CALD ResourcesCALD ResourcesCulturally and Linguistically Diverse

Supporting our workforce in responding to cultural diversity

for NGO, primary and secondary care health practitioners

CALD Cross Cultural Training CALD Cross Cultural Training Programme for Health ProfessionalsProgramme for Health ProfessionalsCALD 1 Culture and Cultural CompetencyCulture and Cultural Competency

CALD 2 Working with Migrant (Asian) Patients

CALD 3 Working with Refugee Patients

CALD 4 Working with Interpreters

CALD 5 Specialist Training: Working with Asian MH Clients

CALD 6 Specialist Training: Working with Refugee MH Clients

CALD 7 Working with Religious Diversity

CALD 8 Working with CALD Families – Disability Awarenesswww.caldresources.org.nz (CME/CNE/MOPS Accredited)

The HPCA ActThe HPCA Act• Responsible authorities also perform other functions. These

include: setting standards of clinical competence, cultural cultural competence competence and ethical conduct to be observed by health practitioners; (HPCA Act 2003 118i)

• Actively explores the client’s cultural preferencescultural preferences, health behaviours and attitudes regarding care and incorporates information into management plan. (Nursing Council, KPI - Nurse Practitioner)

• The Midwifery Council has integrated cultural competence cultural competence into its competencies for entry to the register of midwives. (Midwifery Council NZ)

History

Religion

Politics Rules Laws

Geographic locationSong/Dance FoodHealth beliefs

Appearance

Dress

Values Beliefs Ethics

EducationCommunication Language

Festivals

Traditions

Customs

What is Culture?

Physical contact

Expression of emotion

Beliefs

Norms

Relationships

Family structure

Rituals

Wordiness

Behaviour

Folk theories

How Culture Impacts Interaction

• Different health expectations, knowledge, experiences and communication styles

• Practitioners can misinterpret cross-cultural situations if they use their own beliefs and norms

• Inexperienced practitioners may prejudge CALD individuals which may lead practitioners to insult a person’s language, beliefs, habits or behaviours

Our Changing World of Practice • 233 ethnic groups in the Auckland region

• 1 in 5 people in Auckland from an Asian ethnic group

• A third of Asian migrants in NZ < 5 years

• Increasing in religious diversity: Sikh, Hindu, Muslim and Buddhist groups (SNZ, 2009)

• Growth in Middle Eastern, Latin American, African (MELAA) populations

• In 2006, all three MELAA ethnicities have approximately 80% of their populations born overseas

Super Diversity in Auckland (SNZ, 2006)

• Seven largest Asian ethnic groups:

• Chinese (147,570) Indian (104,583)

• Korean (30,792) Filipino (16,938)

• Japanese (11,910) Sri Lankan (8,310)

• Cambodian (6,918)

• Other groups include: Thai, Laotian, Vietnamese, Burmese, Bhutanese, Nepalese, Tibetan and Indonesian

• People born in India doubled 2001 - 2006.

• People born in Korea and Fiji increased significantly

Middle Eastern, Latin American, African (MELAA) (SNZ, 2006)

MELAA national total o National total: 35,250 people (1%)o Auckland region: 18,284 people (54% of total

MELAA nationally)

• ADHB: 6867 (36%)• WDHB: 6714 (36%)• CMDHB: 5313 (28%)

Our Changing Workforce

Challenges Across Cultures

What are the challenge/s you face when interacting with someone from a different culture?

•Choose one challenge and move into that group. Spend a few minutes discussing:

o A situation that involves this challengeo Your concerns with dealing with this challenge.

Challenges Across Cultures

How did your challenge appear in this video?What would you advise this Doctor to do differently?

Cultural Competency

“Cultural competence is a set of behaviours and attitudes and a culture within the operation of a system that respects and takes into account the person’s cultural background, cultural beliefs and their values, and incorporates it into the way healthcare is delivered to that individual”

Betancourt Green and Carillo (2002)

What is Cultural Competency?• Awareness – requires awareness of own

values and how these impact on beliefs and interactions

• Sensitivity – includes flexibility, non-judgement, enquiring attitude

• Knowledge – requires knowledge of own and other’s culture

• Skills – the ability to implement the above in practice, with empathy and compassion

Awareness: Dimensions of Culture

Individualism - Collectivism

Power distance

Uncertainty avoidance

Femininity - Masculinity

(Hofstede, 1980)

New Zealand Cultural Values

The Migrant Journey

Impact on Health

Migrant Health Beliefs

Accommodating Health Beliefs

• Accommodating is the willingness to consider the patient's health beliefs and practices and include them in the intervention.

Explanatory Models of Health

• Scientific• Supernatural

• Humoral• Religious

Treatment Examples

• Rest• Herbal treatments• Meditation• Acupuncture• Scraping – Guasha• Cupping

Humoral

Religious Influences in Practice• Dietary requirements• Dress & Physical touch • Gender Issues• Hygiene requirements• Prayer, ritual and

religious festivals• Traditional and

alternative remedies

• Acceptance of procedures, including bloods, drugs and organ transplant

• Reproductive Health

• Pregnancy and birth

• Informed consent

• End of life care

What would you need to know about each of the above?

Skills One (c)

Accommodating Health BeliefsIt is important to:

•Ask (tell me how...)

•Look for connections that help the patient work with you and their own system to ensure the best health outcomes for the patient

•Accommodating migrant beliefs ensures a better health outcome

Working with an Interpreter

You are in control. This course will help you understand how to gain and maintain control of a session when working with interpreters.

The interpreter does not have control because their role is to act as a conduit between the patient and the practitioner.

The patient does not have control because they are dependant on the interpreter to interpret correctly.

Who has control in the session?

Pre-brief• A brief introduction of your role and service.

• Provide brief objectives and outline the purpose of the session.

• Obtain cultural background information

• Confirm the use of the first person throughout the session.

• Establish the mode of interpreting - consecutive or simultaneous.

Structuring a Session

• Greet and direct the patient where to sit.

• Introduce yourself and explain roles.

• Introduce the interpreter and her/his role.

• Assure the patient of confidentiality.

• Inform the patient that everything will be interpreted.

• Familiarise the patient with the mode of interpreting.

Session Ground Rules

• Do not enter into direct conversation with the interpreter.

• Do not ask the interpreter for their opinion.

• Pause at regular intervals for the interpreter to assimilate and interpret.

• Allow interpreter to interpret after every 3-5 sentences.

• Allow enough time for the interpreter to convey information.

De-brief• Summarise the session outcome and identify any

issues meeting the session objectives.

• Clarify interpreting or cultural issues if:o you have concerns or are unsure about contradictory,

negative (non-verbal or verbal), unexpected responses, or lack of response, from the patient.

o you felt that at some point that the translation of information did not correspond with the responses from the patients.

o if you wish to clarify any cultural meanings of some of the words, concepts or responses.

CALD Courses and ResourcesPlease go to www.caldresources.org.nz to find out more about:

a) CALD courses that are available within your DHB for ongoing learning (CME/CNE/MOPS Accredited)

b) CALD resources that are available for ongoing support when working with CALD clients including:o Interpreting and Translation Service

o Culture-Specific Services

o Translated Resources

o Cross-Cultural Resources (to gain more knowledge of other cultures)