1. Linguistically and Culturally Responsive Care Elizabeth Stanger Regional Coordinator, Language Services, Cross Cultural Health & Diversity

2. Outline Demographic information 3 dimensions of service provision Accessibility Responsiveness Comprehensiveness Enablers, Challenges & Opportunities

3. BC Immigration Trends 1991-2001 BC received 425,000 immigrants Most immigrants settle within VCH region 9/10 come to Vancouver

4. Top Immigrant Source Countries 62% of immigrants come from: –China –Hong Kong –Taiwan –India –Philippines

5. Top Immigrant Languages Cantonese Mandarin Punjabi Vietnamese Russian Spanish Farsi (Persian) Japanese Korean

6. BC Refugee Trends Government-Assisted Refugees 03-05 1,580 in total –Age 19-64 - 950 –Age 0-18 - 625

7. BC Refugee Trends Top source areas –African (Sudan, Somalia, Congo, Eritrea, Ethiopia) –Middle East Top source countries –Afghanistan (23%) –Sudan (18%) –Iran (13%) –Colombia (9%) –Indonesia (7%)

8. BC Refugee Trends Do not speak English upon arrival Top languages –Middle Eastern (Dari, Pushto, Farsi, Arabic) –African (Acholi, Lotuho, Lopit, Lokoya, Kiswahili, Oromo, Amharic) –Spanish –Vietnamese (not their first language) –Indonesian (Banda Aceh)

9. BC Refugee Trends All begin their health care at Bridge Clinic Complex medical conditions Complex social and mental health needs

10. Health Status & Immigrant status VCH is the wealthiest health region But the greatest proportion of both the rich and the poor –Immigrants/refugees earn less than Canadian-born –more immigrants/refugees than Canadian born live in poverty and are among the working poor

11. Health Status & Immigrant status VCH is the healthiest region in BC Healthy immigrant effect –But immigrants health status declines the longer they live in Canada –Refugee health status – complex health and mental health issues

12. 3 Dimensions to culturally/linguistically responsive service provision Accessibility Responsiveness Comprehensiveness

13. Accessibility Language Literacy Other access barriers

14. Language Statistics 187 languages spoken in Vancouver 50,000 do not speak English or French 135,000 speak a language other than English at home Over 50% of children speak a language other than English at home 1 in 5 face a potential language barrier

15. Literacy –English and mother tongue Health literacy –Knowledge of western allopathic tradition Health service literacy –Knowledge and expectations of the health system

16. Language Access Programs Interpreter Services Translated Health Education Materials Quality standards for interpretation (1996) Translation guidelines (1998)

17. Interpreter Services Current Projects –Community Mental Health Interpreter Services (pilot) –Translation of child immunization histories –Refugee Interpreter Training/Support Project (in process)

18. Translated Patient Education Materials Over 300 translated materials New regional database for access by patient or provider http://vch.eduhealth.ca

19. Responsiveness Cultural and linguistic competence –between patient and provider –in the program –in the organization

20. Models of Program/ Service Responsiveness Ethno-specific program/service Bridging program/services Multiculturalizing a mainstream program/service * A combination of these approaches is needed

21. Ethno-specific Healthiest Babies Possible –Vietnamese, Spanish, Aboriginal Diabetes education sessions –Cantonese, Mandarin and Farsi (Persian) Adult Day Centres –Chown, Chieng and LChaim Language designated positions –Chinese, Punjabi and Spanish community health nurses

22. Bridging Cross Cultural Health Brokers –Palliative, perinatal and mental health Settlement Health Worker Bridge Clinic

23. Multiculturalizing Cross Cultural Mental Health Community engagement consultations –Hip Fracture Project –Palliative Care Re-design –Mental health services re-design

24. Comprehensiveness meeting the full spectrum of a communitys health needs –what is currently missing? –emerging needs?

25. Some efforts underway….. Substance use and mental health –for Punjabi-speaking community Ethnic minority seniors –Geriatric mental health

26. Your comments? Your questions?