Cafe Scientifique: Cultural Competency and Safety

Cultural Competency and Safety
Simon Brascoupé Senior Adviser, Aboriginal Relations and Initiatives Unit
National Aboriginal Health Organization
Read online: “ Cultural Safety: Exploring the Applicability of the Concept of Cultural Safety to Aboriginal Health and Community Wellness” http://www.naho.ca/jah/english/jah05_02/V5_I2_Cultural_01.pdf

Cultural Safety Overview
Social Determinants
Colonization
Cultural Competency
Cultural Safety
Healing & Wellness
Benefits

“ Poorer people live shorter lives and are more often ill than the rich. This disparity has drawn attention to the remarkable sensitivity of health to the social environment.” (WHO 2003)

Key Development Indicators
Harvard University Project:
Sovereignty Matters
Institutions Matter
Leadership Matters
Culture Matters

Four Major Challenges

Colonization
Diseases (such as influenza, small pox, measles, polio, diphtheria, tuberculosis and later, diabetes, heart disease and cancer);
The destruction of traditional economies through the expropriation of traditional lands and resources;
The undermining of traditional identity, spirituality, language and culture through missionization, residential schools and government day schools;
The destruction of indigenous forms of governance, community organization and community cohesion through the imposition of European governmental forms; and
The breakdown of healthy patterns of individual, family and community life.
Mapping the Healing Journey 2002

Underlying Causes

Cultural Competency
There has been growing interest in the delivery of culturally competent care and training.
Cultural competency is the delivery of respectful and responsive services that meet needs of patients as a strategy to reduce disparities, provide quality care and improve health outcomes.
Cultural competent training is on a continuum; from cultural awareness, to cross-cultural to cultural competency.
Cultural competence organizations have a set of values and principles, and demonstrate behaviours, attitudes, policies, and structures that enable them to work effectively and efficiently cross-culturally.
The benefits of culturally competent organizations are improved: workforce retention, patient satisfaction and compliance and communications.
A recent study on the growing number of cultural competent health organizations concluded that "cultural competence seems to be evolving from a marginal to a mainstream health care policy issue and as a potential strategy to improve quality and address disparities."

Cultural Competency
A set of congruent behaviours, attitudes and policies that enables human service organizations to work effectively with various racial, ethnic, religious and linguistic groups
University of Calgary, Cultural Diversity Institute, 2000

Cultural Competence Continuum National Center for Cultural Competence 1989.

Employee Benefits
Higher levels of personal job satisfaction
Reduced conflicts with colleagues
Reduced complaints by service users
Improved outcomes for service users
Improved compliance with instructions
Improved communication with people that reduces stress/anxiety
Decrease in repeat visits/phone calls
Community Action Forum 2008

Client Benefits
Individual needs are met
Easier to develop trust and share information
Less anxiety
Better outcomes (learning, health, etc.)
High levels of satisfaction with service
Increased compliance

Employer Benefits
Retention of employees
Reduction in re-training costs
Increased productivity
Reduced complaints, grievances, legislative issues (Human Rights)
Increased opportunities for funding/fundraising opportunities
Increased opportunities for volunteers

The Continuum
Cultural awareness becomes central when we have to interact with people from other cultures.
People see, interpret and evaluate things in a different ways.
What is considered an appropriate behaviour in one culture is frequently inappropriate in another one.
Misunderstandings arise when I use my meanings to make sense of your reality.
Source: Stephanie Quappe and Giovanna Cantatore 2005
Cross-cultural training is training for cross-cultural communication and experiences.
Preparing people to work in a cross-cultural environment, for example, Peace Corps volunteers complete cross-cultural training which include:
History and culture
Norms and values
Communication
Source: Peace Corps

Cultural competent organizations
Have a defined set of values and principles, and demonstrate behaviors, attitudes, policies, and structures that enable them to work effective cross-culturally.
Have the capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge, and (5) adapt to diversity and the cultural contexts of communities they serve.
Incorporate the above in all aspects of policy-making, administration, practice and service delivery, systematically involve consumers, families and communities.
Source: National Center for Cultural Competence

Cultural Safety
Is a concept first developed in New Zealand to provide quality care within the cultural values and norms of the Maori.
The concept is spreading to other fields of human services, like education and healing.
Spread to other areas of the globe, particularly with Indigenous Peoples in former European colonies.

Continuum

Cultural Safe Care & Outcomes
To provide quality care within the cultural values and norms of the patient.
Culturally unsafe practice as “any actions that diminish, demean or disempower the cultural identity and well being of an individual.”
OUTCOMES
Improved collaboration and partnership
Improved health

Culturally Unsafe Care (NAHO 2008)

Cultural Safet y
Build trusting foundation with clients
Clients rights clearly stated; code of ethics, etc
Safe therapeutic process: plan for healing journey
Create comfortable place and safe atmosphere
Reinforce safety: assistance throughout healing journey
Aboriginal Healing Foundation

Healing Path

Aboriginal Healing Movement
In the past twenty-five years in Canada, a wide variety of experiences, programs and activities have been part of what may be described as the "Aboriginal healing movement". These have included:
Participation in traditional healing and cultural activities;
Culturally based wilderness camps and programs;
Treatment and healing programs;
Counselling and group work; and
Community development initiatives.

What is healing?

Healing Lessons Learned
Healing is possible for individuals and communities. Both appear to go through distinct stages of a healing journey.
The healing journey is a long-term process, probably involving several decades.
Healing cannot be confined to issues such as addictions, abuse or violence.
Healing interventions and programs have most impact when they take place within the context of a wider community development plan.
Community healing requires personal, cultural, economic, political, and social development initiatives woven together into a coherent, long-term, coordinated strategy.
Such a coherent strategy requires integrated program development, funding delivery and on-going evaluation.
Healing is directly connected to nation building. At some point, there needs to be a merger of program efforts between community healing activities and movements towards self-government and community development.

Cultural Safety Framework

Cultural Safety Path
Cultural safety is an important first step in building trust
Cultural safety, like cultural competency can be taught.
Trust is critical to development because of the mistrust and historical trauma caused by colonization.
Taken from a policy perspective, whole organisations have become culturally safe through strategic planning and training.
The literature provides evidence that cultural competence and safety result in improved health outcomes.
A culturally safe delivery system can strengthen the capacity of the communities to be resilient to the stressors that push them from risk to crisis.

Cultural Safety: 5 Principles (Ball 2007)

Culturally Competent Organizations
Set of values, principles & structures to work cross-culturally.
Work in the cultural contexts of communities they serve.
Work part of policy-making, administration, practice and service delivery
Systematically involve clients, families and communities
Cultural competence is a long-term developmental process
Both individuals and organizations are at various levels of awareness, knowledge and skills along the cultural competence continuum.
The National Center for Cultural Competence

Benefits
Why Culturally Competent Health Care?
Improve quality of services and outcomes
Respond to Aboriginal needs
Meet accreditation requirements
Reduce liability and malpractice
Support workforce diversity initiatives
Improve retention of health human resources
Achieve social justice

Miigwetch, Nia:wen, Thank You!

Cafe Scientifique: Cultural Competency and Safety

by National Aboriginal Health Organization on Oct 06, 2010

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