Objective 3: To undertake work to further develop the cultural competence of the DHHS workforce.

Transcription

1 POPULATION HEALTH Scoping Paper Objective 3: To undertake work to further develop the cultural competence of the DHHS workforce. Victoria Hadley, Refugee Health Project Officer May 2012

2 Introduction The role of the Refugee Health Project Officer is to assist with the systemic improvement of Statewide Services and health and wellbeing outcomes of people with a refugee background. Objective 3 of the project is to undertake work to further develop the cultural competence of the Tasmanian (DHHS) workforce. All Australians have the right to access health care that meets their needs. In our culturally and linguistically diverse society, this right can only be upheld if cultural issues are core business at every level of the health system systemic, organisational, professional and individual. The Cultural Competency in Health guide is one step towards this goal, giving a model for cultural competency that can be applied by health systems and organisations to improve health for all. Cultural Competency in Health: a guide for policy, partnerships and participation (NHMRC 2006) The healthcare workplace is complex, as are the diverse linguistic and cultural communities it provides services to. Therefore, assisting DHHS to develop a culturally responsive workforce will have challenges. This paper will outline some of the existing resources and possible opportunities available to further develop the cultural competence of the DHHS workforce, with a focus on refugee health. Defining Cultural Competence: While there is no universally accepted definition of cultural competence, the following remains one of the most frequently cited and succinct: Cultural competence is a set of congruent behaviours, attitudes and policies that come together in a system, agency or among professionals and enable that system, agency or those professionals to work effectively in cross-cultural situations. (Cross, Bazron et al. 1989). Page 2 of 15

3 Executive Summary Several areas for system development were identified where the Refugee Health Project Officer might be able to take the lead or provide key supports for DHHS and DHHS-funded services: Introductory cultural competency resources Induction program coverage of cultural competency Access to further cultural competency and refugee health training Information Kit on cultural competency and refugee health Links with Working with Interpreter training Page 3 of 15

4 Methodology To identify work to be undertaken to further develop the cultural competence of the DHHS workforce, consultations were held with the key providers of refugee health cultural competency training, Statewide. Those staff being the Multicultural Liaison Officer (NWAHS), Social Worker Migrant/Refugee Liaison Officer (NAHS), Clinical Nurse Consultant Refugee Health (NAHS), Migrant/Refugee Liaison Officer (SAHS) and Clinical Nurse Consultant Refugee Health (SAHS). Invaluable information was also gathered from interviews with the Aboriginal Health policy officer who has overseen the development and provision of Aboriginal Cultural Competency training throughout the Department. Invitations to attend a selection of the DHHS training programs, designed and delivered by the Southern Migrant Liaison Officer, provided opportunities to discuss content in detail and observe delivery. Participation in training provided by the Phoenix Centre and the Victorian Centre for Culture, Ethnicity and Health added to the total picture. A review was made of existing and new, written and audio visual resources, PowerPoint presentations and e-learn modules. These were resources developed locally, nationally and internationally. Page 4 of 15

5 Discussion Organisation Commitment Some key DHHS services value cultural competence. Evidence for this was found through a broad search of the DHHS Intranet using the term cultural competence. This revealed three main types of references: (1) Positions, (2) Policy and (3) Training. 1. Positions The existence of positions employed across the three Area Health Services (Tasmanian Health Organisations from July 2012), where the focus on and their role in relation to cultural competence are embedded in their position descriptions: Multicultural Liaison Officer, North West Area Health Service Focus: facilitate the provision of culturally sensitive and appropriate services to patients of diverse needs and diverse backgrounds. Role: develop and facilitate cultural awareness for hospital health care providers. Clinical Nurse Consultant Refugee Health Services, Northern Area Health Service (RH CNC NAHS) Role: participating in a process at personal, professional and system levels working towards a cultural(ly) competent health service delivery for refugees as part of the LGH commitment to Diversity in Health. Clinical Nurse Consultant Refugee Health Services, Southern Area Health Service Role: Participation in a process working towards a culturally competent health service delivery for Refugees as part of the RHH commitment to Diversity in Health. Refugee/Migrant Liaison Officer (RMLO), Southern Area Health Service This assistance includes facilitating the provision of culturally sensitive and appropriate services to patients and their families who are from culturally and linguistically diverse backgrounds. The RMLO conducts information and in-service training programs for hospital staff. Topics include cross-cultural awareness and use and booking of interpreters. Social Worker Culturally and Linguistically Diverse, Northern Area Health Service Scope of Work performed: Responsible for the provision of Social Work services in accordance with the Code of Ethics of the Australian Association of Social Workers (Part Culturally competent, safe and sensitive practice, includes: (g) When engaged in education, administration, policy development and the like, social workers will promote awareness of cultural and cross-cultural issues and culturally competent practice; (h) Social workers will participate in developing and implementing culturally competent, safe and sensitive practice; (i) Where possible, social workers will seek guidance regarding Page 5 of 15

6 service development and delivery from community members ; (j) Social workers will provide a culturally safe service system ; (l) Social workers will recognise and challenge racism and other forms of oppression experienced by a range of culturally and linguistically diverse groups. ) 2. Policy - Launceston General Hospital s Refugee Health Referral Policy Purpose: To provide comprehensive, culturally appropriate and competent health services to refugee patients and their families. RH CNC NAHS provides best practice advice and support to develop culturally competent health service. 3. Training - DHHS Aboriginal Health Cultural Competence Training DHHS staff are encouraged to undertake Aboriginal cultural competence training to increase their knowledge and understanding of Tasmanian Aboriginal people, their history and culture. The program aims to achieve a culturally competent Agency to help improve health outcomes for Tasmanian Aboriginal people. Other information relating to cultural competency, and links to online training to work with interpreters in health settings is also available through the position of DHHS Policy Officer Multicultural Health (for example, a resource supporting incorporation of cultural competency into accreditation frameworks). Much information is internally accessible on the DHHS Knowledge Base (KB). However, the KB is not found with DHHS intranet search tools, and is a not a traditional source of information for many DHHS staff. This information will in time to be transferred to the DHHS intranet and/or internet pages. Page 6 of 15

7 Current Delivery of Cultural Competence Awareness and Training in DHHS Cultural competence is an ongoing process encompassing systems and processes as well as individual behaviour. It is so much more than reading a cultural profile (although this type of background information can be useful). Site or service specific work - The previously mentioned DHHS Refugee Health-related positions are constantly collecting and developing cultural competency resources for use in the delivery of their work, mainly with clinicians and frontline staff based in the public hospitals. Since the creation of the Area Health Services, there have been demands to respond to the needs of this broader service boundary. For example: The Southern Tasmanian Area Health Service Refugee Migrant Liaison Officer, (based in the Social Work Department of the Royal Hobart Hospital (RHH) reports delivering two or three cultural competence awareness sessions each week. For example sessions to RHH staff in the Women s and Children s Clinic, Obstetricians & Gynaecologists, Interns, Emergency Department, Dieticians, Paediatricians and Paediatric interns. Sessions have also included delivery to Southern Tasmania Area Health Service (STAHS) Community based nurses at the Clarence Integrated Care Centre, Allied Health professionals including physiotherapists and social workers at the Glenorchy Community Health Centre and State-wide videoconference training session for STAHS Primary Health professionals. The STAHS RMLO has also developed resource items such as: Interpreter Information sheets Tips for Dealing with Low Health Literacy PowerPoint presentations specific to the workforce requesting training, ie Working with Culturally and Linguistically Diverse Patients in Maternity Induction - The inclusion of cultural competency during the induction of new DHHS and RHH staff has been part of the practice of the southern Migrant/Refugee Liaison Officers and Refugee Health Clinical Nurse Consultants in their work areas. This valuable approach could be taken further across DHHS. However, since April 2011, changes were made to the existing general DHHS Orientation sessions, and the delivery of RHH-specific induction, the positions above no longer have this avenue to present cultural competence information to the broad workforce. Page 7 of 15

8 DHHS-wide training - DHHS currently has Aboriginal Health Cultural Competence Training (ACCT) available to all staff across the state. This is organised by the Aboriginal Health Unit (AHU) with inhouse administrative support to arrange sessions in various sites, and has either a DHHS-employed person, or a consultant to deliver the training. It is provided free to DHHS staff and DHHS funded NGO s and usually run from 10:00 am to 3:00 pm including a break. This training has been made mandatory for all new employees in Housing Tasmania, and Children and Youth Services. The AHU is encouraging other DHHS areas to consider a more proactive approach to this training. In the past 12months about 500 staff completed the training (the majority from DHHS, but some from the non Government sector). Verbal feedback from these sessions included that this type of face-toface, uniform training should be extended to other cultural or vulnerable groups in Tasmania. The AHU also supports an online presence of cultural competency training as part of orientation for new employees. Gaps and Emerging Opportunities Health and social services must take a responsive, respectful and client-focused approach. That means empowering the many health professionals and service workers to support and encourage the health and wellbeing of their clients. dedicated staff are working in Tasmanian communities every day, understand the local issues and have the power to make a difference. A Healthy Tasmania: setting new directions for health and wellbeing (DHHS 2011) p31. Most health services in other states and territories clearly state the need for cultural competency. The NSW Health website (South Eastern Sydney & Illawarra Area Health Service 2012) states that to work appropriately, responsively and confidently with clients and patients with a refugee background requires specific knowledge, built upon general cultural competency training. The NSW Health website goes on to point out that a culturally competent health workforce should strive to provide services that are consistent with the client s needs and values, firstly, by acknowledging them, and secondly by, responding to them appropriately. Therefore, Health care practitioners need to develop a broad repertoire of skills, knowledge, attitudes, perspectives and practices which they can use to enhance their relationships with clients and colleagues. Page 8 of 15

9 Induction - Due to the removal of opportunities for Refugee Health-related staff to participate in induction programs, this gap could be addressed by exploring opportunities to have cultural competency included in the recently developed Right Start. This is DHHS s new employee onboarding program, which includes a selection of e-learning modules covering topics included in the former Agency induction (now referred to as orientation) program. Stand Alone Resources While there are existing resources available for DHHS through the internal KnowledgeBase and through specific DHHS positions, the development of a three-module set of resources might be considered: A: General Introduction to Cultural Competency (to be developed by the Refugee Project Officer) B: Communication and Working with Interpreters (to be developed by the Refugee Project Officer) C: Refugee Health (to be developed from existing work by the MLO s and CNC s RH) Provision of stand alone resources would enable an introduction to the concepts of cultural competence for new staff. By extending this access to all DHHS staff, would also capture newly returning to work staff, and those moving from one role to another, to ensure everyone has a foundation level of knowledge. Staff would then be more prepared for additional training relating to cultural competency and refugee health (that the previously mentioned specialist positions might provide or support). The information and contacts could also be accessed by others who plan staff development and training. This work would also enable a review of existing materials, updating where possible and development of resources to fill gaps. It would also include a co-ordinated drawing together of items, and work to enable ongoing access across DHHS. This could be shared more broadly in the future as the opportunities arise. These modules might be part of Right Start, and/or another e-learning package, or DHHS web-based platforms. The intention is not to add to the workload of staff already delivering cultural competency training or other staff development, but to help reach more DHHS staff, and support the inclusion of cultural competency and refugee health into existing training and clinical education programs. Cultural Competency Training Program A different model could also be considered, similar to the format for the DHHS Aboriginal Health Cultural Safety training. This model is effective but would have staff funding implications for DHHS. Page 9 of 15

10 Recommendations 1. Develop content for an introductory cultural competence stand alone resource Generic, foundation information covering cultural competency, that can then be reformatted (Eg e-module, PowerPoint presentation, etc). 2. DHHS orientation program coverage of cultural competency - Investigate incorporation of the (1) Introductory cultural competency resource in the DHHS Right Start Orientation program. This will link with work from the Interpreter Scoping Paper Recommendation 3.1: Investigate or have input to how induction programs for new staff and orientations for staff changing work areas. 3. Access to further cultural competency and refugee health training - Work with existing key DHHS staff to make available where possible their training and/or resources relating to cultural competency and refugee health, to other parts of DHHS. The aim is to reduce the load on these few existing workers, and improve agency-wide coverage by increasing access to, and encouraging uptake by other DHHS services through workforce development, safety and quality improvement, accreditation, and other strategies. In time, the training and/or resources could where possible also be made available to DHHS-funded services and the community sector. 4. Information kit on cultural competency and refugee health 4.1 Review, update or delete existing DHHS materials and identify new resources and on-line training relating to cultural competency and refugee health and collate into an Information Kit. 4.2 Make the Information Kit available to DHHS staff. For example on the DHHS intra/internet, Knowledge Base, in the Multicultural Health Newsletters, hard copy distribution, etc. In time, the training and/or resources could also be made available to DHHS-funded services and relevant parts of the community sector. 5. Links with Working with Interpreter training - Investigate linking the stand alone resources from Recommendation 1 with the work being done through the Interpreter Scoping Paper Recommendation 3.2: to develop information to encourage onsite training or mentoring of nonclinical people, (eg receptionists and volunteers) on the need for and use of language supports, including working with Interpreters. Diagram 1 (on page 7) shows how all of the recommendations might look when linked, and building on each other over time. Page 10 of 15

11 Recommended Next Steps Table 1 (on page 8) sets out the recommendations, indicates the type of role the Refugee Health Project Officer and other possible stakeholders might play in actioning the recommendations. The table also suggests a timeframe for where action on each recommendation might begin. In summary, the tasks recommended for the Refugee Health Project Officer to commence in the short term (second quarter of 2012) are: 1. Develop content for an introductory cultural competency stand alone resource 2. DHHS orientation program coverage of cultural competency 4. Information kit on cultural competency and refugee health 5. Links with Working with Interpreters training The recommendations and suggested timeframes need to be reviewed by the Manager, Population Health Equity, and the implications for the Refugee Health Project Officer and Multicultural Health Policy Officer work plans discussed. The recommendations of this scoping paper and timeframes need to be reviewed alongside subsequent scoping papers, work plans, the structural developments of the health system, and the priorities of the DHHS system and staff. This scoping paper will be released to keep stakeholders informed and support engagement. Page 11 of 15

12 Diagram 1: Potential links between all of the Recommendations to extend the reach of new and existing cultural competency supports Page 12 of 15

13 Table 1: Next steps Recommendation Role of Refugee Health Project Officer Estimated Time Frames Potential Partners 1. Develop content for an Introductory Cultural Competency Stand Alone Resource Generic information covering cultural competency, that can then be reformatted (E.g. e-module, PowerPoint presentation, etc.). Time-limited state-wide project Short term* Key DHHS staff Multicultural Health Policy Officer 2. DHHS Orientation program coverage of Cultural Competency Investigate incorporation of the (1) Introductory cultural competency resource in the DHHS Right Start Orientation program. This will link with work from the Interpreter Scoping Paper Recommendation 3.1: Investigate or have input to how induction programs for new staff and orientations for staff changing work areas. Time-limited state-wide project Short term Human Resources 3. Access to further Cultural Competency and Refugee Health Training Work with existing key DHHS staff to make available training and/or resources relating to cultural competency and refugee health. Time-limited state-wide project Medium term Key DHHS staff 4. Information Kit on Cultural Competency and Refugee Health 4.1 Review, update or delete existing DHHS materials and identify new resources and online training relating to cultural competency and refugee health. Collate into Information Kit. Time-limited state-wide project Short term Key DHHS staff Page 13 of 15

14 4.2 Make the Information Kit available to DHHS staff. For example on the DHHS intra/internet, Knowledge Base, in the Multicultural Health Newsletters, hard copy distribution, etc. Time-limited state-wide project Short term IT Communications and Marketing 5. Links with Working with Interpreters training Investigate linking the stand alone resources from Recommendation 1 with the work being done through the Interpreter Scoping Paper Recommendation 3.2. Time-limited state-wide project Short term (using existing resources and sites) IT Communications and Marketing Short term = commence second quarter of 2012 Medium term = commence 2 nd half of 2012 pending whole of Government &/or whole of DHHS decisions. Long term = commence 2013 pending whole of Government and/or whole of DHHS decisions * Pending whole of Government and/or whole of DHHS decisions. Page 14 of 15

15 References Cross, T., B. Bazron, et al. (1989). Towards A Culturally Competent System of Care, Volume I. Washington, DC, Georgetown University Child Development Center, CASSP Technical Assistance Center. DHHS (2011). A Healthy Tasmania: setting new directions for health and wellbeing. NHMRC (2006). Cultural Competency in Health: a guide for policy, partnerships and participation. South Eastern Sydney & Illawarra Area Health Service. (2012). "Cultural Competence." Multicultural Health Service Retrieved 04 April 2012, 2012, from Page 15 of 15