1. CALD Resources CALD Resources Culturally and Linguistically Diverse Supporting our workforce in responding to cultural diversity for NGO, primary and secondary care health practitioners

2. CALD Cross Cultural Training Programme for Health Professionals Culture and Cultural Competency CALD 1Culture 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 7Working with Religious Diversity CALD 8 Working with CALD Families – Disability Awareness www.caldresources.org.nz(CME/CNE/MOPS Accredited)

3. The HPCA Act cultural competenceResponsible authorities also perform other functions. These include: setting standards of clinical competence, cultural competence and ethical conduct to be observed by health practitioners; (HPCA Act 2003 118i) cultural preferencesActively explores the client’s cultural preferences, health behaviours and attitudes regarding care and incorporates information into management plan. (Nursing Council, KPI - Nurse Practitioner) cultural competenceThe Midwifery Council has integrated cultural competence into its competencies for entry to the register of midwives. (Midwifery Council NZ)

4. History Religion Politics Rules Laws Geographic location Song/Dance Food Health beliefs Appearance Dress Values Beliefs Ethics Education Communication Language Festivals Traditions Customs What is Culture? Physical contact Expression of emotion Beliefs Norms Relationships Family structure Rituals Wordiness Behaviour Folk theories

6. 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

8. 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

9. 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

10. 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%)

11. Our Changing Workforce

12. 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 challenge o Your concerns with dealing with this challenge.

13. Challenges Across Cultures How did your challenge appear in this video? What would you advise this Doctor to do differently?

14. 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)

15. 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

16. Awareness: Dimensions of Culture Individualism - Collectivism Power distance Uncertainty avoidance Femininity - Masculinity (Hofstede, 1980)

17. New Zealand Cultural Values

18. The Migrant Journey

19. Impact on Health

20. 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

21. Treatment Examples Rest Herbal treatments Meditation Acupuncture Scraping – Guasha Cupping Humoral

22. 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?

23. Skills One (c)

24. Accommodating Health Beliefs It 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

25. 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?

26. 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.

27. 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.

28. 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.

29. 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.

30. CALD Courses and Resources Please go to www.caldresources.org.nz to find out more about:www.caldresources.org.nz 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)