Clinical Assessment and Engagement

Assessment of people with substance use problems is heavily dependent on the clinician’s ability to establish effective communication and rapport across varying language and cultural systems. For CALD people who speak limited English and for clinicians seeking to engage with them, issues of language and culture may be a significant barrier to assessment and treatment. Teach-back or other appropriate techniques can be used to assess the need for language support.

Chapter	Recommendation	Grade of recommendation
16.2	For CALD people, document language spoken at home and where parents/ancestors are from. Enquire about the importance of a patient’s cultural identity to them, without making assumptions. This approach is sometimes referred to as cultural humility.	D

A number of studies indicate CALD patients prefer bicultural and bilingual counselling, where available. Matching patient and therapist culturally in assessment and treatment may also create better outcomes. However, preferences for same-language clinician or interpreter options should be discussed with patients. At times patients may have concerns about confidentiality or experience embarrassment if a clinician is from the same cultural community, which may make open communication more difficult. The same issue may arise regarding interpreters, particularly where there is a relatively small community from a language group.