Cafe Scientifique: Cultural Competency and Safety

National Aboriginal Health Organization

Cultural Competency and Safety

Simon Brascoupé Senior Adviser, Aboriginal Relations and Initiatives Unit


Read online: “Cultural Safety: Exploring the Applicability of the Concept of Cultural Safety to Aboriginal Health and Community Wellness” http://www.naho.ca/jah/english/jah05_02/V5_I2_Cultural_01.pdf


Cultural Safety Overview

• Social Determinants

• Colonization

• Cultural Competency

• Cultural Safety

• Healing & Wellness

• Benefits


“Poorer people live shorter lives and are more often ill than the rich. This disparity has drawn attention to the remarkable sensitivity of health to the social environment.”

(WHO 2003)


Key Development Indicators

• Harvard University Project:– Sovereignty Matters

– Institutions Matter

– Leadership Matters

– Culture Matters


Four Major Challenges


ColonizationDiseases (such as influenza, small pox, measles, polio, diphtheria,

tuberculosis and later, diabetes, heart disease and cancer); The destruction of traditional economies through the expropriation of

traditional lands and resources; The undermining of traditional identity, spirituality, language and

culture through missionization, residential schools and government day schools;

The destruction of indigenous forms of governance, community organization and community cohesion through the imposition of European governmental forms; and

The breakdown of healthy patterns of individual, family and community life.

Mapping the Healing Journey 2002


Underlying Causes


Cultural Competency• There has been growing interest in the delivery of culturally competent care and training. • Cultural competency is the delivery of respectful and responsive services that meet needs of

patients as a strategy to reduce disparities, provide quality care and improve health outcomes. • Cultural competent training is on a continuum; from cultural awareness, to cross-cultural to

cultural competency. • Cultural competence organizations have a set of values and principles, and demonstrate

behaviours, attitudes, policies, and structures that enable them to work effectively and efficiently cross-culturally.

• The benefits of culturally competent organizations are improved: workforce retention, patient satisfaction and compliance and communications.

• A recent study on the growing number of cultural competent health organizations concluded that "cultural competence seems to be evolving from a marginal to a mainstream health care policy issue and as a potential strategy to improve quality and address disparities."


Cultural Competency

A set of congruent behaviours, attitudes and policies that enables human service organizations to work effectively with various racial, ethnic, religious and linguistic groups

University of Calgary, Cultural Diversity Institute, 2000


Cultural Competence ContinuumNational Center for Cultural Competence 1989.


Employee Benefits• Higher levels of personal job satisfaction• Reduced conflicts with colleagues• Reduced complaints by service users• Improved outcomes for service users• Improved compliance with instructions• Improved communication with people that reduces

stress/anxiety• Decrease in repeat visits/phone calls

Community Action Forum 2008


Client Benefits• Individual needs are met• Easier to develop trust and share information• Less anxiety• Better outcomes (learning, health, etc.)• High levels of satisfaction with service• Increased compliance



Employer Benefits

• Retention of employees• Reduction in re-training costs• Increased productivity• Reduced complaints, grievances, legislative issues (Human

Rights)• Increased opportunities for funding/fundraising opportunities• Increased opportunities for volunteers



The Continuum• Cultural awareness becomes central when we have to interact with people from

other cultures. – People see, interpret and evaluate things in a different ways. – What is considered an appropriate behaviour in one culture is frequently inappropriate in another one. – Misunderstandings arise when I use my meanings to make sense of your reality.

Source: Stephanie Quappe and Giovanna Cantatore 2005

• Cross-cultural training is training for cross-cultural communication and experiences.

– Preparing people to work in a cross-cultural environment, for example, Peace Corps volunteers complete cross-cultural training which include:

– History and culture

– Norms and values

– Communication Source: Peace Corps


Cultural competent organizations• Have a defined set of values and principles, and demonstrate behaviors,

attitudes, policies, and structures that enable them to work effective cross-culturally.

• Have the capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge, and (5) adapt to diversity and the cultural contexts of communities they serve.

• Incorporate the above in all aspects of policy-making, administration, practice and service delivery, systematically involve consumers, families and communities.

Source: National Center for Cultural Competence


Cultural Safety• Is a concept first developed in New Zealand to

provide quality care within the cultural values and norms of the Maori.

• The concept is spreading to other fields of human services, like education and healing.

• Spread to other areas of the globe, particularly with Indigenous Peoples in former European colonies.


Continuum


Cultural Safe Care & Outcomes

• To provide quality care within the cultural values and norms of the patient.

• Culturally unsafe practice as “any actions that diminish, demean or disempower the cultural identity and well being of an individual.”

• OUTCOMES• Improved collaboration and partnership• Improved health


Culturally Unsafe Care (NAHO 2008)


Cultural SafetyBuild trusting foundation with clientsClients rights clearly stated; code of ethics, etc Safe therapeutic process: plan for healing journeyCreate comfortable place and safe atmosphereReinforce safety: assistance throughout healing

journeyAboriginal Healing Foundation


Healing Path


Aboriginal Healing Movement

In the past twenty-five years in Canada, a wide variety of experiences, programs and activities have been part of what may be described as the "Aboriginal healing movement". These have included:

Participation in traditional healing and cultural activities; Culturally based wilderness camps and programs; Treatment and healing programs; Counselling and group work; and Community development initiatives.


What is healing?


Healing Lessons Learned

Healing is possible for individuals and communities. Both appear to go through distinct stages of a healing journey.

The healing journey is a long-term process, probably involving several decades. Healing cannot be confined to issues such as addictions, abuse or violence. Healing interventions and programs have most impact when they take place within

the context of a wider community development plan. Community healing requires personal, cultural, economic, political, and social

development initiatives woven together into a coherent, long-term, coordinated strategy.

Such a coherent strategy requires integrated program development, funding delivery and on-going evaluation.

Healing is directly connected to nation building. At some point, there needs to be a merger of program efforts between community healing activities and movements towards self-government and community development.


Cultural SafetyFramework


Cultural Safety Path

Cultural safety is an important first step in building trust

Cultural safety, like cultural competency can be taught.

Trust is critical to development because of the mistrust and historical trauma caused

by colonization.

Taken from a policy perspective, whole organisations have become culturally safe

through strategic planning and training.

The literature provides evidence that cultural competence and safety result in

improved health outcomes.

A culturally safe delivery system can strengthen the capacity of the communities to

be resilient to the stressors that push them from risk to crisis.


Cultural Safety: 5 Principles (Ball 2007)


Culturally Competent Organizations

Set of values, principles & structures to work cross-culturally. Work in the cultural contexts of communities they serve.Work part of policy-making, administration, practice and service

deliverySystematically involve clients, families and communitiesCultural competence is a long-term developmental processBoth individuals and organizations are at various levels of

awareness, knowledge and skills along the cultural competence continuum.

The National Center for Cultural Competence


Benefits

Why Culturally Competent Health Care?Improve quality of services and outcomesRespond to Aboriginal needsMeet accreditation requirements Reduce liability and malpracticeSupport workforce diversity initiativesImprove retention of health human resourcesAchieve social justice


Miigwetch, Nia:wen, Thank You!

Health & Medicine

Cafe Scientifique: Cultural Competency and Safety