1. GPV is a QIC accredited organisation Division CQI & Accreditation Network CALD CULTURAL SAFETY Thursday 19 November 2009 Annette Dupont CALD Immunisation Consultant a.dupont@gpv.org.au (03) 9341 5240

2. 2 Cultural Identity Languages spoken Beliefs and practices Social relations Traditions related to ethnic background

3. 3 Facts and Figures Approx. 25% of Victorians are overseas-born Victorians come from around 250 countries 1 in 5 speak a language other than English Around 200,000 have limited English skills

4. 4 Refugees in the East Greater Dandenong (63%) Casey (17%) (July-Sept 2009 - IHSS 12/10/09)

5. 5 Refugees in the West Hume (37%) Brimbank (21%) Wyndham (19%) (July-Sept 2009 - IHSS 12/10/09)

6. 6 What has ethnicity got to do with health? Some recent findings: Gestational diabetes - Vietnamese-Australian women as a group are at greatest risk of misunderstanding GD according to a multi-ethnic study (Carolan et al, 2009) Obesity – Obesity is more common among immigrant male children where English is not spoken in the home (Renzaho et al, 2009) Vitamin D deficiency – veiled, dark-skinned women are at greater risk e.g. Middle Easterners are at 4-fold risk compared to other Australians (Brock et al, 2004)

7. 7 Immigrant patient needs may include: The need to communicate through a professional interpreter The need to have family involved and present in consultations or treatments The need to encounter health providers from similar cultural or language backgrounds

8. 8 Culturally competent organisations Adapt programs, policies and services to meet the needs and expectations of local culturally and linguistically diverse (CALD) communities Provide and support health services which are: oresponsive oinclusive orespectful oflexible and osensitive

9. 9 Six Guiding Principles of Cultural Competency Seek and maintain ongoing commitment from senior management Work towards the progressive integration of cultural competency principles into all Division systems, quality indicators and processes Provide relevant ongoing staff training and support - and ensure that cultural competency indicators are a part of all programs Include community representation and consultation in program planning, development, monitoring and evaluation Aim for manageability and sustainability Frame within a well-defined economic model Adapted from Veljanovski & Rodriguez (2009)

10. 10 A culturally competent Division … Adapts services and service environments to meet and reflect a diversity of identified cultural needs Promotes practices to provide quality patient care to consumers with limited English e.g. interpreter use Plans and evaluates programs with the involvement of CALD consumers and community groups Fosters relationships with and accesses resources and training from multicultural and refugee agencies

11. 11 A culturally competent Division … Supports learning activities for GPs and nurses caring for asylum seekers, refugees and migrants Profiles diversity in locally available international medical graduates and promotes bicultural workers Disseminates information about cultural values and/or health beliefs and identified gaps in knowledge Establishes linkages between rural health services and metropolitan immigrant specialist services

12. 12 A culturally competent Division … Views cultural competency practices as integral to core business rather than as a specialist area Routinely monitors and evaluates programs to assess responsiveness to the needs of local CALD community Provides or facilitates ongoing training and education on health and diversity to Divisions and clinical staff Promotes interpreter use, the use of community language resources and active consumer engagement

13. 13 A culturally competent Division … Employs CALD program officers, bilingual staff and peer educations to work with local communities Attempts to ensure program and provider workforce reflects the cultural diversity of the catchment area Moves away from “quick fix” approaches Allocates adequate time and resources to develop sustained change Adapted from Cultural Competency in Health (2006)

14. 14 Getting Started National Health and Medical Research Council (2006) Cultural competency in health: A guide for policy, partnerships and participation © Australia 2006. http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/hp19.pdf http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/hp19.pdf A practical guide to CALD consumer participation http://www.ceh.org.au/resources/publications.aspx CALD consumer participation strategies matrix http://www.ceh.org.au/resources/publications.aspx Cultural competencies for health promotion initiatives http://www.ceh.org.au/resources/publications.aspx Lee et al (2009) One service, many voices: enhancing consumer participation in a primary health service for multicultural women. Quality in Primary Care, 17:63-69 Campinha-Bacote, J. (2002) The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13;3:181- 184 Seeleman et al (2009) Cultural competence: A conceptual framework for teaching and learning. Medical Education, 43:229-237 Williams, R. (2009) Working effectively in a culturally diverse setting: A resource kit for Division Program Officers and Practice Nurses. General Practice Victoria, Cultural Safety Workshop. Veljanovski, S. & Rodriguez, P. (2009) Cultural competency for managers and supervisors. Workshop, 20 May, Centre for Ethnicity and Health, Carlton.

15. 15 Selected agencies and clinics Victorian Foundation for Survivors of Torture (Foundation House) Centre for Ethnicity and Health Multicultural Centre for Women's Health Dandenong Community Health Centre North Richmond Community Health Centre Adult Immigrant Clinic at Royal Melbourne Hospital Child Immigrant Clinic at Royal Children’s Hospital Refugee Health Clinic at Dandenong Hospital Asylum Seeker GP Clinic

16. 16 CALD Resources for Practices Refugee health guidelines Desktop guide to refugee health for GPs Refugee health assessment template Refugee vaccine order form Community language immunisation fact sheets Community language resources on hepatitis Centre for Ethnicity and Health – training; resources; multicultural health service etc.

17. 17 Foundation House – Desktop Guide

18. 18 GPV Refugee Health Assessment Template (a helpful picture)

19. 19 Refugee Health and Immunisation Guidelines

20. 20

21. 21 DHS “In your language”

22. 22 Community Language Glossary ( Blood Borne Viruses and Sexually Transmitted Infections)

23. 23 Multicultural Health and Support Service (Centre for Ethnicity and Health)

24. 24 Cultural Competency Workshops