Cultural competence is a broad concept with multiple theoretical underpinnings and conflicting opinions on how it should be materialized. While it is recognized that cultural competence should be an integral part of General Practice, literature in the context of General Practice is limited. The aim of this article is to provide a comprehensive summary of the current literature with respect to the following: the elements of cultural competency that need to be fostered and developed in GPs and GP registrars; how is cultural competence being developed in General Practice currently; and who facilitates the development of cultural competence in General Practice. We conducted an integrative review comprising a systematic literature search followed by a synthesis of the results using a narrative synthesis technique. Fifty articles were included in the final analysis. Cultural competence was conceptualized as requiring elements of knowledge, awareness/attitudes and skills/behaviours by most articles. The ways in which elements of cultural competence were developed in General Practice appeared to be highly varied and rigorous evaluation was generally lacking, particularly with respect to improvement in patient outcomes. Formal cultural competence training in General Practice appeared to be underdeveloped despite GP registrars generally desiring more training. The development of most aspects of cultural competence relied on informal learning and in-practice exposure but this required proper guidance and facilitation by supervisors and educators. Levels of critical and cultural self-reflection amongst General Practitioners and GP registrars varied and were potentially underdeveloped. Most standalone training workshops were led by trained medical educators however the value of cultural mentors was recognised by patients, educators and GP registrars across many studies. Cultural competency development of GP registrars should receive more focus, particularly training in non-conscious bias, anti-racism training and critical self-reflectiveness. There is a need for further exploration of how cultural competence training is delivered within the GP training model, including clarifying the supervisor’s role. It is hoped this discussion will inform future research and training practices in order to achieve quality and respectful care to patients across cultures, and to remove health inequities that exist between cultural groups.

https://link.springer.com/content/pdf/10.1186%2Fs12875-016-0560-6.pdf

Developing cultural competence in general practitioners: an integrative review of the literature

The American Association of Suicidology

Adolescent body dissatisfaction and disordered eating: Predictors of later risky health behaviours

Between 1% and 3% of persons in general population are estimated to have some degree of intellectual disability. A diagnosis of intellectual disability is based on clinical history, level of intellectual ability and level of adaptive function. Both, the intellectual and adaptive functioning are measured using individually administered standardized tests. More than 75% of persons who have intellectual disability have mild intellectual disability and an underlying specific etiology is less likely to be identified; whereas, in a small percentage of persons with severe intellectual disability, an underlying specific biologic cause is highly likely to be identified. Genetic abnormalities, inborn errors of metabolism and brain malformations are major categories of causes identified in severe to profound intellectual disability. The initial clinical presentation and recognition depends on the severity and underlying cause of intellectual disability. The etiology, severity, cognitive abilities, and adaptive function, vary among persons with intellectual disability and need consideration in developing a treatment plan. The physician plays an essential role in the evaluation, treatment of associated medical conditions and preventive care, and in facilitating and coordinating consultative services and community based care.

A clinical primer on intellectual disability

Self-cutting as a form of self-harm is a common and multifaceted phenomenon among adolescents. The aim of this study was to investigate whether the location of self-cutting (arms or other areas of the body) could help to assess the severity of the underlying psychiatric problems. A sample of adolescents who reported self-cutting (n = 440) was drawn from a large sample of community adolescents (n = 4,019). The majority of self-cutting adolescents, 296 (67.2%), reported cutting only the upper arms, while 144 (32.8%) also cut other parts of the body. The data included a structured self-rating questionnaire, questions about self-cutting, the Youth Self-Report (YSR) for adolescents aged 11-18 years, the Beck Depression Inventory, the Toronto Alexithymia Scale and the Adolescent Dissociative Experience Scale (A-DES). The results indicate that self-cutting on other parts of body than the arms was associated with female gender, a wide range of emotional and dissociative symptoms and suicidal ideation. In logistic regression analysis, the most pronounced association between self-cutting on other places than the arms was found with YSR subscales withdrawn/depressed, social problems and thought problems, and dissociation (A-DES). We conclude that self-cutting adolescents, mostly girls, with wounds elsewhere than on the arms present with the most serious psychiatric symptoms. It is important to perform a careful physical examination when an adolescent has unexplained wounds or scars on the arms or on other parts of the body. These adolescents also need a caring and conscientious psychiatric examination and possible psychiatric treatment.

Adolescent self-cutting elsewhere than on the arms reveals more serious psychiatric symptoms

Intellectual disability is clinically recognized in childhood and adolescence by deficits in cognitive and adaptive abilities. The prevalence of intellectual disability is 1% in the general population. While most individuals have mild intellectual disability, 6 per 1,000 individuals have severe intellectual disability. In persons with mild intellectual disability a specific underlying etiology is generally not recognized; whereas, a specific genetic or biologic etiology is more likely to be recognized in persons who have severe intellectual disability. The diagnosis of intellectual disability requires clinical evaluation and judgment as well as a formal testing of the cognitive and adaptive functions. Such formal testing is done by individually administered standardized tests. The treatment of persons with intellectual disability at an individual level depends on the identified underlying cause, if any, and appropriate support to allow optimal functioning and independent living. Persons who have severe intellectual disability require life-long intensive supports. In addition to general medical care, persons who have intellectual disability also need interventions in the educational settings, provision of educational remediation and accommodations, and appropriate level of community based support. The management, quality of life and longevity vary depending up on the severity of intellectual disability and adequacy of community based support systems.

Intellectual disability: definitions, evaluation and principles of treatment

Deliberate self-harm (DSH) is a common though often hidden condition in children and adolescents that may result in suicide. This discussion covers several aspects of DSH including its prevalence, etiology, and management. The relationships of DSH to body dissatisfaction and suicide are specifically considered. Even though most cases of DSH do not end in overt suicide, DSH reflects that potential underlying psychological pathophysiology, and likelihood of eventual death from self-murder, cannot always be predicted or prevented. It is important to take all acts of DSH as serious, and to offer comprehensive management to prevent future acts of DSH and potential suicide.

/pdf/the-relationship-between-deliberate-self-harm-behavior-body-27ogxt97wf.pdf

The relationship between deliberate self-harm behavior, body dissatisfaction, and suicide in adolescents: current concepts.

There have been significant changes in the way Autism has been defined especially in the last decade. The changes encompass criteria over a spectrum rather than individual diagnoses based on clusters of criteria. With these changes, there has been a push for earlier screening and diagnosis to be made to ensure individual impacted by the deficits have ample time and opportunity to receive the services they need. Additionally, with the changes that have come up, screening tools and assessments have also been changed and improved to assist with the increasing demand of early screening. Screeners have been created to help in primary care settings so physicians can gauge the severity of symptoms and refer patients to the appropriate resources. The assessment and diagnostic process for Autism involves a large battery including parental interviews and forms, the ADOS-II, and a multitude of other intellectual assessments to get a full picture of what the individual is experiencing. Once an individual is diagnosed with Autism, the interventionist team, physicians, and clinicians assist the family in finding the appropriate resources and treatment plan. There are several evidence-based therapies that exist that have been effective in improving the quality of life of individuals with Autism Spectrum Disorder diagnoses. Although several interventions and therapies exist, there are some potential interventions some use that need to more research to know how truly effective they are.

Autism spectrum disorder: psychological and functional assessment, and behavioral treatment approaches

The increasing number of culturally diverse patients in primary care and the demands to provide culturally sensitive health care make it essential that physicians provide care that is responsive to a culturally diverse population. Physicians must use cross-cultural techniques in their assessment and management practices. The cross-culturally competent physician has the potential to increase his or her ability to provide effective and culturally responsive treatment to a wider spectrum of patients, resulting in more positive treatment outcomes.

Cross-Cultural Assessment and Management in Primary Care

Increased visibility of adverse encounters between individuals with autism spectrum disorder (ASD) and law enforcement (LE) has stimulated a dialog among providers. There are a variety of contributing factors to the increase, including the recognized lack of training of LE professionals on the needs of individuals with ASD and the paucity of awareness of resources by the families of these individuals. The aim of this article is to provide insight into developmental-behavioral pediatric professionals, to enhance safety and reduce adverse outcomes for individuals with ASD in schools and the community.

Roger W Apple

Papers

Intellectual disability: definitions, evaluation and principles of treatment

The relationship between deliberate self-harm behavior, body dissatisfaction, and suicide in adolescents: current concepts.

Autism spectrum disorder: psychological and functional assessment, and behavioral treatment approaches

Cross-Cultural Assessment and Management in Primary Care

Collaborating with Families and Law Enforcement Agencies to Improve Outcomes for Individuals with Autism Spectrum Disorder.