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Cultural awareness training for health professionals is now commonplace across a variety of sectors. Its popularity has spawned several alternatives (i.e., cultural competence, cultural safety, cultural humility, cultural intelligence) and overlapping derivatives (diversity training, anti-racism training, micro-aggression training). The ever-increasing reach of cultural awareness initiatives in health settings has generally been well intentioned - to improve cross-cultural clinical encounters and patient outcomes with the broader expectation of reducing health disparities. Yet the capacity of cultural awareness training to accomplish or even impact such outcomes is seldom comprehensively scrutinized. In response, this paper applies a much needed critical lens to cultural awareness training and its derivatives by examining their underpinning philosophies, assumptions and most importantly, verification of their effectiveness. The paper finds cultural awareness approaches to be over-generalizing, simplistic and impractical. They may even induce unintended negative consequences. Decades of research point to their failure to realize meaningful outcomes in health care settings and beyond. Broader expectations of their capacity to reduce health disparities are almost certainly unachievable. Alternative suggestions for improving cross-cultural health care interactions and research are discussed within.

Background Cross-cultural educational initiatives for professionals are now commonplace across a variety of sectors including health care. A growing number of studies have attempted to explore the utility of such initiatives on workplace behaviors and client outcomes. Yet few studies have explored how professionals perceive cross-cultural educational models (e.g., cultural awareness, cultural competence) and the extent to which they (and their organizations) execute the principles in practice. In response, this study aimed to explore the general perspectives of health care professionals on culturally competent care, their experiences working with multi-cultural patients, their own levels of cultural competence and the extent to which they believe their workplaces address cross-cultural challenges. Methods The perspectives and experiences of a sample of 56 health care professionals across several health care systems from a Mid-Western state in the United States were sourced via a 19-item questionnaire. The questionnaire comprised both open-ended questions and multiple choice items. Percentages across participant responses were calculated for multiple choice items. A thematic analysis of open-ended responses was undertaken to identify dominant themes. Results Participants largely expressed confidence in their ability to meet the needs of multi-cultural clientele despite almost half the sample not having undergone formal cross-cultural training. The majority of the sample appeared to view cross-cultural education from a ‘cultural awareness’ perspective - effective cross-cultural care was often defined in terms of possessing useful cultural knowledge (e.g., norms and customs) and facilitating communication (the use of interpreters); in other words, from an immediate practical standpoint. The principles of systemic cross-cultural approaches (e.g., cultural competence, cultural safety) such as a recognition of racism, power imbalances, entrenched majority culture biases and the need for self-reflexivity (awareness of one’s own prejudices) were scarcely acknowledged by study participants. Conclusions Findings indicate a need for interventions that acknowledge the value of cultural awareness-based approaches, while also exploring the utility of more comprehensive cultural competence and safety approaches.

Background Possessing a strong cultural identity has been shown to protect against mental health symptoms and buffer distress prompted by discrimination. However, no research to date has explored the protective influences of cultural identity and cultural engagement on violent offending. This paper investigates the relationships between cultural identity/engagement and violent recidivism for a cohort of Australian Indigenous people in custody. Methods A total of 122 adults from 11 prisons in the state of Victoria completed a semi-structured interview comprising cultural identification and cultural engagement material in custody. All official police charges for violent offences were obtained for participants who were released from custody into the community over a period of 2 years. Results No meaningful relationship between cultural identity and violent recidivism was identified. However a significant association between cultural engagement and violent recidivism was obtained. Further analyses demonstrated that this relationship was significant only for participants with a strong Indigenous cultural identity. Participants with higher levels of cultural engagement took longer to violently re-offend although this association did not reach significance. Conclusions For Australian Indigenous people in custody, ‘cultural engagement’ was significantly associated with non-recidivism. The observed protective impact of cultural engagement is a novel finding in a correctional context. Whereas identity alone did not buffer recidivism directly, it may have had an indirect influence given its relationship with cultural engagement. The findings of the study emphasize the importance of culture for Indigenous people in custody and a greater need for correctional institutions to accommodate Indigenous cultural considerations.

Background Disparities across a number of health indicators between the general population and particular racial and cultural minority groups including African Americans, Native Americans and Latino/a Americans have been well documented. Some evidence suggests that particular groups may receive poorer standards of care due to biased beliefs or attitudes held by health professionals. Less research has been conducted in specifically non-urban areas with smaller minority populations. Methods This study explored the self-reported health care experiences for 117 racial and cultural minority Americans residing in a Mid-Western jurisdiction. Prior health care experiences (including perceived discrimination), attitudes towards cultural competence and satisfaction with health care interactions were ascertained and compared across for four sub-groups (African-American, Native American, Latino/a American, Asian American). A series of multiple regression models then explored relationships between a concert of independent variables (cultural strength, prior experiences of discrimination, education level) and health care service preferences and outcomes. Results Overall, racial/cultural minority groups (African Americans, Native Americans, Latino/a Americans, and Asian Americans) reported general satisfaction with current healthcare providers, low levels of both health care provider racism and poor treatment, high levels of cultural strength and good access to health care services. Native American participants however, reported more frequent episodes of poor treatment compared to other groups. Incidentally, poor treatment predicted lower levels of treatment satisfaction and racist experiences predicted being afraid of attending conventional health care services. Cultural strength predicted a preference for consulting a health care professional from the same cultural background. Conclusions This study provided a rare insight into minority health care expectations and experiences in a region with comparatively lower proportions of racial and cultural minorities. Additionally, the study explored the impact of cultural strength on health care interactions and outcomes. While the bulk of the sample reported satisfaction with treatment, the notable minority of participants reporting poor treatment is still of some concern. Cultural strength did not appear to impact health care behaviours although it predicted a desire for cultural matching. Implications for culturally competent health care provision are discussed within.

Background Approximately 1 in 5 to 1 in 6 Indigenous Australian males are currently imprisoned or have previously been imprisoned. Recent work has also pointed to a widening socio-economic gap within the Indigenous population. Given the myriad social, wellbeing and environmental risk factors associated with justice-involvement, it is conceivable that incarceration may contribute to the increasing disparities found within the Indigenous population. This study aimed to explore the presence and extent of an ‘incarceration gap’ within the Indigenous population and to uncover which social factors characterise the disparity. Methods The study utilised data from the 2014–5 National Aboriginal and Torres Strait Islander Social Survey (NATSISS). A number of socio-economic, environmental and clinical factors were compared by life-time incarceration status. Chi-square tests were used to examine the association between incarceration status and each of the comparison variables. Results Disparities were observed within the Indigenous Australian population across a number of important health and socio-economic markers by incarceration status - the most pronounced being for educational obtainment – year 10 completion (Never incarcerated 73%, Ever incarcerated 50%), labour force participation (Never incarcerated 56%, Ever incarcerated 26%) and drug/alcohol problems (Never incarcerated 7%, Ever incarcerated 29%). Never-incarcerated Indigenous males yielded aggregate proportions across numerous variables that approximated or matched general Australian population estimates. Conclusions There appears to be evidence for a substantial ‘incarceration gap’ within the Indigenous Australian population.

Background High rates of suicidal behaviours among Indigenous Australians have been documented. Justice-involved individuals are also at a higher risk for engaging in suicidal behaviours. This study sought to ascertain the prevalence and correlates of suicidal behaviours for 107 Indigenous adult males in custody in Victoria, Australia. Methods Participants undertook a structured interview comprising a psychiatric assessment. Information on suicidal behaviours (ideation and attempts), socio-demographics, environmental stressors, negative life events and mental health was obtained. Results A high proportion of Indigenous males in custody experienced lifetime suicidal ideation (63.7%) and over one-half had attempted suicide (54.5%). A smaller, yet significant number of participants experienced ideation over the past 12 months (27.9%). Having a loved one pass away within the past 12 months predicted recent ideation; lifetime ideation and a diagnosis of Post-Traumatic Stress Disorder predicted a lifetime suicide attempt. Conclusions The prevalence of suicidal behaviours among Indigenous people in custody is remarkably high. Correlates of suicidal behaviours for Indigenous people in custody in this study likely manifest in the community, denoting an urgent public health response. Prevention must begin in communities at-risk for suicidal behaviours. The development of low intensity mental health service infrastructure in communities to promote awareness and provide accessible, least restrictive support and treatment is necessary. Correctional institutions must also continue to improve custodial suicide prevention and management initiatives.

International research suggests that migrants face additional challenges that may heighten their risk of experiencing family violence (FV). South Asians are one of Australia’s fastest growing immigrant populations—yet relatively little is known about their experiences of FV. This study sought to address this research gap by ascertaining what could be gleaned about FV experiences of Australian South Asians the Australian Bureau of Statistic’s 2016 Personal Safety Survey (PSS). While prior versions of the PSS have been deemed non-representative of minority cultural groups, it remains the largest FV victimisation dataset in Australia, and undoubtedly would include information about South Asian Australians. Specifically this study examined the lifetime prevalence and 10-year incidence of most recent FV among South Asian-born (SAB) immigrants and compared these figures to Australian-born (AB) individuals. SAB Australians included in the PSS reported lower lifetime prevalence of intimate partner violence (IPV) and a lower 10-year incidence of at least one type of FV (IPV and/or non-partner FV) than AB Australians. The sampling approach of the PSS was shown to have substantial methodological limitations that reduced the utility of these findings. Specifically, the sampling of South Asian immigrants in Australia was not demographically representative nor was the sample size sufficient for meaningful analysis. The implications of these limitations and recommendations to address them in future population-level FV surveys are explored.

Purpose – The psychopathy checklist: youth version (PCL: YV) checklist is an assessment of youth psychopathic traits and is regularly validated by way of its associations with re-offending and violence. Yet existing research has been conducted with predominantly white Caucasian cohorts and extant evidence suggests that associations with recidivism are stronger in samples with greater proportions of white offenders. The paper aims to discuss these issues. Design/methodology/approach – This study investigated the cross-cultural validity of the PCL: YV for an ethnically diverse Australian sample of 175 young male offenders in custody. Participants were assessed in custody with the PCL: YV and offending data were collected post-release for up to 18 months. Findings – PCL: YV total and domain scores were comparable across ethnicity; however the instrument demonstrated stronger relationships with recidivism for Australian participants with an English speaking background compared to Indigenous and culturally and linguistically diverse participants. Practical implications – The authors advocate the cautionary employment of the PCL: YV as a violence risk prediction instrument with minority young offenders regionally, pending further evidence. Originality/value – This study addresses the capacity of the PCL: YV to predict violence across different ethnic groups. Cross-cultural youth psychopathy research is currently inadequate and existing studies suggest that the PCL: YV is a weaker predictor of violence in culturally diverse samples. This investigation provides much needed information on the capacity of the PCL: YV to extend to different ethnic groups who are represented Australia’s youth prison population. This is the first study of its kind regionally, and more importantly is the first PCL: YV study with an Indigenous Australian comparison group. This is particularly important given that Indigenous Australians are heavily overrepresented in Australia’s criminal justice system and require appropriate risk assessment measures to ensure they are not misclassified. Research such as this is now of particular interest given the recent judicial decision made in Ewert vs Canada.

Purpose – The purpose of this paper is to explore the relationship between psychopathic features as measured with the Psychopathy Checklist: Youth Version (PCL:YV) and behavioural and emotional functioning in young female offenders in custody. Design/methodology/approach – This is a quantitative interview study investigating the relationship with psychopathic traits, measured with the PCL:YV (Forth et al., 2003), and different psychological characteristics as well as AD/HD, self-harm, and childhood trauma in adolescent offenders across genders. Data were collected from a sample of 40 female and 40 male adolescents who were incarcerated in Victoria, Australia. Findings – Results indicated that the behavioural subscales of the PCL:YV were associated with externalising behaviours possibly underpinned by histories of abuse and substantiated child protection incidences. The presence of AD/HD was strongly associated with affective deficits suggesting that the PCL:YV may be identifying young females with AD/HD rather than core psychopathic traits. Findings also indicate that female-specific manifestations of manipulation are likely being misidentified as behavioural phenomena precluding clinical recognition as a core interpersonal trait. Significant dissimilarities with a young male comparison group were identified and are discussed within. Research limitations/implications – The sample size is very small and the results should be seen as an indication rather than generalising. Originality/value – Studies on female juvenile offenders is rare and this study adds to the literature on the construct of psychopathy and its relationship to psychosocial factors as well as associations with AD/HD, self-harm, and childhood trauma, among incarcerated adolescents.

Background The over-representation of Indigenous Australians in custody is well documented, yet little is known about whether the health and social needs of Indigenous prisoners are met in correctional facilities. This study sought to identify common areas of need in a representative sample of Indigenous people in custody, and consider how well prison services were addressing these issues. Methods The sample comprised 122 Aboriginal and Torres Strait Islander people in custody in Victoria. Participants were administered the Camberwell Assessment of Need Forensic-Short Version to ascertain the presence or absence of needs in custody. Statistical analyses to determine associations with re-offence were conducted. Results Findings indicated that prisons were able to meet the non-criminogenic needs of many offenders; however there was a limited capacity to address specific criminogenic needs. Psychological distress, substance abuse, poor treatment adherence and threatening behaviours were considered ongoing needs regardless of supports/interventions being provided. Moreover, these four unaddressed needs were all associated with future recidivism. Conclusions Effective prison treatment services focusing on these four areas of need are urgently required. Such initiatives require continuation post-release combined with additional assistance to uphold basic non-criminogenic needs acquired in prison.