Cultural Assessment

Given the task of translating general knowledge about Asian cultures and the Asian American population, the clinician must conduct a cultural assessment of each client to determine how applicable the clinical guidelines about tradi tional Asian Americans (as often characterized in clinical guidelines) are to the particular Asian American client. Although demographic characteristics (such as generational status or length of residence in the United States) can often provide cues as to the prototypical cultural profile and behavioral tendencies of some Asian Americans, it is especially important not to assume cultural-psychological attributes of the Asian American client based on the demographics. For example, the general literature suggests that first-generation immigrant Asian Americans are more likely to adhere to traditional cultural practices, to be reluctant to seek professional mental health services, to terminate treatment prematurely, and to prefer a directive counseling style. However, such general guidelines may not apply well to a first-generation Chinese American immigrant who was born and raised in South America, or to a first-generation Vietnamese American immigrant youth who lives in a largely Hispanic neighborhood and identifies culturally with the Mexican American culture.

It must also be acknowledged that there is an inherent tension in structuring the initial session with an Asian American client. On one hand, a thorough assessment of the client as a "cultural being" is necessary for the clinician to determine how to proceed with further assessment and treatment with this particular client (Dana, 1993). On the other hand, if assessment without any intervention is all that is accomplished in the initial session, the clinician runs a risk of losing the client to premature termination due to lack of achieved credibility (S. Sue & Zane, 1987). In order to balance the need for cultural assessment with the recommendation to achieve credibility, the clinician must become practiced in conducting an expeditious assessment of the client's cultural orientation without resorting to stereotyping. One strategy for conducting an efficient cultural assessment in the initial session is to use a measure of acculturation and ethnic identity.

Why is acculturation such a central variable to assess? Acculturation of the Asian American client, or the extent to which he or she has been exposed to and gained skills for operating within various American cultural contexts, can indicate to the clinician how much cultural modification may be required in order to assess and treat this client. A clinician faced with an Asian American client is typically trained in the Western models of assessment and treatment, hence the clinician is well acculturated to the American and Western culture at least in the mental health system. Western thinking permeates the typical clinician's knowledge of what causes mental health problems and what heals such problems. On the other hand, the Asian American population varies greatly in their level of acculturation to the American culture and to the extent to which they share the Western-trained clinician's conceptualization of what causes mental health problems and what heals such problems. It is generally accepted that the more acculturated an Asian American client is to the American culture, the more appropriate the Western modes of assessment or treatment. For example, the MMPI-2 norms are more likely to be applicable for a fourth-generation Japanese American college graduate than to a recently immigrated Japanese elderly.

Unfortunately, the measurement of acculturation has been extensively contested in the fields of ethnic and cross-cultural psychology, and there is no one standard way to assess acculturation of an Asian American individual. Most researchers agree that acculturation is a multifaceted process that occurs when individuals from two or more cultures have continuous first-hand contact, resulting in changes in the original cultural patterns. However, a number of concerns have been raised regarding the conceptualization and psychometric properties of various written measures to measures this construct among Asian Americans (Nagata, 1994; Ponterotto, Baluch, & Carielli, 1998). For Asian Americans, a myriad of ethnic-specific acculturation and identity measures have been devised for various Asian American ethnic groups (Dana, 1993; Paniagua, 1994), but most such measures have yet to be subjected to wide use or extensive psychometric validation. The most widely accepted scale in Asian American mental health research is the Suinn-Lew Asian Self-Identity and Acculturation Scale (SL-ASIA; Suinn, Rickard-Figueroa, Lew, & Virgil, 1987), a pan-Asian measure of acculturation and identity. In its development, Suinn and his colleagues adopted the format of the original Acculturation Rating Scale for Mexican Americans (ARSMA; Cuellar, Harris, & Jasso, 1980) and included 21 multiple-choice items covering behavior, language, identity, friendship, generation and geographic history, and attitudes. A total score (the mean of the 21 items) is interpreted to indicate the respondent's level of acculturation, from low acculturation (high Asian identity) to high acculturation (high Western identity or assimilation).

A review of published studies that used SL-ASIA (Ponterotto et al., 1998) highlighted both strengths and shortcomings of this measure as a research instrument. Of note, the lack of conceptual clarity behind SL-ASIA was criticized surrounding the question of whether Asian American acculturation is best conceptualized as a unidimensional or multidimensional construct. The original SL-ASIA classified individuals on a unidimensional index from low to high acculturation, and those individuals scoring in the midrange were labeled as "bicultural." However, it is possible for an individual to identify highly with both the minority and the majority culture (Oetting & Beauvais, 1991). In response to these critiques, Suinn (1998) recently added five additional items to the SL-ASIA to allow for the assessment of acculturation as reflecting Asian and Western values, behavioral competency (i.e., how well one fits in with Asian or Western social contexts), and self-identity as a bicultural person.

Further, despite its limitations as a research tool, potential clinical utility of the SL-ASIA scale has been noted (Dana, 1993; Ponterotto, Baluch, & Carielli, 1998). In particular, Ponterotto and colleagues argued that some of the SL-ASIA items could easily be incorporated into a clinical interview that would assist the clinician in obtaining a quick and general sense of the client's acculturation level. Suinn (1998) himself provided sample scenarios of how the SL-ASIA score may be used in clinical settings to predict outcomes of therapy based on the therapist-client match in cultural orientation. For example, Suinn postulated that an Asian American client with strong Asian values and behavioral competencies in both Asian and Western social contexts may do fine with a non-Asian clinician who encourages self-disclosure, whereas another Asian American client with strong Asian values but behavioral competency only in Asian social contexts may not do as well with a non-Asian clinician who encourages self-disclosure.

In addition to the SL-ASIA, two promising measures of related cultural constructs have been developed recently, which provide additional options for clinicians to assess various aspects of an Asian American client's cultural and ethnic identification. Yamada, Marsella, and Yamada (1998) devised a measure of ethnocultural identity, which the researchers refer to as the behavioral component of ethnic identity (as opposed to the attitudinal and the value components of ethnic identity). The resulting Ethnocultural Identity Behavioral Index (EIBI) is a 19-item self-report measure applicable to any ethnic group. Initial psychometric study with Asian Americans and Pacific Islander Americans in Hawaii suggest that EIBI appears to be a reliable and valid measure for assessing the level of an individual's involvement with an ethnocultural group. In contrast to Yamada et al.'s attempts to develop a behavioral index, Tsai, Ying, and Lee (in press) sought to measure the subjective meanings attached to "being Chinese" and "being American" among a diverse group of Chinese Americans. The researchers developed the Chinese and the American versions of the General Ethnicity Questionnaire (GEQ) to test both the unidimensional and bidimensional models of acculturation. The GEQ samples multiple domains of cultural orientation including language use and proficiency, affiliation with specific ethnic persons (i.e., Chinese or American), participation in ethnic activities, attitudes toward the ethnic group, exposure to specific culture, and preference for ethnic food. The analyses of the responses of Chinese Americans on the GEQ measures found that "being Chinese" and "being American" were unrelated for American-born Chinese Americans but were negatively related for immigrant Chinese. The researchers explained that when immigrants first arrive in the United States, they consider themselves to be "Chinese" and not "American." However, as the immigrants gain more exposure to the American culture, the immigrants may begin to internalize an American identity while "being Chinese" increasingly becomes tied to limited specific contexts in which they have contacts with Chinese people, things, and events. These findings from the Tsai et al. (in press) study underscores the importance of assessing the subjective meanings attached to an individual's cultural identity.

The clinician may wish to administer any of the above-mentioned scales in a written format to the Asian American client prior to the first interview to obtain a rough estimate of the client's acculturation and self-identification, then follow up on some key items regarding cultural orientation and identity in the more thorough cultural assessment during the first session. In particular, the measures that sample multiple domains are particularly useful in identifying the acculturation profiles of the client in different life domains. The clinician should keep in mind that acculturation may not proceed at a uniform rate among the different domains even within an individual, much less among the family members. For example, a South Asian American individual who appears to be highly acculturated with respect to behavior (e.g., adoption of Western dress, manners, English fluency) may still substantially endorse traditional values and behavior within the family system (Prathikanti, 1997).

E. Lee (1982) advocates an approach to the assessment of Asian American families that involves gathering additional information beyond traditional intake data, and many of her suggestions can be also applied to individual cases. Importantly, Lee stresses the importance of gathering information not just about the client system and the family system but also the community system in which the Asian American individual or the family operate, such as formal and informal referral and support network, attitudes toward health and mental illness of community members, impact of immigration and refugee policies, and so on. Similarly, a model of parallel assessment for Asian American children and adolescents has been proposed by Huang (1997), in which the clinician is advised to carry out in parallel the standard assessment and the ethnocultural assessment. The standard assessment consists of evaluating the individual (e.g., appearance, speech, language, affect), family (e.g., composition, subsystems, hierarchy), school (e.g., demographics, philosophy about achievement, cohe-siveness), and peers (e.g., nature and degree of involvement, values congruence). The ethnocultural assessment gathers additional information about the individual (e.g., generational status, level of acculturation, ethnicity, and self-concept), family (e.g., migration history, level of acculturation, "generation gaps"), school (e.g., history with cultural differences, ethnic/racial composition), and peers (e.g., ethnicity and race, level of acculturation). Huang provides a detail recommendation for assessing each of these components. Another systematic approach to assessment was suggested by Shiang et al. (1998), who proposed a cultural modification of Beutler and Clarkin's (1990) systematic treatment selection (STS) model of client assessment and treatment planning. Within the STS framework, Shiang et al. suggest a way to make clinical practice decisions that are culturally informed (e.g., what should be the focus of the intervention?) In sum, there are a number of excellent recent innovations in conducting a cultural assessment of Asian American clients and families to assist the clinician in planning a culturally competent intervention.

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