TEMAS (Tell-Me-A-Story) Assessment in Multicultural Societies

Giuseppe Costantino, Richard H. Dana, Robert G. Malgady

• Publisher: Routledge
• Year: 2020
• Print ISBN: 9780805844511
• eBook ISBN: 9781000149517
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Ethnic minority children now comprise over 75 percent of students in 100 of the largest cities in the United States. However, these students have not been given equal access to, nor benefited from, the contemporary mental health system as have their non-minority peers. TEMAS (Tell-Me-A-Story) Assessment in Multicultural Societies examines the health/mental care system in which professional service providers, including psychologists, labor to offer quality care for youth in the United States. The authors ardently support the use of the TEMAS assessment instrument as a useful tool for diagnosis of all youngsters, particularly its use on the growing population of minority children and adolescents.

Part I presents a rationale and context for employing TEMAS. Introductory chapters describe the mental health status of the population at-risk, as well as systems of care for youth where assessment and intervention are components. Topics to follow highlight a history of positive TEMAS test reviews with the detail required by instructors for preparing dedicated TEMAS courses. The volume thoroughly outlines cross-cultural studies and illustrates case examples of European-American, Hispanic/Latino, Asian-American, and forensic studies.

TEMAS (Tell-Me-A-Story) Assessment in Multicultural Societies brings practical insight to instructors who teach standard assessment courses; clinicians, counselors, and school psychologists; assessment specialists; and administrators concerned with mental health services designed for children and adolescents.

I

INTRODUCTION

Part I consists of four chapters designed to provide a context for TEMAS.

Chapter 1 describes the contemporary mental health system for children and adolescents in the United States. For at least 50 years, the seriousness and range of child/adolescent mental health problems has gradually increased and now merits national concern. Definitive, consistent, and consensual definitions of psychological distress have been lacking for this population and contribute to confusion and inefficiency in accessing relevant and helpful services. Responsive, adequate, quality care is infrequent, particularly for services of documented utility using research-driven, improved technologies that satisfy consumers. As difficult as these circumstances have been for mainstream, middle-class, Caucasian children/adolescents, ethnic minority children and those from poverty-ridden families have suffered more and received even less relevant and satisfactory services. Mental health resource allocation commensurate with the numbers of these children and families has not occurred. Managed care has been generally less responsible in the public sector due to health care policy subordinating mental health, medical model service priorities, minimization of individual and cultural differences, and restrictive cost-effective standards for care.

In providing this context for TEMAS, chapter 1 examines the existing child/adolescent systems of care and offers a research-driven, outcome-oriented, cost-effective model of public sector care-the Multicultural Assessment-Intervention Process model (MAIP). The MAIP model for quality care responds to the burgeoning multicultural child/adolescent population by embedding culturally competent assessment and intervention services at the client-consumer, agency, and community levels. This model is consistent with the California statewide public sector cultural competency initiative and a recovery-oriented vision for quality mental health care. This recovery vision emphasizes strengths and a positive psychology of human functioning within a developmental science framework. TEMAS figures conspicuously in the MAIP model as a comprehensive assessment instrument applicable for entire child/adolescent populations and necessary for a responsible intake process within managed-care time constraints. TEMAS meets some of the most salient youth assessment needs by providing medical model diagnostic input-but also develops comprehensive, culturally relevant information concerning personality resources consistent with a recoveryorientation.

Chapter 2 examines the cultural competency concept within the health/mental health professions. Beginning with the Child and Adolescent Service System Program (CASSP) minority cultural initiatives in the late 1980s, minority cultural initiatives have been present with varying degrees of advocacy, acceptance, and centrality in all of these professions. These initiatives are all relevant and necessary for the development of an inter-disciplinary cultural competency model described in this chapter. This model is identified by attributes, construct dimensions, training modalities, and outcome characteristics of professional mental health service providers. This competency model can reaffirm, extend, and improve the quality of assessment training, practice, and research. TEMAS provides continuity for picture-story performance methods by attending to historical TAT deficiencies as a test and has reestablished and legitimized the TAT legacy for comprehensive narrative assessment of children/adolescents. TEMAS has a unique and essential role in the development of multicultural assessment competency in the United States and internationally.

Chapter 3 describes a gradual change from a method-centered, positivist-empiricist science toward a human-centered science of psychological assessment. This enlarged perspective permits an overview of current assessment training limitations partially responsible for the diminishing role of comprehensive assessment with performance measures. The availability of TEMAS to provide consistent, reliable, and useful personality-psychopathology information lies at the heart of a reconstituted assessment process for all children and adolescents. TEMAS, as a major storytelling test, contributes to a renaissance of comprehensive assessment signaled by the development of psychometrically respectable performance measures. TEMAS is also consistent with therapeutic assessment within a judgment-based practice of care.

Chapter 3 reviews similar and dissimilar picture-story instruments. Except for TEMAS, picture-story instruments have been unsystematically and partially adapted for multicultural children/adolescents rather than by deliberate construction for these populations. Adaptations have included the nature of stimuli, administration directions, service delivery social etiquette, and moderator variables, as well as special norms and interpretation guidelines. Although these instrument adaptations serve to reduce bias, there has been controversy concerning their legitimacy. This controversy was due to the false assumption that these instruments were universal in nature and required only translation for multicultural/cross cultural use. A rationale for application of adapted storytelling instruments for multicultural populations included specific comparative criteria, or desiderata. Comparing the adequacy of adapted storytelling instruments on these criteria for multicultural applications strongly favors TEMAS.

Chapter 4 presents a history of TEMAS origins and development that is descriptive, detailed, and comprehensive. This chapter chronicles TAT origins with improvements including research-derived card adaptations, an objective scoring system, low and high inference interpretation, and culture-specific as well as international child/adolescent normative data.

In contrast to the TAT, TEMAS uses card stimuli representing age, gender, and specific minority and nonminority versions delineating physical appearance in culturally relevant and familiar backgrounds. These card sets have been employed with several multicultural populations in the United States (i.e., Hispanics, African Americans, and Asian Americans) and an increasing number of different foreign countries. Designed to depict conflict situations amenable to problem solving in urban settings, cards of medium ambiguity and definite structure were printed in color to stimulate affect. These adaptations were designed to maximize card pull. Long and short parallel forms of 9 and 23 cards, respectively, present identical themes. Separate cards in each form were developed to depict a single gender and both genders as well as age-specific settings. Multicultural characters are presented in both the minority and nonminority versions.

A scoring system rationale incorporated social, cognitive, and narrative theoretical models. TEMAS stories are reliably scored for18 cognitive functions, 9 personality functions, and 7 affective dimensions. These scores provide information concerning personality strengths and deficits, and adaptive and maladaptive personality development, and they facilitate measurement and interpretation of psychopathology and personality within sociocultural systems.

1

Child/Adolescent Mental Health Needs and Services

A series of nationally disseminated reports from 1969 to 2003 indicated consensus concerning the magnitude of child adolescent mental health problems and the insufficiency of available mental health resources. However, these reports embodied goals of contemporary quality mental health care for eliminating barriers to access, endorsing increased consumer-family responsibilities, screening, comprehensive assessment, and prevention within research-driven services and improved technologies for service delivery and evaluation. A recovery-oriented vision within a developmental science framework affirms that recovery from severe mental illnesses can and does occur. Implementation of this vision now requires reintegration of comprehensive assessment within a multicultural competency model for delivery of quality care for children and adolescents.

Comprehensive assessment using standard tests and methods has largely been omitted in managed care in favor of simpler, routine diagnoses of mental health disorders as preferred avenues for decisions relevant to subsequent services. This omission exacerbates the currently incomplete relationship between problem specification and problem alleviation, particularly for ethnic minorities. Standard tests and methods as well as new instruments are now required for assessment of these populations. Multicultural assessment is now essential for evaluating the adequacy of mental health care as well as for implementing a positive mental health psychology.

The continuing necessity for comprehensive assessment during a transformation of the mental health system must also affirm that assessment/diagnosis and intervention/treatment components are coequal, interdependent, and necessary components of quality care. There is a crucial role for multicultural assessment, particularly for the Tell-Me A-Story Test (TEMAS), in concert with the Multicultural Assessment Intervention Process model (MAIP) to foster effective services and service delivery embracing the full range of child adolescent consumers. TEMAS and the MAIP model are complementary avenues for implementing a positive, strength-based recovery vision.

This chapter examines the mental health needs and services context for TEMAS and describes agency-driven MAIP model components of access/intake (including screening and comprehensive assessment), multicultural competency training, formulations and conceptualizations for diagnosis and treatment planning, treatments/interventions, and outcome evaluations within a research aegis.

MENTAL HEALTH STATUS: A POPULATION AT-RISK

Adults face increasingly high stress from multiple stressors in managing the social and economic aspects of their lives, and family discord is rampant. Caring for children is often compromised and diluted by fewer two-parent homes and absence of support from intact, ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication Page
• Contents
• Foreword
• Preface
• Acknowledgments
• Part I Introductory Considerations
• Part II Essentials of Temas Assessment
• Part III Clinical Utility of Temas: Case Studies
• Author Index
• Subject Index