Cultural Competency Cultural Competency in Health in Health

About cultural About cultural competencycompetency

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 A guide to improving cultural competencycultural 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 Increasing cultural competency competency

PrinciplesFour Dimensional ModelDeveloping 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 convictioncapacity for action

Individual applies knowledge, conviction, capacity for action to

inform organisation, profession &

system

Organisation &

profession support

individual

Practical approaches 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 www.vu.edu.au/diversity

Cultural Competency for Healthy Living: a guide for policy, partnerships and participation - www.nhmrc.gov.au

Multicultural Mental Health Australia www.mmha.org.au

Centre for Culture, Ethnicity and Health www.ceh.org.au

How to find out more

Cultural Competency Cultural Competency in Health Care….in Health Care….

Who’s responsible?Who’s responsible?

EverybodyEverybody