275 Spell, L. A., 505 Spencer, S., 13, 97–98 Spielberger, C. D., 178, 182 Spilka, B., 387 Spilsbury, J. C., 634 Spitzer, R. L., 136 Spokane, A. R., 273, 280, 281 Spray, J. A., 92 Spray, K., 378 Spreen, O., 554 Spruill, J., 568 Squires, J., 570, 579 Srivastava, A. K., 459 Stahl, S. M., 595 Stakowski, S. M., 24 Staniszewska, A., 300 Stansfeld, S. A., 180 Stark, K., 347, 350 Stark, S., 378 Steele, C. M., 13–14, 97, 98, 514, 515 Stefanis, C., 385 Stein, L.A.R., 427, 437 Steinberg, J., 595 Steinberg, L., 288 Steitz, J. A., 349 Stejskal, W. J., 362 Stephenson, M., 365 Stern, Y., 530, 550, 555, 595 Sternberg, R. J., 449–452, 454–458, 461, 502 Stevens, M. J., 429, 438 Stevens, R. A., 480, 481 Stevens, S. S., 36 Stevenson, H. W., 351 Steward, W. T., 114 Stewart, A. L., 595 Stewart, R., 597 Stigler, J. W., 351, 451 Stillwell, W. E., 301, 305 Stobart, G., 5, 6

NAME INDEX Stock, H. L., 658 Stock, J. R., 583 Stodlsky, S., 53 Stone, G. L., 54 Storey, J. E., 595 Strack, K. M., 375 Stracuzzi, T., 57 Straker, G., 176 Strand, S., 523 Strelau, J., 403 Stricker, G., 117, 363 Strickland, T. L., 542 Stukenberg, K., 428, 437 Sturgeon, S., 594 Stutsman, R., 565 Subich, L. M., 278–280, 282–287 Sue, D., 134, 136, 137, 139, 148, 388, 392, 552, 574 Sue, D. W., 64, 109–110, 115, 118, 134–137, 139, 143, 146, 148, 258, 388, 392, 574 Sue, L., 117–118 Sue, S., 46, 115, 117, 118, 134, 180, 183, 274, 389–394, 429, 438, 441, 500, 552 Suga, S., 176 Sugihara, Y., 436, 439, 440 Suh, E., 301 Suh, E. M., 389 Suinn, R. M., 77, 83, 551 Sullivan, H. S., 324 Summers, J. D., 603 Sun, Y., 276 Sundberg, N., 349 Super, C. M., 452, 459 Super, D. E., 277, 282, 283 Sutton, R. E., 99 Suzuki, L. A., 110, 111, 134, 144, 426, 435, 490, 511, 514, 666, 667, 669 Svinicki, J., 583 Swain, M., 552 Swaney, K. B., 280 Swenson, C. H., 349, 350 Swinnerton, B., 100 Szapocznik, J., 82–83, 263 T Tait, K., 100 Tajfel, H., 54 Takashi-Chinen, R., 140, 145 Takeuchi, D. T., 117, 134 Talley, L., 207 Talleyrand, R. M., 80, 81 Tan, J. A., 376, 378 Tang, A., 177, 183, 188, 203 Tann, S. S., 300, 313

Tanzer, N. K., 107 Tarver, D. D., 135 Tarvydas, V. M., 24 Taulbee, E. S., 349 Taussig, I. M., 595, 607, 615 Taylor, A. Z., 288 Taylor, J. G., 275, 276 Taylor, K. M., 284 Taylor, M. J., 555 Taylor, S. J., 311, 312 Tebes, J., 119 Teglasi, H., 324, 325, 341–342, 346, 358 Teichman, Y., 353 Tellegen, A., 426, 427 Teng, E. L., 595, 604, 605 Ter Laak, J., 349 Teranishi, R. T., 101 Teresi, J. A., 595, 601 Terman, D. L., 630 Terpylak, O., 376 Testa, M. A., 299 Tharinger, D. J., 347, 350 Theorell, T., 273 Thernstrom, A., 524 Thernstrom, S., 524 Thomas, C. W., 52 Thomas, W., 471 Thombs, B., 65 Thompson, A. S., 279 Thompson, C., 143 Thompson, C. E., 323, 359 Thompson, D. R., 605 Thompson, L. A., 524 Thompson, R. C., 283, 386 Thompson, S. J., 9 Thompson, T. C., 414 Thorndike, E., 505 Thorndike, R. M., 513 Thorsteinsson, E. B., 512 Threlfall, J., 100 Thurlow, M. L., 9, 10 Tiemann, J., 366 Timberlake, T. L., 273 Timbrook, R. E., 427, 437 Tix, A. P., 64 Tkachuk, M. J., 364, 436, 439 Toku, M., 350, 351 Tokudome, S., 608 Tolan, P. H., 119 Toliver, S., 136 Tomchin, E. M., 510 Tomlinson, M. J., 283 Ton, H., 136, 139, 143, 144, 148 Toole, M. J., 197

691

692 NAME INDEX Toossi, M., 15 Toporek, R. L., 110, 117, 135 Torino, G. C., 135 Touradji, P., 550, 555, 595 Tracey, T. J., 280, 281 Tracy, M. L., 22 Tran, K. A., 199 Triandis, H. C., 301, 389 Trickett, E. J., 78, 117 Trimble, J. E., 58, 118, 135, 274, 391, 551 Trocme, N., 646 Trumbull, E., 473 Trusty, J., 275 Tsai, D. C., 429, 438 Tsushima, W. T., 557 Tsytsarev, S. V., 651 Tu, S. P., 595 Tuma, F., 168 Turner, S. L., 274, 276, 286 Turner, S. M., 172, 180, 226, 437 U Um, K., 179–180 Umana-Taylor, A. J., 55 Unterbrink, C., 431, 438 Unverzgt, F. W., 595 Urbina, S., 455 Utsey, S. O., 56, 57, 59, 139, 140, 146, 147, 299 Uzgiris, I., 565, 580 V Vaage, A. B., 110, 139 Vacha-Haase, T., 282, 435, 439 Vader, C., 550 Valencia, E. Y., 73 Valencia, R. R., 511, 514, 667 Valenstein, M., 609 Valle, R., 595, 601 Van de Vijver, F., 107, 112, 116, 182, 188 van de Vijver, F.J.R., 15, 16, 450, 451, 667 van der Kolk, B., 226 Van der Veer, G., 168 Van der Zee, K. I., 55, 59, 61, 62 Van Gorp, W. G., 609 Van Heck, G., 309, 310 Van Meek, L., 394–395 Van Ommeren, M., 197 Van Oudenhoven, J. P., 55, 59, 61, 62 Van Rijswijk, P., 349 Van Rooy, D. L., 504 Vandiver, B. J., 53, 54, 56–58, 66, 138, 146 Vangel, S. J., 603 VanHoutten, V., 550

VanSant, S., 414 Varese, L., 207 Varney, N., 554 Vasquez, M. J., 388 Vaughn, H., 554 Velasquez, R. J., 390–393 Vera, E. M., 275 Vera, M., 113, 116–117 Verdeli, H., 207 Vergara, A., 207 Vernon, P. A., 403 Vernon, P. E., 512 Vetter, H., 108 Vidair, B., 577 Vigil, P., 77, 551 Viglione, D. J., 362, 363 Vila, D., 113 Viswesvaran, C., 504 Vitaliano, P., 604 Vontress, C. E., 60, 63 Vygotsky, L. S., 351, 455 W Wade, J. C., 65, 139 Wagner, D., 628 Wainer, H., 93 Wakcher, S., 376 Waldenfogel, J., 11 Walker, C. M., 281, 287, 289 Wallbrown, F. H., 380 Walsh, D. A., 645 Walsh, J. A., 116 Walton, J. R., 354 Wandrei, K., 109 Ward, C., 512 Warfa, N., 180 Warner, J. A., 436, 439, 440 Warner, R., 301, 311, 312 Warren, A. K., 138 Watanabe, J., 595 Watkins, C. E., 393 Watkins, M. W., 524 Watt, S. K., 138 Watzlawick, P., 27 Weathers, M. D., 505 Wechsler, D., 328, 349, 462–463, 523, 554, 565, 582 Wedding, D., 542–547 Wegmann, P., 354 Weinberger, J., 342 Weiner, M. F., 602 Weinstein, H. M., 207 Weisman, A., 113, 116–117 Weiss, D. J., 94, 188

NAME INDEX Weiss, L. G., 667 Weiss, S. C., 349 Weiss, T., 170, 183–185 Weisz, J. R., 113 Weldon, M., 595, 602 Wells, A. M., 117 Welsh, D. E., 604 Welsh, K. A., 601 Werner-Lin, A., 59 Wernicke, C., 543–544 Westermeyer, J., 107, 173, 175, 176, 179, 185, 201, 221, 223–225, 227, 550 Wettersten, K. B., 274 Whatley, P. R., 429, 437, 441 Whiston, S. C., 273, 276, 279 White, G. M., 459 White, M., 249 Whitworth, R. H., 381, 431, 438 Whyte, S. R., 604 Wicherski, M., 108 Wiedl, K. H., 455 Wiese, D. L., 278 Wiggers, H., 406–407 Wiggins, J. S., 346, 358 Wilen, D. K., 222 Wilkinson, G., 601 Williams, B., 139 Williams, C. B., 135 Williams, J., 109 Williams, J.B.W., 136 Williams, O., III 139 Williams, R. A., 135, 263 Williams, T. S., 11 Williamson, D., 379, 382 Willmann, E., 506 Wilson, B., 349 Wilson, W. J., 273, 274 Wilton, L., 135 Wimsatt, M. K., 22 Winer, J. L., 283 Wingenfeld, S., 585 Winokur, A., 204 Winokur, D. F., 204 Witt, D., 478 Wittgenstein, L., 44 Wnek, L., 583 Wober, M., 452 Woike, B. A., 347 Wolfe, N., 595 Wolfson, D., 542, 546–548, 554, 557 Wong, C.M.T., 506 Wong, E. C., 116–117 Wong, G., 594, 595

Wong, N.Y.C., 182, 188 Wood, D., 556–557 Wood, J. M., 114, 346–348, 362 Wood, R. Y., 615 Worrell, F. C., 53 Worthington, R. L., 273 Wu, C., 603 Wyshak, G., 205 X Xu, S., 359 Y Yama, M. F., 347, 349 Yamada, A-M., 109 Yamamoto, K., 387 Yang, J., 611 Yang, P. H., 365 Yang, S., 457, 458 Yanico, B. J., 283 Yansen, E. A., 577 Yao, E. L., 83 Yazedjian, A., 55 Yeh, C. J., 13, 144 Yeo, G., 595 Yesavage, J. A., 610, 611 Ying, Y., 385 Young, S., 595 Yu, S., 611 Z Zaal, J. N., 61 Zafrir, H., 353 Zandi, T., 610–611 Zane, N., 46, 74, 75, 78, 82–85, 115, 134 Zao, K. E., 282, 287 Zayas, L. H., 116 Zea, M. C., 73, 77, 78, 81 Zehler, A. M., 535 Zeidner, M., 503, 504 Zellman, G. L., 629 Zhang, T., 359 Zhang, W., 602 Zhang, Z., 170 Zheng, Y-P., 108 Zhou, D., 603 Zietsmann, G., 418 Zimet, G. D., 576 Zimet, S. G., 576 Zsembik, B. A., 596 Zumbo, B. D., 15 Zung, W. W., 610 Zwick, R., 13, 500

693

SUBJECT INDEX

A AAMD Adaptive Behavior Scale, 583 Ability testing: and abilities as developing expertise, 452–457; across cultures, 449–463; and models of relationship among abilities, tests, and cultures, 449–463; and question of which abilities, 457–462; and Scholastic Assessment Test (SAT), 491–502; standard positions on, 451–452; and taking ability tests, 462–463; and transportability of ability tests, 451–457; and views from cultures around world, 457–462; and Western psychological views, 457 Academic achievement testing: and analysis of distracters in multiple choice items, 537–539; for culturally diverse groups, 520–539; developing, for fairness, 533–534; group differences in standardized, 524–533; and implication of achievement gaps for schooling, 532–533; and mean observed Black-White achievement gaps for NAEP, 525; and NAEP reading, math, and science results for 2005, 525–531; and Nation’s Report Card assessment of fourth-grade student performance, 2005, 527–530; psychometric issues in, and English-language learners (ELL), 534–539; and relationship of

694

learning, ability, and achievement, 521–523; role of general mental ability in, 520–524; and test bias, 533–534 Acculturation: assessing, 82–86; and contextual considerations, 79–80; definition of, 76; dimensionality of, 76–77; and ethnic identity, 80–81; and multicultural assessment, 73–87; practice of measuring, 85–86; and racial identity, 81–82; research, 83–85; understanding, 75–80 Acculturation Rating Scale for Mexican Americans, 77 Achenbach System of Empirically Based Assessment, 333 Adaptive Behavior Inventory for Children, 583 Adjective Check List, 411 Adolescent Personality Questionnaire, 376 Advanced Placement, 14, 532 Agahinda, 204 Ages and Stages Questionnaires (ASQ), 579 AH6 Group Tests of High Level Intelligence, 492 Albany Medical College (New York), 406–407 Aleknagik Project, 415 Aleknagik School (Alaska), 414

SUBJECT INDEX American Counseling Association, 23, 135, 273; Code of Ethics, 24 American Educational and Research Association, 93, 181, 389 American Educational Research Association, 273 American Medical Student Foundation, 407 American Psychiatric Association, 107, 133, 143, 147, 148, 273, 653 American Psychological Association, 22, 23, 58, 73, 93, 115, 135, 143, 181, 198, 273–276, 289, 388–393, 427; Ethics Code, 234; Presidential Task Force on Evidence-Based Practice, 117; Task Force on the Delivery of Services to Ethnic Minority Populations, 198 American University, Beirut, 353 Americans with Disabilities Act (1990), 96 Amnesty International, 168, 196 Anime (Japanese cartoons), 351–352 Annual Refugee and Asylee Report (U.S. Department of Homeland Security Office of Immigration Statistics), 196 APA Council of Representatives, 568 Aptitude assessment: and acculturation, 512–513; and alternative forms of intelligence, 503–510; and biological measures of intelligence, 503; and cultural equivalence, 513; and cultural loading, 513; and differential item functioning, 515; and emotional and social intelligence tests and characteristics of their standardization samples as noted by Buros’s reviews, 507–509; and emotional intelligence, 503–505; and health factors, 512; and home environment, 511; and influences on racial and ethnic group variability, 510–515; and intelligence tests and characteristics of their standardization samples as noted by Buros’s reviews, 492–498; and language, 512; multicultural issues and, 490–515; and multiple intelligences, 510; and racial and ethnic group differences on intelligence and aptitude tests, 490–491; and residential and regional issues, 512; and social intelligence, 505–506; and socioeconomic status (SES), 511; and stereotype threat, 514–515; and test bias, 513–514 Assessment and Placement Services for Community Colleges (College Board), 44 Assessment, Evaluation, and Programming System for Eligibility (AEPS:E), 571, 579

Assessment Evaluation and Programming System for Infants and Children, 586 Assessment, Evaluation, and Programming System for Infants and Children (AEPS), 571, 578 Assets and Health Dynamics of the Oldest Old (AHEAD), 596 Association for Psychological Type, 407 Association of American Medical Colleges, 406 Association of Rwandan Trauma Counselors, 209, 212 Atlas of Type Tables (Macdaid, McCaulley, and Kainz), 415 Auditory Learning Test, 606 Axis I, 431 Axis II, 431 B BarOn Emotional Quotient Inventory: Youth Version, 504, 507 Battelle Developmental Inventory Screening Test, 578, 579, 583, 584 Bayley Scales of Infant Development, 565, 566, 579 Beck Depression Inventory, 103, 189, 610 Behavioral Assessment System for Children (BASC), 334, 335, 338, 341; Self-Report of Personality (BASC-SRP), 334, 335, 338 Bender-Gestalt technique, 348, 612 Benton Visual Retention Test, 554 Berkeley Growth Study, 565 Bernard Category Test, 555, 556 Black and White Racial Identity: Theory, Research, and Practice (Helms), 52–58 Black Racial Identity Attitude Scale (RAIS-B), 54 Boston Indochinese Psychiatric Clinic, 199–200 Boulder model of clinical training, 113–114 Bowen family systems therapy, 255, 256 Brazelton Neonatal Behavioral Assessment (NBAS), 579 Brigance Diagnostic Inventory of Early Development, 583, 584 Buros Institute of Mental Measurements, 44, 447, 491, 492, 506, 507 Buros Mental Measurements Yearbook, 506 C California Brief Multicultural Competence Scale (CBMCS), 118

695

696 SUBJECT INDEX California Department of Mental Health Office of Multicultural Services (CDMH-OMD), 119 California Endowment, 135 California Psychological Inventory (CPI-434), 378, 380–381, 411; and acculturation, 390–391; cross-cultural considerations in, 385–388; and equivalence, 389–390; future multicultural research with, 393–395; introduction to, 382–383; multicultural personality assessment implications for, 388–393; multicultural studies involving, 386–387; normative data, 385; and racial and ethnic identity, 391; reliability of, 383; scale descriptions, 384; validity of, 384–385 California State Board of Education, Diana v., 12 Career Decision-Making Self-Efficacy Scale (CDMSE), 284, 285 Carolina Curriculum for Infants and Toddlers with Special Needs, 571, 578, 579, 584 C-BASIIC (Cognitive-Behavioral Assessment of Stressful Interactions with Infants and Children), 576 Center for Applications of Psychological Type (CAPT), 407 Center for Research on Latino Mental Health and Other Health Disparities, 115 Center for Victims of Torture, 231–232, 233 Chapin Social Insight Test, 507 Child Behavior Checklist Teacher Rating Form (TRF; Achenbach and Rescola), 331, 341 Child maltreatment: assessing for, 627–648; and care of newborns, 644–645; culture as mask or smokescreen in, 646–647; and false negatives, 645–647; and false positives, 634–645; and flexible boundaries, 634–635; and hairstyles and clothing, 640–641; how culture matters in assessment of, 647–648; and lack of cooperation, 639; and lack of information about child, 640; and linguistic misunderstandings, 640; and misunderstanding with schools, 635–637; and Mongolian spots, 645; and one father, two families, 643–644; radial disproportionality in, 628; and sleeping arrangements, 641–643; suspicion of, 629–633; traditional medical interventions for, 638; and unfamiliar discipline methods, 637–638; what constitutes, 633–647

Child Protective Services (CPS), 632 Child Welfare Information Gateway, 628 Children’s Apperception Test, 348, 359 Children’s Depression Inventory (CDI), 334, 336, 340, 341 Children’s Personality Questionnaire, 376 Civil Rights Act (1964), 199 Clinical diagnosis, 107–123; and assessment, 110–112; and intervention, 112–113; and pathology, mental health and nonpathology, behavioral health, 109–110; practice models, 114–119; and psychological science, 113–114; research guidelines and conceptual model for, 114–119 Clinical Manual to Geriatric Psychiatry (Spar and LaRue), 610 Clinton administration, 199 CLOX Spanish Version, 603 Code of Fair Testing Practices in Education (Joint Committee on Testing Practices), 93 Cognitive Abilities Screening Instrument (CASI), 605 Collaborative language systems therapy, 250 College Board, 44, 491, 532 College Level Academic Skills Test, 101 Committee on the Family, Group for Advancement of Psychiatry, 109 Community model, 117 Community Screening Interview for Dementia, 605 Community test norms: and approximately normal empirical distribution of test scores, 37; building, 34–50; and composition of norm group, 41–42; and definition of norm, 36; and item response theory, 39–41; and theoretical normal distribution, 36–39; and theoretical normal distribution compared to approximately normal distribution, 38 Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology, 667 Competency Assessment Instrument, 663 Competency Screening Test, 662–663, 663 Competency to stand trial: and clinician’s biases and fears, 661; and criticism of Jensen’s perspective in multicultural diversity in IQ scores, 654–656; and DSM diagnosis, 658; and explanations for over representation of minority groups, 662–663; goals and objectives of assessment of, 652–654; and impact of defendant’s social role on evaluation of,

SUBJECT INDEX 660; and intelligence as cultural construct, 657; and multicultural aspects of restored competency, 660–661; multicultural evaluation of, and racial biases in IQ testing, 654–657; overview, 651–652; and types of biases in multicultural assessment of, 658–659 Composite International Diagnostic Interview, 207 Comprehensive Bibliography of the CPI Assessment: 1948–2002, 388 Comprehensive Test of Nonverbal Intelligence, 492 Comprehensive Trail Making Test, 549 Computer-adaptive testing (CAT), 94 Computer-Assisted Competence Assessment, 663 Computer-based assessment: and computer administration of tests, 96–97; and computer-adaptive testing (CAT), 94; and computer-based instruction (CBI), 94–95; and computer-based testing (CBT), 93–95; multicultural issues in, 92–104; and use of computerized tests with multicultural populations, 95–98; and use of computers in assessment, 92–93 Computer-based instruction (CBI), 94 Computer-based testing (CBT), 93–95; in clinical settings, 102–103; in educational and clinical settings, 98–103; in schools, 99–100; scoring and interpretation of, 97–98; test design and development of, 95–96; in university settings, 99–102 Computerized fixed tests (CFT), 93 Connecticut Department of Mental Health and Addiction Services (DMHAS), 119 Consortium to Establish a Registry for Alzheimer’s disease (CERAD), 600, 604 Construct bias, 15, 534 Consulting Psychologists Press (CPP), 407, 408, 418 Content bias, 533–534 Council of National Associations for the Advancement of Ethnic Minority Interests, 115 Cross Cultural Communication Systems (CIFE), 234 Cross Racial Identity Scale (CRIS), 53, 54, 56–57 Cross-Cultural Assessment of Quality of Life Concepts Questionnaire (CCAQLCQ), 309 Cultural assessment: for all clients, 136–138; conceptual framework and interview protocol for, 132–155; counselor

characteristics and behaviors in, 147; and cultural identity, 144; current conceptual framework and cultural assessment interview protocol for, 140–149; development of conceptual framework and interview protocol for, 138–140; and existential/spiritual issues, 147; and experience with bias, 146–147; and family culture and expectations, 145–146; and immigration issues, 147; implementing, 149–150; and implications of cultural factors between counselor and client, 148; and level of acculturation, 144–145; and level of racial/cultural identity development, 146; overview of conceptual framework for, 141–142; and problem conceptualization and attitudes toward helping, 143–144; and rationale for cultural assessment, 134–136; and summary of cultural factors and implications for diagnosis, case conceptualization, and treatment, 148–149 Cultural Assessment Interview Protocol (CAIP), 140, 141, 150–155 Cultural competence, 117–118 Culture: and acculturation, 551; conceptual domains of, 550–551; and culture-specific folkways and mores, 552; defined, 6, 46; and ethnocentrism, 551; and linguistics, 551–552; and subpopulation cultural differences, 553 Culture, Medicine, and Psychiatry (Lewis-Fernandez), 107 D Dementia Rating Scale, 605 Denver Developmental Screening Test (DDST), 579 Detroit Test of Learning Aptitude-P (DTLA-P3), 582 Developmental Activities Screening Inventory, 579, 583, 584 Developmental Indicators for the Assessment of Learning, 583, 584 Developmental Observation Checklist System (DOCS), 578 Developmental Profile-II, 579, 586 Developmental Programming for Infants and Young Children, 586 Diagnostic Assessment of Reading Comprehension (DARC), 480–481 Diana v. California State Board of Education, 12

697

698 SUBJECT INDEX Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), 107, 108, 110, 111, 123, 203–204, 239, 651 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), 107, 108, 111, 135, 143, 179, 180–181, 199, 431; Case Book, 136 Differential Ability Scales-II (DAS), 582 Differential item functioning (DIF), 15, 501, 533 Differential predictive validity, 534 Disabilities Education Act, 585 Diverse populations: assisting, 198; and bilingual-bicultural model in refugee mental health, 199–200; challenges of, 198–199; cultural adaptation and translation of assessment instruments in, 195–214; identification of, 196; and international postconflict response to mental health, 201–206; models of assessing, 199–201; and Rwanda, 206–217; and torture rehabilitation programs, 200–201; torture, war, civil conflict and, 196–197 Draw-a-Person Questionnaire (DAPQ), 356 Draw-a-Person: Screening Procedure for Emotional Disturbance (DAP:SPED), 355–356 Draw-a-Person (DAP) Test, 347–349, 352 Drawing assessment technique, 347–348; cross-cultural research on, 348–349; and family drawings from Cuban rafter children, 354–355; and House-Tree-Person drawing, 353–354; and human figure drawings, 348–350; and Japanese children’s human figure drawings, 352; and Kinetic Family Drawing (KFD) test, 354; and Middle Eastern human figure drawings, 352–353; and universality of stages of human figure drawing, 350–352 E Education of the Handicapped Act, 566 Education Trust, 274 Educational Self-Efficacy-Adolescents Scale, 286 Educational Testing Service (ETS), 406–407 EIWA, 606–607, 615 Elderly: African American, 606; Asian American, 607–608; assessment instruments for use with culturally diverse, 602–603; assessment issues for working with diverse populations of, 594–615; and case study of elderly Chinese client,

611–613; culturally biased assessment of, 596–597; and dementia and older adult assessment, 600–601; depression and pseudodementia in, 608–611; depression screening scales for, 606–611; and educational history, 599; elements of culturally sensitive, comprehensive assessments of, 597–600; and employment history, 599; and intelligence testing with minority older adults, 601–608; inviting family members to interview of, 598; Latino/Hispanic American, 606–607; and medications, 598; and use of mental status examinations with minority older adults, 601 Emotional Judgment Inventory, 508 Emotionally focused therapy, 255 English as a second language (ESL), 476, 479 English language learners (ELL), 534–535; modification of language demands for, 535–536 English-language learners: and assessment of Academic Achievement, 482–485; and assessment of English-language proficiency, 475–479; and determining English-language proficiency, 475–478; educational assessment of, 471–486; and length of time to learn English, 478–479; and oral language and literacy assessment, 479–482 Essentials of Psychological Testing (Cronbach), 34–35 Ethical concern, 24 Ethical Principles and Code of Conduct (American Psychological Association), 181 Ethical problem, 24 Ethnic identity, defined, 80–81 Ethnic Identity Scale (EIS), 55 Ethnic minority populations: building community test norms for, 34–35 Evidence-base practice, 117 F Fair Test: The National Center for Fair and Open Testing, 502 Family Needs Survey, 575–576 Family Strengths Scale, 576 Family Support Scale, 576 Family systems, diverse: assessment of, 247–270; and idiographic models, 249–53; and key concepts of representative idiographic models, 250; and key concepts of representative nomothetic models, 255; and nomothetic models, 253–257; and

SUBJECT INDEX range of options in family assessment, 248–257; and systematic nomothetic-idiographic blends, 257–259 Family-oriented, culturally sensitive (FOCUS) Assessment of young children, 573; and assessing family characteristics, 574–577; and assessing young children’s developmental competencies, 577–584; content of training for, 569; and culturally competent and family–centered early childhood evaluation, 571; and family-oriented, culturally sensitive infant/toddler assessment and intervention, 571–587; and instruments for assessing preschool-aged children, 582–583; and legislative mandate for quick assessment, 570–571; overview, 565–567; and traditional versus alternative assessment methods, 570; training and continuing professional development in, 572–574; and training practitioners to be family focused and culturally sensitive, 567–571 Fels Growth Study, 565 Figure Location Test, 548 Finger Tapping test, 556 Fingertip Numbering Writing Test, 548 FIRST Project, 221–223, 226 5 Axis, 239 Fold Object Memory Test, 556 Forum Activistes des Contre la Torture (FACT; Forum for Activists against Torture), 208, 209 Forum for Activists against Torture (FACT; Forum Activistes des Contre la Torture), 208, 209 From Persecution to Prison (Keller), 166–167 Fuld Object Memory Evaluation (FOME), 603 G General Occupational Themes (GOT), 279 Georgia Court Competency Test, 663 Geriatric Depression Scale, 610 Gestalt psychology, 346 Global Assessment of Functioning (GAF), 239 Global Commission on International Migration, 196 Goodenough-Harris Drawing Test, 583 Graduate Record Examination (GRE), 14, 98, 501 Group for the Advancement of Psychiatry, 652–653

Guhahamuka, 204 Guidelines for Test Adaptation (International Test Commission), 182 Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists (American Psychological Association), 135, 278, 568, 666 H Halstead Category Test, 556 Halstead-Reitan Neuropsychological Test Battery, 547–548, 556, 557 Hamilton Rating Scale for Depression (HRSD), 610 Hammill Multiablility Intelligence Test, 492 Handbook of Cross-Cultural and Multicultural Personality Assessment (Dana), 121 Handbook of Multicultural Assessment (first edition; Suzuki, Ponterotto, and Meller), 6, 426, 435 Harvard Growth Study, 565 Harvard Program in Refugee Trauma, 207 Harvard Project Zero (Harvard University), 510 Harvard Trauma Questionnaire, 189, 205, 208, 210, 212, 213, 232; comparison of original and back translation of, selected items from Trauma Symptom Section, 211; use of, in Rwanda, 211–213 Hawaii Early Learning Profile (HELP), 571, 578, 579, 584 High/Scope Child Observation Record for Infants and Toddlers (High/Scope Educational Research Foundation), 571 Home Observation and Measurement of the Environment (HOME), 575 Hooper Visual Organization Test, 554 Hopkins Symptom Checklist-25, 189, 204, 207 House-Tree-Person technique, 347–348 How I Think Questionnaire, 508 Human Rights Watch, 196–197 I IDEA Amendments, 567 Ideographic response to interventions model (RTI), 566

699

700 SUBJECT INDEX Immigrants: and cultural brokerage, 224–225; delivering quality health service to, through interpreter, 220–240; and FIRST Project, 221–222; and interpreter services, 222–223; and interpreting in mental health setting, 225–227; and language competency, 223–224; and selecting interpreters, 227–230; and training of interpreters, 227; and untrained interpreter in treatment, 225 Immigrants and Refugees Surviving Torture (FIRST Project), 220 Immigration and Nationality Act, 166, 205 Impression Management scale (IM), 376 Improving Access to Services for Persons with Limited English Proficiency (Executive Order 13166; Clinton), 199 Individualized Family Service Plan (IFSP), 567 Individuals with Disabilities Act, 566 Indochinese Psychiatric Clinic (Boston), 205 Infant-Toddler Developmental Assessment (IDA), 571 Infant/Toddler Environment Rating Scale, 575 Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), 604 Infrequency scale (INF), 376 Instrument for Measuring Progress, 586 Intelligence, 457 Interdisciplinary Fitness Interview, 663 Internal Displacement Monitoring Centre, 197 International Classification of Diseases (ICD), 239 International Congress of Ministers of Health for Mental Health and Post-Conflict Recovery, 197 International Postconflict Response to Mental Health: and cross-cultural assessment instruments, 204–206; cross-cultural translation and adaptation in, 201–203; and ethnographic mini-assessment of local perceptions, 205; example of, in Rwanda, 203–206 International Rorschach Society, 363 International Test Commission (ITC), 182, 184 Interpreters: and assessment, 231–233; clinicians working with, 233–234; code of ethics in training, 230–231; and cultural brokerage, 224; delivering quality mental health service to immigrants and refugees through, 220–240; ethical standards

regarding, 234–236; and FIRST Project interpreter curriculum, 237–241; and full-language bilingualism, 230; and general interpreter characteristics, 228–230; and interpreter services, 222–223; and interpreting in mental health setting, 225–227; and language competency, 223–224; selecting, 227–230; training of, 227; and trends in interpreting, 226–241; untrained, in treatment, 225 Iowa Growth Study, 565 Iowa Test of Basic Skills (ITBS) Social Studies, 480–481, 535 Item response theory, 39–41, 94, 96; example of item characteristic curve in, 39; and item characteristic curve referenced with two individuals of different latent ability, 40 J Joint Committee on Testing Practices, 92, 93 Journal of Blacks in Higher Education, 499, 500 Journal of Multicultural Counseling and Development, 56 Jungian Type Survey, 411 K Kaufman Adolescent and Adult Intelligence Test, 493 Kaufman Assessment Battery for Children (KABC-II), 582 Kaufman Brief Intelligence Test, 493 Kigali Health Institute (Rwanda), 212 Kinetic Family Drawing test, 348 L Laboratory of Comparative Human Cognition, 452, 455, 462 Language Assessment Scales (LAS) Reading Component, 480–481 Language, Identity, and Behavior acculturation scale, 78 Lau v. Nichols, 472 Leiter International Performance Scale, 582 Likert scales, use of, 188 Linguistics, 116 M MacArthur Competence Assessment Tool-Criminal Adjudication, 663 Manga (Japanese comic books), 351–352 Maternal Social Support Index, 576

SUBJECT INDEX Mattis Dementia Rating Scale (DRS), 600–601, 612 Mayer-Salovey-Caruso Emotional Intelligence Test, 493, 504–505, 508 Mayo Clinic Older Americans Normative Studies (MOANS), 606, 608 MBTI Applications: A Decade of Research on the Myers-Briggs Type Indicator, 408 McCarthy Scales of Children’s Abilities, 508, 565, 566 Measuring Trauma, Measuring Torture (Mollica), 207 Measurement of Intelligence by Drawings (Goodenough), 348 Medicaid, 222 Medical College Aptitude Test, 406 Medical Outcomes Trust, 202 Medicare, 222 Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services), 222 Mental health service, quality: delivering, to immigrants and refugees through interpreter, 220–240; interpreting in setting of, 225–227 Merrill-Palmer Scale of Development, 565, 582 Method bias, 15 Microcomputer Adaptive Testing High-Risk Urban Students tool, 99 MIDAS: Multiple Intelligence Developmental Assessment Scales, 493 Middle School Self-Efficacy Scale, 285 Migration Policy Institute, 196 Mill-Hill Vocabulary Scale, 462 Mill-Hill Vocabulary Test, 454 Millon Clinical Multiaxial Inventory–III (MCMI-III), 376; background, 425–426; cross-validation sample, 434; development sample, 433; normative and cross-validation samples, 432–435; performance of non-white people in United States, 431–436; studies of African Americans, 435–436; studies of American Indians, 436; studies of Asian Americans, 436; studies of Latino population, 436; summary of MCMI studies of U.S. non-white groups, 439; summary, with non-white groups in United States, 437–438 Millon Index of Personality Styles, 411 Mini Cog, 604 Mini-Mental Status Examination, 597, 600, 602; adjusted, 603; Chinese version, 602;

Korean version, 603; Spanish version, 602 Minnesota Multiphasic Personality Inventory-2 (MMPI-2), 107, 376; background, 425–426; performances of non-white people in United States, 426–431; studies of African Americans, 427–429; studies of American Indians, 429–430; studies of Latino population, 430–431; summary of, with non-white groups in United States, 437–438 Minnesota Preschool Scale, 565 Minority Student Achievement Network (MSAN), 532 Missouri Comprehensive Guidance Evaluation Survey: Grades 6–9 (MCGES), 286 Miville-Guzman Universality-Diversity Scale (MGUDS), 55, 61, 65 Multicultural assessment: future directions in, 669–670; and limited availability of appropriate assessment tools, 668; in practice, 667–669; problems in application of best practices in, 668–669; and tests as gatekeepers, 668; trends and future directions, 666–670 Multicultural assessment validity (MAV): and achievement tests review, 44; and creating multicultural norms, 42–44; cultural influence on, 25–27; and example of differential item functioning for white and Latino individuals of same latent ability, 43; foundational principles, 28–29; as preeminent ethical issue in psychological assessment, 22–32; and problems measuring multicultural diversity, 45–50; process description, 25–27; and ubiquity of invalid assessment, 23–24; ultimate test of, 31–32 Multicultural Assessment-Intervention Process (MAIP), 118, 120, 123; original model, 121; schematic flowchart of components of, 122 Multicultural diversity: problems measuring, 45–50 Multicultural personality: definition of, 63–64; empirical findings, 64–65; recommendations for measurement of, 65; theoretical influences on, 59–63; theory and measurement, 58–66 Multicultural Personality Questionnaire (MPQ), 55, 65 Multidimensional Inventory of Black Identity (MIBI), 54

701

702 SUBJECT INDEX Multidimensional Scale of Perceived Social Support, 576 Multi-Factor Emotional Intelligence Scale, 504–505 Multi-Group Ethnic Identity Measure, 288 Multigroup Ethnic Identity Measure (MEIM), 53 Multigroup Ethnic Identity Measure-Revised (MEIM-R), 55, 57–58, 66–67 Multiple Intelligences Assessment Technique, 510 Myers-Briggs Type Indicator (MBTI), 378; and applications of type, 412–417; in career counseling, 415–416; development of, 405–406; distributors, 420; in education, 412–415; multicultural applications of, 402–419; in organizations, 416–417; professional associations, 420–421; psychometric properties of, 409–411; reliability of, 409–410; spread of, 406–408; test-retest reliability of, 410–411; and type across cultures, 417–419; type descriptions, 406; validity of, 411 N Narrative assessment techniques, 357–361; and cross-cultural research and adaptations, 359–360 Narrative therapy, 250 National Academy of Science, 13 National Association for the Education of Young Children (NAEYC), 570 National Association of School Psychologists, 568 National Career Development Association, 273 National Clearinghouse for English Language Acquisition and Language Instruction Educational Programs, 471, 472 National Consortium of Torture Treatment Centers, 200 National Council on Measurement in Education, 93, 181, 273, 389 National Education Statistics, 274 National Institutes of Health, 206 National Multicultural Conference and Summit, 568 National Science Foundation, 289 National University of Rwanda, Butare, 212 NEO Personality Inventory-Revised, 378 Neuropsychological assessment: and African Americans, 554–555; and Asian Americans, 556–559; comments on interpretation in, 557–558; critical issues

in, 550–553; cursory history of, 543–544; and definition of neuropsychological, 542; and Halstead-Reitan Neuropsychological Test Battery, 547–548; and Hispanic Americans, 556; multicultural research on, 553–557; and Native Americans, 557; overview, 542–443; and review of brain-behavior relationships, 545–546; selected approaches, 546–549; and Test of Verbal Conceptualization and Fluency, 548–550 Neuropsychological Assessment Battery (Consortium to Establish a Registry for Alzheimer’s disease), 600 Neuropsychological Evaluation of the Spanish Speaker (Ardila, Rosselli, Puente), 600 New York City Board of Education, Division of Public Affairs, 46 New York Times, 41 Nichols, Lau v., 472 No Child Left Behind (NCLB) Act, 10, 472, 473, 483, 535, 566 Non-Reading Intelligence Tests, 494 Norm, defined, 36 O Office of Minority Health (U.S. Department of Health and Human Services), 222 Office of Refugee Resettlement, 199 Oklahoma Racial Attitude Survey (ORAS), 54 Older African-American Normative Studies, 606 Oltman and Educational Testing Service, 102 Ordinal Scale of Development (1975), 565, 579, 584 P Parenting Daily Hassles Scale, 576 Parenting Stress Index (PSI), 576 Paris Anthropological Society, 543 Performance Intelligence Quotient (PIQ), 555 Personality Research Form, 378 Physicians for Human Rights, 166, 170 Physicians Toolkit and Curriculum, 233 Piagetian stages of development, 349, 452 Pictorial Test of Intelligence, 494 Piers Harris Self-Concept Scale, 334, 341 Population thinking, 116 Portland Intercultural Psychiatric Program, 199–200 Praxis Series: Professional Assessments for Beginning Teachers, 102 Precis of Bias in Mental Testing (Jensen), 654

SUBJECT INDEX ˜ Pre-Language Assessment Scales Espanol ˜ (Pre-LAS Espanol), 480 ‘‘Principles and Recommended Standards for Cultural Competence Education of Health Care Providers’’ (California Endowment), 135 Project 1 Billion (International Congress of Ministers of Health for Mental Health and Post-Conflict Recovery), 197 Project Spectrum (Harvard Project Zero), 510 Projective assessment: and cross-cultural research and adaptations, 359–360; and cross-cultural research on drawing techniques, 348–357; and cross-cultural Rorschach research, 364–365; and culturally sensitive assessment process, 356; and development of culturally sensitive techniques, 355–356; and drawing assessment technique, 347–348; and family drawings from Cuban rafter children, 354–355; and House-Tree-Person drawings, 353–354; and human figure drawing, 348–350; and Japanese children’s human figure drawings, 352; and Kinetic Family Drawing Test, 354; and Middle Eastern human figure drawings, 352; multicultural issues in, 346–366; and narrative assessment techniques, 357–361; and narrative projective assessment techniques, 358–359; and Rorschach technique, 361–366; and universality of stages of human figure drawing, 350–352 Propriospect, 26 Psychodiagnositic (Rorschach), 361–366 Psychoeducational assessment: high-stakes decisions in, 11–15; issues in culturally appropriate, 5–17; psychometric considerations in, 7–8; recommendations for nonbiased assessment practices in, 15–17; and test administration, 9–10; and test construction, 6–7; and translation and adaptation of tests, 8–9 Psychological Types (Jung), 402, 404, 405 Psychological types, Jung’s theory of, 403–404 Psychology, Public Policy, and Law, 521 PTSD Checklist-Civilian Version, 207 Purdue Pegboard Test, 554 Q Quality-of-Life Assessment (QOL): and conceptual equivalence, 307; and Cross-Cultural Assessment of Quality of

Life Concepts Questionnaire (CCAQLCQ), 309, 311; cross-cultural considerations in, 299–313; and ethnography, 312–313; interpretive constructivist approach to, 312; and item equivalence, 308; and Jane (case), 328–333; and Maria (case), 338–341; overview, 299–301; phenomenological approach to, 311–312; qualitative inquiry and, 311–313; reliability and validity coefficients for, measures, 309; review of instruments and techniques for, 308–311; and scale equivalence, 308; and Schedule for Evaluation of Individual Quality of Life (SEIQoL), 309–310; and semantic equivalence, 307–308; and Tiffany (case), 334–338; and World Health Organization Quality of Life-100, 309, 309–311 Quality-of-Life, defined, 299 R Racial and ethnic identity: development, 52–58; and multicultural personality, 52–67; popular models and assessments of, 54–55; recent developments in assessment of, 53–58; and summary of recent racial and ethnic identity psychometric developments, 58 Racial Identity Attitude Scale-Black (RIAS-B), 429 Racial identity, defined, 81–82 Raven’s Progressive Matrices, 582 Refugees and asylum seekers: and body language, eye contact, and facial expressivity, 172–173; choosing psychological instruments for assessment of, 180–189; and client familiarity with psychological evaluation process, 171–172; cognitive functioning in, 176–177; cross-cultural evaluation of, 166–191; cross-cultural issues in assessment of, 171–180; and culturally base beliefs, 175–176; defined, 166–167; delivering quality health services to, through interpreter, 220–240; and differences in language and nonverbal communication, 177–180; and differing sets of experiences, 174–175; and grooming and attire, 173; orientation to time, 173–174; psychological evaluation of, 170–171; and torture trauma, 167–169; trauma in lives of, 167–170; and trauma of resettlement, 169–170 Rehabilitation Act (1973), 96

703

704 SUBJECT INDEX Reitan Indiana Aphasia Screening test, 548 Report of the National Literacy Panel on Language Minority Children and Youth, 482 Response to interventions (RTI), 585 Rorschach Comprehensive System, 326, 331–334, 362, 363 Rorschach technique, 107, 333, 347, 348, 361–366; and cross-cultural Rorschach research, 364–365 Rwanda: background information on, 206–207; Ministry of Health, 212; providing care and support for in-country team in, 213–214; review of trauma studies in, 207–208; and Rwandan Women’s Inter-Association Study and Assessment, 208; study of, 206–217; translation process for, 208–211; and use of Harvard Trauma Questionnaire in new culture, 211–213 Rwandan National Ethics Committee, 206 Rwandan Patriotic Front, 207 Rwandan Women’s Inter-Association Study and Assessment (RWISA), 206, 208, 213 Rwandan Women’s Network, 207 S Scale to Assess World Views and the Cultural Identity Checklist (Lonner and Ibrahim), 112 Schedule for Evaluation of Individual Quality of Life (SEIQoL), 309–310 Scholastic Achievement Test (SAT), 532 Scholastic Aptitude Scales, 44 Scholastic Assessment Test (SAT), 13, 14, 41, 98, 477, 491–502; and explanations for racial and ethnic group differences, 502; Reasoning Test, 491, 499; Subject Test, 491; Subject Test score breakdown by racial and ethnic group, 499 Seashore Rhythm Test, 555, 556 Self-Directed Search (SDS), 279, 280 Self-Report of Personality (BASC-SRP; Behavioral Assessment for Children), 334 Sentence Completion technique, 348 Sixteen Personality Factor Questionnaire (fifth edition; 16PF-5): and acculturation, 390–391; cultural considerations of, 379–382; and equivalence, 389–390; future multicultural research with, 393–395; introduction to, 375–382; multicultural personality assessment implications for, 388–393; multicultural studies involving, 380–381; normative data, 378–379; and racial and ethnic identity, 391; reliability

of, 376–378; scale descriptions, 377; validity of, 378 Sixteenth Mental Measurements Yearbook (Buros Institute), 44 Skills Confidence Inventory (SCI), 284 Slosson Full-Range Intelligence Test, 494 Slosson Intelligence Test, 495 Snijders-Oomen Non-Verbal Intelligence Scale for Young Children, 495 Social cognitive career training (SCCT), 277, 288 Social Intelligence: The New Science of Human Relationship (Goleman), 505 Social Skills Inventory, 509 Society for Personality Assessment, 114 Solution-focused therapy, 250 Standards for Educational and Psychological Testing (American Educational and Research Association, American Psychological Association, and National Council on Measurement in Education), 93, 181, 533, 534 Stanford Achievement Test, 535 Stanford Acute Stress Reaction Questionnaire, 207 Stanford-Binet Intelligence Scales, 495, 582; for Early Childhood, 495 Stanford-Binet test, 462–463 State of California, Williams v., 474 Stephenson Multigroup Acculturation Scale, 365 StepOne for Parents, 112 Stoelting Brief Nonverbal Intelligence Test, 496 Strategic family therapy, 255 Strength of Grip Test, 548 Strong Interest Inventory (SII), 279, 280, 411 Structural family therapy (SFT), 255; boundaries, 261–262; case illustration, 267–269; and circular causality, 262–263; and communicating assessment to client family, 266–267; and idiographic elements, 263–264; nomothetic elements in, 259–263; as nomothetic-idiographic rendition, 259–269; and question of assessment, 264–266; subsystems, 260–261 Subjective well-being (SWB), 299 Suinn-Lew Asian Self Identity Acculturation Scale (SL-Asia), 77 Surgeon General’s Report on Mental Health: Culture, Race, and Ethnicity (U.S. Department of Health and Human Services), 222

SUBJECT INDEX Symbol Digit Modalities Test (SDMT), 554 System of Multicultural Pluralistic Assessment (SOMPA), 16 T Tactile Form Recognition Test, 548 Teacher Report Form, 341 Teele Inventory for Multiple Intelligences, 496 Tell-Me-a-Story Test (TEMAS). See TEMAS (Tell-Me-a-Story) multicultural test TEMAS (Tell-Me-a-Story) multicultural test, 42–43, 108, 312–313, 359, 360; administration and scoring, 326–328; development, 326; overview of, 323–324; rationale for, as narrative instrument, 324–341 Test bias, 533–534 Test of Nonverbal Intelligence, 496 Test of Verbal Conceptualization and Fluency (TVCF), 546, 548–550 Tested Language Proficiency English Language (TOEFL), 228–230 Tests: assessment accommodations in administration of, 9–10; construction of, 6–7; translation and adaptation of, 8–9 Thematic Apperception Test (TAT), 107, 325, 347, 358 Torture, defined, 168 Torture Worldwide (Amnesty International), 196 Trail-making test, 548, 556 Transdisciplinary Play-Based Assessment, 579 Tromso Social Intelligence Scale, 506 Type Differentiation Indicator, 408 Typology Laboratory (University of Florida), 407 U United Nations, 168, 196–197, 207, 209 United Nations Convention on the Rights of the Child, 645 United States Department of Homeland Security, 165 Universal Nonverbal Intelligence Test, 496 Universal-diverse orientation (UDO), 60, 61, 65 University of California, 13 University of California, Santa Barbara, 500 University of Chicago Medical School, 547 University of Florida, 407 University of Minnesota Hospitals, 426 Urban Institute, 474

U.S. Air Force, 504–505 U.S. Bureau of the Census, 46, 58–59, 73, 220, 429, 549, 566–567, 594, 629 U.S. Department of Education, 274, 471; National Assessment of Educational Progress (NAEP), 524, 535 U.S. Department of Health and Human Services, 168, 198, 222, 628; Office of Minority Health, 222 U.S. Department of Homeland Security, 196 U.S. Department of State, 196–197 U.S. Office of Refugee Resettlement, 220 USAID/Rwanda, 209 V Vail model of clinical training, 113–114 Values Scale (VS), 280 Verbal Intelligence Quotient (VIQ), 555 Verbal Item Difficulty, 501 Veterans Administration Medical Center, 435 Vineland Adaptive Behavior Scales, 583 Visible Racial/Ethnic Identity Attitude Scale, 288 Visual Form Discrimination Test (BVRT), 554 Vocational assessment, culturally competent, with at-risk adolescents in middle and high school: and career development tasks, 276–278; and perceptions of career opportunities and supports and barriers, 286–287; and recommendations for practical applications and future research needed, 287–289; and research on interests, 279; research on, with culturally diverse students, 278–286; and self-efficacy beliefs, 283–284; and status in process of career decision making and exploration, 283; and values, 282 W Wechsler Abbreviated Scale of Intelligence, 496 Wechsler Adult Intelligence Scale, 497, 597, 600 Wechsler Intelligence Scale for Children (WISC), 16, 185, 323, 349, 462–463, 497, 554, 601 Wechsler Memory Scale, 554, 606 Wechsler Preschool and Primary Scale of Intelligence, 492, 497, 565, 582 Well-Being scale (Wb), 383 Wernicke’s area, 544 White Racial Consciousness Development Scale-Revised (WRCD-R), 55, 57

705

706 SUBJECT INDEX White Racial Identity Attitude Scale (WRAIS), 55 Wide Range Intelligence Test, 497, 555, 600–601 Williams v. State of California, 474 Wisconsin Card Sorting Test, 549 Women’s Equality in Access to Care and Treatment (WE-Actx), 206 Women’s Inter-Agency HIV Study (WIHS), 206 ˜ Language Survey, Woodcock-Munoz 479–480 Worcester, Massachusetts, 414 Work Profile Questionnaire: Emotional Intelligence, 498, 509

Work Progress Administrator, 426 World Federation for Mental Health, 198 World Health Organization, 198, 201, 202, 232, 299; Quality of Life-100, 309; Quality-of-Life Group (WHOQOL Group), 299, 309 World Health Report 2006–Working Together for Health (World Health Organization, 212 World Vision, 203 World War II, 405 Z Zung Self-Rating Scale, 610