Slides form a presentation at the 2014 PacRim conference.

1. Cultural Competency
in the Disability Sector:
Coping with Complexity in the 21st Century
P R E S E N T E R
MR HAMISH ROBERTSON
DR JOANNE TRAVAGLIA
MS EMANUEL D’URSO
MR GAVIN WESSON

2. Ageing, disability and diversity in
context
• Australia’s population is ageing which has implications for the future of
care at all levels, from planning to individual households.
• The diversity of Australian society means that certain population groups
and locations are ageing faster than others and that there are increasing
numbers of people with disabilities (of all ages)
• This has implications for the demands placed on families, communities,
volunteers and funded service providers.
• Social changes mean that the traditional concepts of diversity and
disability are undergoing change.
• The society we can expect to see in 2050, when population ageing peaks,
is likely to be very different to what we see today.
• The nature of and the arrangements we rely on for care provision are
changing rapidly to, with the move to person directed funding.
• Traditional and emergent conceptions of diversity have implications for
the provision of care in Australia from the present until at least 2050, and
beyond.

3. So, how can
we make
things better?
1. Expect complexity
2. Address vulnerability
3. Respond organisationally
4. Practice critically
5. Engage philosophically

4. Systems perspective
We need new ways of thinking and of working in order to accommodate
the complexity of the challenges in and urgent need for health system
innovation and change (Herbert and Best 2011 in Adam et al, 2012: iv1)
In other words, we need to move away from understanding:
Care and support systems as being made up of individual components,
delivered via silos and structures
AND
Patients, clients, carers, family members, friends etc etc as single
category individuals. People are ‘elderly’ AND gay AND CALD AND have
a disability AND…

5. What is diversity?
1. Diversity is a descriptor: of the complexity of humans as individuals,
groups and communities;
2. Diversity can be a critical perspective: which recognises sustained
underlying inequalities and inequities, that is discrepancies, in all
societies and groups and ‘categories’ of humans;
3. Diversity can drive an imperative: to address these discrepancies.

6. What is vulnerability?
• Vulnerability has been defined as susceptibility to any kind of harm,
whether physical, moral or spiritual, at the hands of an agent or agency,
a factor which … needs to be recognised and negotiated in health [and
disability] care transactions. (Hurst: 2008)
• A functional definition of vulnerability is an individual or groups'
susceptibility to risk of harm.
• Vulnerability can be identified as occurring as a result of one or more
social, structural, situational or [we will argue] systems causes
• While vulnerability is well understood in terms of individual clients and
groups, it is also needs to be considered at a population level in terms
of service planning and delivery

7. Vulnerability
Social
Symbolic
Situational
System
Structural
Socio-cultural factors which
increase individuals’ or groups
exposure to risk
Socio-political and
economic (structural)
forces can reinforce
individual and group
vulnerability
Individual/group
exposure, risk,
resilience and resource
factors
Symbolic factors that
increase/decrease risk of harm
Factors which contribute to
symbolic violence
Legislative, policy,
funding and service
structures and
increase or decrease
access to resources
if available

8. The principle of equity involves:
• ensuring that … care services serving
disadvantaged populations are not of poorer
quality or less accessible;
• that the allocation and application of resources are
in relation to need and;
• ensuring that positive efforts are make to achieve
greater uptake and use of effective services by
making extra efforts to reach whose health is
worse.
Independent Inquiry into Inequalities in Health
(Acheson Report)

9. Collaboration across
disciplines, sectors and
organizations
Transformat-
ional
leadership
Critically reflective practice
Sustained
dialogue and
development
Proactive
engagement
with clients,
carers and
communities
Conceptual
framework

10. Respond
structurally
System
Organisation
or service
Team
Individual

11. Why we moved to a diversity approach
• History in health of both oppressive and emancipatory
practices (‘race’, class, gender, disability, eugenics etc)
• Graduated history of policy responses to specific aspects
of socio-cultural diversity eg. gender, sexuality, disability
etc
• Low citizenship/political philosophy engagement
• Narrower focus on public health/health promotion etc
• State authority and capital interests combined
• Fluid nature of negotiation processes and countervailing
strategies

12. The move away from ‘migrant’ Health
Move away from traditional
‘welfare’ approach to ‘migrant’
health which is characterised by:
• helping the ‘victim’;
• focus on language (rather
than communication
barriers);
• focus on cultural ‘difference’
rather than on individuals
differences and similarities;
• focus on the individual as the
source of the difficulty.

13. To a diversity capability approach
• Recognition that diversity
permeates every aspect of health
care;
• Focus on the competence of the
provider, rather than (only) the
characteristics of the clients;
• Focus on inducements to stimulate
and motivate partnerships;
• Sharing of responsibility and costs;
• Cultural competence as an benefit
not an expense.

14. Limitations of a culture only approach
• Easier to ignore underlying systemic issues
• Focus on ‘culture’ alone can lead to locating the ‘problem’ in client
• Focus on ‘culture’ as only, or key variable can negate other
differences, concerns and/or similarities between clients and
practitioners
• Allows (some) practitioners to claim ‘too many cultures, too much
information’ to learn
• Fosters dependency (or denial) on ‘specialised’ or willing staff

15. Diversity capability perspective
• A commitment to recognising and responding effectively to every
client as an individual within their current context, whilst
responding to shared experiences, culture(s), health issues and
concerns of communities.
• Aim is to encourage, support and empower staff for provide
equitable and effective services.
• Central to this is the development of an organisation which is
developing cultural competence through a range of professional
methods and strategies aimed at reducing the impact of inequality.

16. Diversity capability perspective
• Culture is not necessarily the only dimension or at times, even the
primary dimension to be considered.
• The diversity health approach seeks to identify how culture
interacts with a range of other variables such as language,
ethnicity, gender, disability, sexuality, religious beliefs, and socio-
economic backgrounds in both clients and staff, within health care
interactions.
• Diversity health does not take culture or ethnicity as the ‘central
issue’ but seeks to identify ways, and strategies, to assess and
address the issues of most importance to individuals and
communities

17. Diversity and
health services
research
1. Quality and
safety of care
2.
Organisational
development
3. Workforce
development
4. Staff
capabilities
5. Partnerships,
alliances and
engagement
6. Research,
analysis and
evaluation
Travaglia, Roberston (2010)
Organisational
response to di

18. Accurate information
Monitoring of patterns of use
Monitoring of patterns of outcomes
Constant feedback on the needs of communities and clients
Strategies to ensure the quality
and safety of care

19. Population
Personal
Philosophy
Policy
Planning
Personnel
Practice
Programmes
Products
Travaglia and Robertson (2001)
Organisational
development
framework

20. Strategies to support
workforce development
Ongoing formal and informal training and practice development
Face to face, CD Rom, intranet based, and ‘coaching’ approaches
Partnerships with higher education and learning institutions
Partnerships with communities and groups
Language strategy

21. Strategies to support staff
capabilities
Capabilities versus ‘sensitivity’ or ‘awareness’ alone
Identification of generic and specific competencies
Recognition, reward and enhancement of existing capabilities
Competency based training aligned with profession and organisational
requirements and recognition
Performance agreements include diversity capabilities

22. Partnerships, alliances and
engagement
Commitment to continuous engagement, deep listening and dialogue
Community group consultations, conferences and workshops
Site and department cost sharing
National and international exchanges

23. Research and evaluation
Establishment of an organsiation research agenda to overcome ad hoc
nature of data and information collection
Development of SMART diversity targets and KPIs
Funding of commissioned research projects
Grants program
Evaluation of services and programs

24. Critical approaches to diversity
• Questioning professional knowledge and its
construction
• Enacting critical and uncomfortable views of
culture(s)
• Addressing the quotidian enactment of power
• Contextualising (placing, spacing and temporizing)
• Co-creating culture as “and also” as well as
“instead of” or “either or”
• Ensuring epistemic justice and practicing epistemic
humility

25. You know you engaging proactively when you:
• Acknowledge that diversity is about ‘us’ not about ‘them’
• Honestly and compassionately deal with genuine fears and
concerns of individuals, including yourself, about diversity
• Work towards changing some (all!) of the organisational
‘givens’
• Demonstrate new approaches and behaviours
• Acknowledge the embedded nature of discriminatory
perspectives in individuals, services, organisations and
societies, and work effectively towards minimising them
• Identify and emphasize commonalties, while valuing and
supporting differences

26. A fundamental basis of our being-in-the-world is for Heidegger, not
matter or spirit, but care: Being-in-the-world has always dispersed itself
or even split itself up into definite ways of Being-in - having to do with
something, producing something, attending to something and looking
after it, making use of something, giving something up and letting it go,
undertaking, accomplishing, evincing, interrogating, considering,
discussing, determining. . .
That something is care …
Martin Heidegger, Being and Time, trans. John Macquarrie and Edward
Robinson. New York: Harper & Row, 1962

27. Conclusion: guiding principles
• William Osler: It is more important to know what kind of a person
has a [disability], than to know what kind of [disability] a person has
• What is important to this person in their current context?

28. Selected references
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no. HWE 42. Canberra: AIHW
Australian Institute of Health and Welfare (2012). Australia’s health 2012. Australia’s health series no.13. Cat. no. AUS 156. Canberra:
AIHW.
Australian Institute of Health and Welfare 2011. Australia’s welfare 2011. Australia’s welfare series no. 10. Cat. no. AUS 142. Canberra:
AIHW.
Beck U (1992). Risk Society: Towards a New Modernity. London: Sage.
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