Adapting services to the needs of children and families with complex migration experiences: The Toulouse University Hospital's intercultural consultation.

This article presents the recently created intercultural consultation at the Medical and Psychological Health Care Service (CMP) of the University Hospital la Grave at Toulouse. The approach of the intercultural consultation was elaborated in response to the increasing diversity of children and families using the service in Toulouse. It is also based on local research that indicates the difficulties service providers encounter when trying to establish a solid therapeutic alliance with families with complex migration backgrounds who accumulate different disadvantaging factors. The intercultural consultation adapts existing models of culture-sensitive consultations in child mental health care in France and Canada to the local context in Toulouse. We describe the underlying principles of the intercultural consultation work, the therapeutic and mediation techniques used, and the way the work is integrated into the global service provision of the CMP. The process is illustrated with a case study followed by a discussion of the innovations.

[Healthcare models for traumatized refugees in Germany]. / Versorgungsmodelle für traumatisierte Flüchtlinge in Deutschland.

People with a migration background are a risk group for psychiatric disorders. Innovative, transnational and sustainable projects are necessary to ensure adequate care for refugees and asylum seekers. Selected projects of the University of Munich, the Charité Berlin and the University of Konstanz show promising approaches in addition to other initiatives.

Lifetime prevalence of mental disorders among first and second generation individuals with Turkish migration backgrounds in Germany.

BACKGROUND: This paper focuses on the lifetime prevalence of mental disorders in individuals with Turkish migration backgrounds in Germany, as there is a lack of reliable epidemiological data on this subject. METHODS: In total, 662 adults with Turkish migration backgrounds were interviewed in Hamburg and Berlin by trained, bilingual interviewers using the computerized Composite International Diagnostic Interview (CIDI DIA-X Version 2.8) to assess diagnoses according to the DSM-IVTR. RESULTS: The analyses showed a weighted lifetime prevalence of 78.8% for any mental disorder, 21.6% for more than one and 7.3% for five or more disorders. Any mood disorder (41.9%), any anxiety disorder (35.7%) and any somatoform disorder/syndrome (33.7%) had the highest prevalences. Despite the sociodemographic differences between the first and second generations, there were no significant differences in the lifetime prevalence between generations, with the exception of any bipolar disorder. Female gender, older age and no current partnership were significantly associated with the occurrence of any mood disorder. CONCLUSIONS: Overall, the results indicate a high lifetime prevalence in individuals with Turkish migration backgrounds in Germany. These initial data are highly relevant to the German clinical and psychosocial healthcare system; however, the methodological limitations and potential biases should be considered when interpreting the results.

An Intervention Supporting the Mental Health of Children with a Refugee Background.

This contribution proposes an intervention methodology that provides improved access to and effectiveness of mental health care facilities in Brussels, Belgium, for children and their families with a refugee and migration background. Migration is a complex process that involves several potential risk factors, and referral to mental health facilities is often ineffective. Consequently, optimal developmental opportunities for refugee children are hampered. The intervention is underpinned by a broad-based contextual perspective that seeks to bring to the surface and tackles the many challenges faced by these families. It takes into account the unique developmental context of refugee children, as well as the interplay with broader systems.

Is the general self-efficacy scale a reliable measure to be used in cross-cultural studies? Results from Brazil, Germany and Colombia

This study evaluated cross-cultural measurement invariance for the General Self-efficacy Scale (GSES) in a large Brazilian (N = 2.394) and representative German (N = 2.046) and Colombian (N = 1.500) samples. Initially, multipleindicators multiple-causes (MIMIC) analyses showed that sex and age were biasing items responses on the total sample (2 and 10 items, respectively). After controlling for these two covariates, a multigroup confirmatory factor analysis (MGCFA) was employed. Configural invariance was attested. However, metric invariance was not supported for five items, in a total of 10, and scalar invariance was not supported for all items. We also evaluated the differences between the latent scores estimated by two models: MIMIC and MGCFA unconstraining the non-equivalent parameters across countries. The average difference was equal to (.07) on the estimation of the latent scores, and 22.8% of the scores were biased in at least .10 standardized points. Bias effects were above the mean for the German group, which the average difference was equal to (.09), and 33.7% of the scores were biased in at least .10. In synthesis, the GSES did not provide evidence of measurement invariance to be employed in this cross-cultural study. More than that, our results showed that even when controlling for sex and age effects, the absence of control on items parameters in the MGCFA analyses across countries would implicate in bias of the latent scores estimation, with a higher effect for the German population (AU)

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Cultural psychiatry in Tel Aviv: how relevant!

The First Mediterranean Conference on Cultural Psychiatry took place in Tel Aviv, Israel. This conference was a great success. With about 200 participants, mostly from Israel but with also 46 participants coming from 13 other countries: Mediterranean countries, Europe, North America and Australia. It contained three intensive days of plenary lectures and symposia, and a very impressive film, "Waltz with Bashir". The proceedings included 88 lectures, and there were 8 posters, which meant that nearly half of the attending persons were giving a lecture, as is always the case in real scientific conferences. Four parallel programs were running at the same time, which made it very difficult to choose which to attend. Inevitably, this report reflects only a part of the conference.

Enhancing cultural responsiveness: the development of a pilot transcultural secondary consultation program.

OBJECTIVE: This paper describes the development of a pilot secondary consultation program by a state-wide transcultural psychiatry unit, Victorian Transcultural Mental Health (VTMH), in partnership with a rural mental health service, Goulburn Valley Area Mental Health Service (GVAMHS), and the responses of the clinicians who participated. METHOD: A series of eight consultations were facilitated by the VTMH in 2010 and attended by a total of 57 GVAMHS clinicians; five sessions were conducted face-to-face and three by videoconference. Facilitators recorded the details of discussions at each session. Participants and facilitators offered feedback that was analysed to improve the quality of cultural responsiveness at GVAMHS. RESULTS: Participants from a range of disciplines provided consistently positive feedback. The sessions provided an effective forum for discussing cultural formulations and culturally sensitive approaches to working with individuals and their families. CONCLUSIONS: This pilot secondary consultation program provided clinicians in a rural area with a forum in which to reflect on cross-cultural mental health issues. This pilot has informed the development of subsequent VTMH cultural consultation services.

Indigenizing mental health services: New Zealand experience.

Mental health services in New Zealand have been significantly altered by Maori cultural values. Since 1980, a monocultural approach has given way to the incorporation of Maori language, Maori health perspectives, and Maori psychological frameworks in the assessment, treatment, and care of patients. Maori provider organizations, an expanded Maori health workforce, and Maori leadership have been crucial catalysts for the transformation. The shifts have paralleled similar changes in other sectors, reflecting a broader societal movement within which indigeneity has received greater acknowledgement. The author's bicultural background, psychiatric training, and inclusion in Maori networks were important for promoting the transformation.

A transdisciplinary, transcultural model for health care.

For the past 28 years, members of the Transcultural Nursing Society have been pioneers in generating knowledge about transcultural health issues, and this important body of knowledge will continue to increase and influence nursing research and practice worldwide. Yet at the same time, worldwide changes, demographic disparities, and new discoveries necessitate transitioning what has been a nursing discipline approach to that of a more inclusive transdisciplinary alliance. This alliance will build on pioneering strengths but also link with other disciplines such as anthropology, genetics, epidemiology, law, economics, and health policy to build cutting-edge research and theory for transcultural health care. A transdisciplinary, transcultural model for health care is presented for discussion, debate, and input. Suggestions are made for how such a model might be implemented through a changed curriculum using on-line education including consultation, teaching, and research.

Understanding culture and ethnicity: basic rudiments of an "anthropsychological" perspective for understanding human behavior.

While there appears to be general consensus in the behavioral sciences as to the importance of culture and ethnicity in shaping behavior, the discipline of psychology, a major producer of psychotherapists, is often resistant to the study of the basic concepts; seeing it as the domain of other disciplines. Thus, psychologically trained practitioners may not have rudimentary understanding of these concept; while endorsing and even trying to incorporate ethnically and culturally sensitive practices and techniques. This paper provides a basic reformulation of culture and ethnicity and presents the novel concept of an "anthropsychological" model for understanding individual behavior while being sensitive to ethnicity and culture.