1. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Providing care that is culturally appropriate © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca

2. 1.Why culturally appropriate care matters 2.How culture influences health care and health outcomes 3.Deciding on an interpreter, or translator 4.Taking a patient history: learning to be patient 5.An example from practice: injury prevention Today’s topics

3. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca It is critical to improving Health outcomes Patient safety Patient satisfaction Why culturally appropriate care matters 1

4. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca The terminology Cultural Competence: Skills you can learn that makes the care you provide more effective. Cultural safety: This is the result of effective learning on your part. It is how the patient benefits. Cultural Humility: Your ongoing commitment to self-evaluation and longer- term awareness of bias.

5. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Becoming culturally competent Cultural competence is a way for you to provide better patient care. It allows you to work effectively with Canada’s diverse populations.

6. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca What is LEARN? It’s a model for teaching professionals how to achieve cultural competence: Listen with sympathy and understanding to the patient’s perception of a problem. Explain your perceptions of a problem. Acknowledge and discuss differences and similarities. Recommend treatment. Negotiate agreement.

7. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Image source: Slide 6, Introduction to clinical cultural competence. Clinical Cultural Competency Series. Courtesy of the Centre for Innovation & Excellence in Child & Family Centred Care at SickKids Hospital. What is culture? It is more than you might assume it to be. Hidden and obvious elements of any culture How culture influences health care and health outcomes 2

8. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Culture affects how patients (and their families): View health and illness Understand the causes of health and illness Experience and describe pain Understand and comply with treatment options Interact with health care professionals Stigmatize certain physical or mental health issues © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Aspects of culture that affect health care

9. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Recognize that the health care system has a culture all its own. This culture is familiar to you, but foreign to patients. What can make a difference? Health care providers are more likely to have positive interactions with patients and provide better care if they understand what distinguishes their patients’ cultural values, beliefs and practices from their own.

10. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Make sure you understand how the patient understands what is happening. Recognize that families may use complementary and alternative therapies. Remind them that doing so can delay or interfere with testing or treatment plans. Tips to increase your effectiveness

11. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Take time to assess the patient’s support system, language skills, and stage of adaptation to Canada. Find out whether a patient or family would benefit from spoken or visual messages rather than printed health information. Two more tips

12. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca These are two different professions. An interpreter―sometimes called a cultural interpreter―is someone (or a group of people) who can be integrated into your institution’s systems. Interpreters do more than translate words. Some are former health professionals. A translator is often trained to work with written texts. Their focus may be limited to accurately rendering English or French to a mother tongue. Deciding on an interpreter or translator 3

13. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca An assessment of a patient’s needs begins before the first appointment. That’s why hospitals, medical practices, and community health centres need to build interpretation into their systems. Making an institutional commitment

14. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Miscommunication can increase the risk of medical errors, inappropriate treatments and emergency room visits. Cultural interpreters facilitate both verbal and nonverbal communication. As needed, they can mediate concepts and cultural practices unfamiliar to you―and to the patient. Why does interpretation matter?

15. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Why? 1.An accurate assessment of any newcomer child or youth requires complete communication without misunderstandings on either side. 2.It is a heavy burden to place on a child and may negatively impact family dynamics. Avoid using children and youth as interpreters

16. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Engage a trained interpreter for your newcomer patients whenever possible. Community cultural organizations may be able to provide trained and professional cultural interpreters. In Quebec, file a request through the patient’s centre de santé et des services sociaux (CSSS). Make it possible to commit to interpreters

17. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Having a culturally appropriate approach to this task is more important than developing a checklist! Taking a history: learning to be patient 4

18. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Points to consider Getting to know a new immigrant or refugee child involves a thorough history, physical examination and appropriate investigations. You need to be sensitive to and aware of cultural and language differences. You may need to involve a professional interpreter.

19. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Culturally appropriate care Look for chronic illnesses that may not have been adequately treated and diseases not usually seen in Canada. Be aware that immigrant and refugee children may present with different problems, both physical and psychosocial. It may take several appointments to complete the initial medical assessment. Three more points to consider

20. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Your demeanor Smile. Use a slow, gentle approach to the conversation. Set aside enough time for the interaction. Family dynamics You might expect to obtain most of a history from an older child or teen. However, certain cultures might prefer that you address questions to an elder person, even though that person may not always have the correct answers. Dynamics between you and the patient Although cultural factors may influence how people interact with health professionals, remember that each individual is unique. Families may not wish to “set an agenda” during this first interaction. You may need to take the lead. Skills to develop and include in history-taking

21. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Skills to develop and include in history-taking Immigration status Billing systems may require the patient to provide information on insurance or health care coverage. This will usually reveal their immigration status. Some patients do not wish to reveal their status to you. Cultural background and migration experience The patient’s life experience might include war, death, violence, torture, hunger or imprisonment. Such trauma may affect their health and whether they trust and respect authority figures. Even if you have some knowledge of problems in different parts of the world, do not generalize or make assumptions. Canada’s health care system Give an overview of how the Canadian health care system works. Explain where the family fits within this system. Determine what provincial/territorial or federal coverage for health care is available to them.

22. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca How does a cultural competency lens affect the way you communicate about a topic like injury prevention to newcomer patients? An example from practice: injury preventio n 5

23. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Poverty: Recent immigrants are more likely to be among the working poor than other Canadians. Poverty is a risk factor for preventable injuries to children in Canada. Unfamiliarity with Canadian climate: Spring run-off and unsafe ice conditions in winter are just two of many outdoor hazards. Lack of awareness: Safety norms may be different in their country of origin. Newcomers may not know about mandatory safety laws and their benefits (child car seats; flotation devices; bike helmets, etc). Understanding the unique risk factors

24. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Lack of family supports and social isolation may limit options for child care. Rental or shared housing can make it more difficult to make modifications or repairs for safety. The cost of equipment can be a barrier (e.g. safety gates, smoke alarms). Specific challenges for newcomers

25. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca Many newcomers prefer to receive prevention messages in their own language, in small groups. Find out whether community agencies offer this. Prenatal and community health classes often include injury prevention topics. Encourage parents to attend. Information for parents in multiple languages can be found online. Links are available at: www.kidsnewtocanada.ca. www.kidsnewtocanada.ca Adopting a wider, team approach

26. © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca THANK YOU! www.kidsnewtocanada.ca © 2014 Canadian Paediatric Society I www.kidsnewtocanada.ca