Cultural Competency in Health Cultural Competency in Health

About cultural competency What is it? Why do we need it? What does it do? Who is responsible?

“ Behaviours, attitudes and policies that enable systems, organisations, professions and individuals to work effectively in cross-cultural situations ” What is cultural competency?

 improves health and wellbeing by integrating culture into delivery of health services  focuses on capacity of health systems  more than awareness of difference  everyone’s responsibility - not “special interest” groups  it’s not new !!… good health policy & services meet consumers’ needs What is cultural competency?

 Everyone has a right to health care that meets their needs  Australia’s diversity is increasing  Health system not always responsive  Health inequalities experienced by many groups  Health services, managers and practitioners are accountable for meeting needs of all consumers  World-wide pressure to improve  Bangkok Charter 2005, WHO World Health Report 2006 Why do we need cultural competency in health?

 Improves equity & access for all groups  Good business practice  More effective service for health consumers and carers  Better use of health resources Benefits

 Acknowledges benefits of diversity  Achieves best, most appropriate care for each consumer  Ensures self-determination for consumers and communities  Holds governments, health organisations and managers accountable for meeting needs of the communities they serve A culturally competent health system

Governments – all levels Policy decision-makers – all agencies / all levels of government (not just health!) Managers – CEOs, finance, operational managers of health & related services Professions – professional bodies and their members Workers & practitioners – in health & related organisations Individuals – Everyone can learn and contribute Who’s responsible?

A guide to improving cultural competency New NHMRC guide Aim Target audience

— NHMRC Guide — Cultural competency in health: a guide for policy, partnerships and participation National focus Complements existing work Generic approach  Applies to wide range of groups – not specialised Provides model – 4 domains for action  systemic, organisational, professional & individual Focus on healthier living & environments, obesity & overweight Recognises gaps, identifies next steps Based on research, consultation & feedback Prepared by experts /researchers in public health

Aim of Guide Support development of health care services that meet needs of culturally & linguistically diverse communities High level policy & decision-makers Impact on-the-ground health services Anyone interested in health & related policy Target audience

Outcomes Stimulate broader discussion Ownership of issues Begin nationally supported, sustained change Provide ideas for next steps

Increasing cultural competency Principles Four Dimensional Model Developing Competency

 Adopt principles – that underpin cultural competency in health  Take action – on infrastructure & human resources that support cultural competency  Set standards – establish specific competencies at system, organisation, professional and individual level Systems, organisations, professions can

1.Engaging consumers & communities and sustaining reciprocal relationships 2.Leadership and accountability for sustained change 3.Building on strengths — know the community, know what works 4.A shared responsibility — creating partnerships and sustainability Principles for cultural competency

Principle 1 Engaging consumers & communities and sustaining reciprocal relationships  Promotion of healthier living and environments is a reciprocal relationship  CALD background communities and health services engage, learn & exchange at all stages of health care research, development and delivery

Leadership and accountability for sustained change  Begins at highest levels of systems, organisations and professions  Continues to individual development and practice Principle 2

Building on strengths — know the community, know what works  Population health approach  Use data, information on diverse communities  Acknowledge CALD experience – successful practice  Understand risk factors & protective behaviours Principle 3

A shared responsibility — creating partnerships and sustainability  Partnerships – between health and human services, education and research sectors  Find systematic and long-term approaches Principle 4

Four dimensions for action … The Model Source: Research and consultation report commissioned for NHMRC project

 Fosters culturally competent behaviour through:  Effective policies and procedures  Mechanisms for monitoring  Sufficient resources  Policies that support involvement of culturally diverse communities in health matters Action at Systemic Level

 Cultural competency is valued, integral to core business, supported and evaluated  Skills and resources to support diverse clients are in place  Management committed to diversity management  e.g. training for staff, cultural and linguistic diversity in staffing Action at Organisational Level

 Makes cultural competency important part of education & professional development  Professions develop cultural competence standards  Guidance provided for working lives of individuals Action at Professional Level

 Individuals develop optimum knowledge, attitudes, behaviours re cultural competence  Individual health professionals are supported to work with diverse communities  Individuals develop relevant, appropriate, sustainable health promotion programs Action at Individual Level

 Competency = knowledge, conviction, capacity for action  Systems, organisations, professional groups & individuals can develop cultural competencies in specific areas… Develop competencies

 Policy / Evaluation  e.g. a policy framework that directs & supports cultural competency across health system  Budgeting & resources  e.g. high priority areas are specifically budgeted for – staff training, interpreter & language skills  Consumer participation  e.g. reps of diverse communities are included at all stages of service development & delivery Specific competencies…

 Management  e.g. performance agreements hold managers accountable  Education/skills  e.g. professions consider cultural / linguistic diversity in communication & health practice  Self-reflection  e.g. individuals understand potential impact of cultural & linguistic diversity on clients, & adapt practice to meet cross-cultural requirements Specific competencies…

Competence = knowledge conviction capacity for action Individual applies knowledge, conviction, capacity for action to inform organisation, profession & system Organisation & profession support individual

Practical approaches Case study scenarios Next steps Resources, contacts & more info

Research shows poor nutrition and low fitness affect some CALD background groups more than others –How would cultural competency principles guide a media campaign to promote healthy eating and improve fitness? Case Study Scenario 1: Media campaign

–Use research identify issues & key groups –Partnerships work with relevant community leaders, share knowledge –Community engagement get communities involved – from planning onward use consumer advisory group, focus groups –Methodology select media outlets used by the CALD background group/s you want to reach –Evaluate before & after data to assess impact Culturally competent approaches …

A Muslim community leader notices low physical activity / reduced fitness among Muslim women in her local area –What culturally competent strategies would help find a solution? Case Study 2: Community group fitness

–Community involvement Muslim women initiate action, identify solutions –Reciprocity Culturally appropriate community consultation, informal discussion, discuss barriers within community & with local authorities –Sustainability Identify culturally appropriate solutions that have ongoing support, e.g. women-only exercise classes, appropriate venues Think about wider factors e.g. child care, transport etc. –Share success Evaluate & document outcomes, share learning with other cultural groups Culturally competent strategies ….

Suggestions for projects & action at all levels  Individual  Organisational  Professional  Systemic Next Steps

Access toolkits or other material to develop self-awareness & competencies Take part in cross-disciplinary forums to share information & skills, promote support & awareness Look for opportunities to introduce or improve cultural competence – discuss with colleagues Next steps for individuals

Participate in partnership forums with govts to apply the Model locally Budget strategies – mobilise resources, prioritise cultural competence Management competencies and performance measures HR strategies –recruitment, succession planning, education Context-specific competencies for your organisation, its community & health workers Next steps for organisations

Demonstrate leadership –raise profile of cultural competency, recommend strategies for professional practice Participate in partnership forums with govts / other agencies on applying the model Reflect principles of cultural competency in ethical & other professional conduct codes Develop policies and context-specific competencies for specific health professional group Promote information to members Next steps: professional groups

A specific resource for Aboriginal and Torres Strait Islander Peoples National collaboration on framework for culturally competent health practice Address gaps in research, information and evidence base Promote best practice diversity organisations Next steps across systems

 Institute for Health and Diversity  Cultural Competency for Healthy Living: a guide for policy, partnerships and participation  Multicultural Mental Health Australia  Centre for Culture, Ethnicity and Health How to find out more

Cultural Competency in Health Care…. Cultural Competency in Health Care…. Who’s responsible? Everybody