Mind the Gap! Developing Skills to Navigate Cultural ... · 1. Discuss why culturally appropriate...

Fireside Chat #411

September 24, 2014 1:00 – 2:00 PM Eastern Time

Mind the Gap! Developing Skills to Navigate Cultural Issues with

Newcomers Children, Youth and Families Attention à la différence!

L’acquisition des habiletés nécessaires pour explorer les problèmes culturels avec des enfants, des adolescents et

des famille néo-canadiens

www.chnet-works.ca

Population Health Improvement Research Network

Canadian Health Human Resources Network University of Ottawa

Dr Dzung X. Vo Clinical Assistant Professor University of British Columbia

Dr Maureen Mayhew Clinical Associate Professor University of British Columbia

Step #1: Teleconference All Audio by telephone • If your line is ‘bad’ – hang up and call back in • Participant lines muted • Recording announcement

Step #2: The Internet Conference (via ‘ADOBE CONNECT’)

No audio via internet 1. SEE the PowerPoint being shown 2. Post your comments/questions 3. Join the interactive poll

Difficulties? You can still participate! Use the back up PowerPoint – download from www.chnet-works.ca Post your comments via email

For assistance: animateur@chnet-works.ca

How to post comments/questions during the Fireside Chat

Joining in by telephone +

Adobe Connect Internet Conference

Use the text box!

Joining by

telephone + backup PowerPoint

By email: Respond to the ‘access instructions’ email

animateur@chnet-works.ca

Please introduce yourself!

• Name

• Organization

• Location

• Group in attendance?

Mind the Gap! Developing Skills to

Navigate Cultural Issues

with Newcomer Children,

Youth & Families

CHNET-WORKS! Webinar

September 24, 2014

Maureen Mayhew,

MD, MPH Clinical Associate Professor

Dzung X. Vo, MD Clinical Assistant Professor

1. Pediatrician

2. Family physician

3. Other type of physician

4. Nurse practitioner

5. Nurse

6. Other healthcare worker

7. Administrator

8. Policy-maker

9. Other

How would you describe yourself?

1. Discuss why culturally appropriate care matters

2. Explain how culture influences health

care/outcomes and how you might address this

3. Describe the role of Acculturation and Identity

Development on health

4. Develop culturally appropriate skills in taking a

patient history

Learning Objectives

Why culturally appropriate

care matters

Health Outcomes

Patient Satisfaction

Patient Safety

Culturally Appropriate Care improves

Dealing with what is… 8

Terminology

Cultural Competence: Skills you can learn that

enable you provide more effective care

Cultural safety: The result of effective learning on

your part - how the patient benefits.

Cultural Humility: Your ongoing commitment to

self-evaluation and longer-term awareness of bias

…….patient-centred care

Webster’s dictionary

Culture

• the beliefs, customs, arts, etc., of a particular

society, group, place, or time

• a way of thinking, behaving, or working that exists

in a place or organization (such as a business)

How culture influences health

care and health outcomes

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.

Visible & invisible elements of culture 11

Aspects of culture that affect health care

View health/illness

Experience pain

Comply w treatment

Interact w HCW

Stigmatize disease

12 y.o. Sudanese girl accompanied by parents.

What would you address this visit?

• First visit

• Quiet & withdrawn;

• Interprets for her parents

with PTSD

• They trust no one else

• Clinic interpreter from

persecutor group

• Mother begins with

complaints of body pain,

poor sleep, constant

worry.

• Dad suffers in silence; no

• Family lives in a 1

bedroom, basement suite

that is poorly maintained.

What would you address this visit?

1. Address use of a child as interpreter

2. Assess mother’s ability to care for the child

3. Assess adaptation issues in the child

4. Assess housing

5. Assess father’s PTSD

6. 1, 2 & 3

7. 2, 4, 5

8. All

Migration = change

What immigrants face

Happiness &

Fascination

Disappointment,

confusion,

frustration….

Gradual

adjustment or

recovery

Acceptance &

adjustment

What immigrants adapt to

Housing

Racism Child

protection & discipline

Sense of security

Social norms

School

Climate

Gender roles

Loss Employment

Language

Loss of status

Disparity/ Poverty

Recreation

Clothing

What is LEARN?

Tool to enable provision of cultural competent care:

Listen with sympathy and understanding

Explain your perceptions of a problem

Acknowledge and discuss differences & similarities

Recommend treatment

Negotiate agreement

• Listen with sympathy and understanding

– Patient perception of health condition

– Patient agenda

– Pre/post/migration & stress/trauma

– Adaptation/acculturation process

– Family conflict?

– Bias or discrimination?

– Risky behaviours e.g. sex, substance?

– Basic needs met?

– Usual age appropriate practices

LEARN (cont’d) 18

• Explain your perceptions of a problem

– Biases & values: Know your own well - KEY

– Respect & validate:

• Strengths - personal and cultural

• Resilience - survived adverse experiences

• Ability to adapt to a new culture

LEARN (cont’d) 19

• Acknowledge

• Discuss differences/similarities

– Let the patient teach you

– Know when to stand firm

• Recommend treatment

– Consider traditional, alternative therapy

• Negotiate agreement

– Ensure both agendas met

LEARN (cont’d) 20

Know your own biases

Work Environment

Social (ethnic,

religious, peers)

Family

Education

Individual Recognize that the

health care system

has a culture all its

own. This culture is

familiar to you, but

foreign to patients.

People often come from private

health systems.

For many, the Canadian health

system makes no sense.

What can make a difference? 22

Case – difficult element; exploration

Example

http://www.kidsnewtocanada.ca/documents/CKNC_cklst(interpreter)_web_FINAL.pdf

• Identify

• Support system

• Language skills

• Health literacy

• Stage of adaptation to Canada

• Spoken or visual health messages versus printed?

Remember: they may have survived events that you can

only begin to imagine……

Moving beyond racial/ethnic

group membership

Acculturation and Ethnic Identity

Development

• 1.5 - Generation Immigrant

• Working Class Family

• Admitted for severe malnutrition

secondary to Anorexia Nervosa

Case: 14-year-old Chinese Canadian 26

• Conflicts at home

• “I hate Chinese food”

• “I wish I wasn’t Chinese!”

• Mother: “I don’t know how to raise a

Canadian child!”

How would you approach family & cultural

issues?

a. Recommend parenting classes

b. Say to Mom, “Your daughter is in Canada

now, she’s not Chinese anymore”

c. Say to teen, “You’re lucky to have a Mom

who cooks great Chinese food!”

d. Explore acculturation and ethnic identity

development

• Racial/Ethnic Categories =

Homogeneous Groups?

• Every youth is unique individual

• Patient – centered care

• BUT: Culture, race, ethnicity plays

powerful role in health and behavior!

Beyond Simple Racial/Ethnic

Mind the Gap! Developing Skills to Navigate Cultural ... · 1. Discuss why culturally appropriate...

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