Table 2 Considerations for test interpretation in an Indigenous context

1.

Detailed History

• Info from others

Have I talked to family, teachers, or others to find out about behaviour at home?

 ○ Self care

 ○ Social interaction or romantic relationships

 ○ Memory, bizarre behaviour, any violation of cultural norms

 ○ Activities of daily living

 ○ Comparison to peers re language development & abilities

 ○ Money management, knowledge of pension etc

• Medical History

 Have I got a medical history from doctors, the client, family or medical files?

 ○ Hearing and vision

 ○ Medication use

 ○ Previous head injury or other mental health or neurological condition

• Info from client

 Have I got a social history from the client?

 ○ Biographical information, family structure (e.g. genogram)

 ○ Any personal or parental substance use (alcohol, tobacco, cannabis, petrol)

 ○ Social circumstances, are their basic needs met (e.g. food, shelter, power, meds)?

 ○ Schooling, work, jobs, or meaningful occupation

 ○ Relationships/family functioning

 ○ Legal issues

2.

Testing Process

Were there any factors influencing the assessment process and what was the impact?

• Context – could anything about the setting have impacted the results?

 ○ Background noise, interruptions, clinician/client gender difference, away from homelands, chaotic setting, pain, discomfort, hunger, family worries, house worries, health worries?

• Motivation – Were they motivated to do well? Do they distrust mainstream systems?

• Engagement – Were they engaged in the process? Was the relationship affable & appropriate?

• Tiredness/alertness – Did they sleep last night? Do they have a place to sleep?

• Intoxication/medications? – Are they taking any drugs and/or do they need medications?

• Perceptual issues – Hearing/vision. Do they need a hearing aid or glasses? Was there background noise/distractions?

• Understanding – Did they understand what you asked them to do?

• Language – Do they need an interpreter? Is the interpreter an appropriate person/relationship?

• Item format – Timed?, question/answer?, pencil/paper?

3.

Test Results

What is the pattern of scores?

 • Where are the discrepancies and is it what I would expect based on my hypotheses about the source of impairment?

4.

Triangulating

Is there concordance between scores, clinical impression, daily functioning and other information?

  • If not, why not? Did the factors above impact?

5.

Implications

All things considered, is this a reliable assessment?

 • If not, do I need more information and can I get it?

 • Is further assessment required?

 • What can I responsibly do with/say about the results?

 • How will this impact their everyday functioning?