Vancouver Coastal Health. First Nations and Aboriginal Culturally Competent and Responsive Strategic Framework Backgrounder and Next Steps

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1 Vancouver Coastal Health First Nations and Aboriginal Culturally Competent and Responsive Strategic Framework Backgrounder and Next Steps Approved by Aboriginal Health Operations Council January 10, 2013

2 Table of Contents 1. INTRODUCTION DEFINITIONS BACKGROUND FRAMEWORK PURPOSE FRAMEWORK RATIONALE GOAL OF FRAMEWORK NEXT STEPS... 4

3 1. INTRODUCTION In the 2012 Partnership Accord with the First Nations Health Authority, Vancouver Coastal Caucus, and Vancouver Costal Health, they committed to develop, implement and evaluate First Nations and Aboriginal cultural competency training to VCH executive, board, staff and contractors and agreed to jointly develop a First Nations and Aboriginal Cultural Responsiveness Strategy for Vancouver Coastal Health. This Strategy is a key deliverable of the Accord and the intention is to create a framework to guide VCH in becoming a culturally competent and responsive organization with the transformation of their practice and service delivery to First Nations and Aboriginal people. 2. DEFINITIONS Culture: represents the values, norms, and traditions that affect how individuals of a particular group perceive, think, interact, behave, and make judgments about their world 1. Cultural Competence: a set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals and enable [them] to work effectively in cross-cultural situations. 2 Cultural Safety: is an outcome, defined and experienced by those who receive the service- they feel safe Is based on respectful engagement that can help patients find paths to well-being Is based on understanding the power differentials inherent in health service delivery, the institutional discrimination, and the need to fix these inequities through education and system change Requires acknowledgment that we are all bearers of culture- there is self reflection about one s own attitudes, beliefs, assumptions and values Cultural safe care involves building trust with Aboriginal patients and recognizing the role of socioeconomic conditions, history and politics in health Requires communicating respect for a patient s beliefs, behaviours and values Ensures the client or patient is a partner in decision making 3 Culturally Competent Organization: A culturally competent organization is committed to serving diverse clients, hiring diverse staff, and establishing programs that address the needs of different client populations. The culturally competent organization fosters a culture of openness and respect. 4 Organizational Cultural Competency requires multi level interventions and supports. Moving beyond cultural awareness, sensitivity and competency for individual staff members (achieved through education to increase awareness of socio cultural issues, skill development and self reflection), 1 Chamberlain, S. P. (2005). Recognizing and responding to cultural differences in the education of culturally and linguistically diverse learners. Intervention in School & Clinic, 40(4), National Centre for Cultural Competence. (n.d.) Curricula Enhancement Module Series. Retrieved January 2013 from 3 Embracing Cultural Competence in the Mental Health and Addiction System. Ontario Federation of Community Empathy, dignity and respect: Creating Cultural safety for Aboriginal people in urban health care. Health Council of Canada. December Management Science for Health. (n.d.) Provider s Guide to Quality and Culture Culturally Competent Organization. Retrieved January 2013 from 1 Vancouver Coastal Health First Nations and Aboriginal Culturally Competent and Responsive Strategic Framework Backgrounder and Next Steps

4 organizational cultural competency includes leadership commitment to foster a culture of openness and respect for different groups, hiring of diverse staff, continual assessment and evaluation of policies and practices, the expansion of cultural knowledge and resources and the adaptation and development of service models and programs to better meet the need of different cultural groups 5 Cultural Responsiveness: extends beyond language to include a much larger set of professional attitudes, knowledge, behaviors and practices, and organizational policies, standards and performance management mechanisms to ensure responsiveness to the diversity of patients who walk through health services doors 6. Cultural responsiveness takes on an organizational focus it focuses on the ability of the system or institution to be culturally competent Key definitions refer to improving professional attitudes, knowledge, behaviors (the people component) and practices, strategies, plan, policies and procedures, standards and performance management / remuneration mechanisms (the institutional component) in order for the whole to be responsive. Cultural responsiveness is not alone concerned with improving the competency of the practitioner but also improving the system in which the practitioner operates BACKGROUND In alignment with the Transformative Change Accord: The First Nations Health Plan, Tripartite First Nations Health Plan and the British Columbia Tripartite Framework Agreement on First Nations Health Governance (2011), VCH has signed a Vancouver Coastal Partnership Accord in May, 2012, creating a new path to improving health outcomes, programs, and services for First Nations in our region. The Accord sets the goal of attaining significant improvements in health outcomes by achieving a higher level of integration through joint planning and engagement, a focus on accountability and evaluation, and providing culturally appropriate, safe and effective services. It acknowledges the diversity in size and traditions of Coastal First Nations, the rights of each First Nation to govern their own affairs, and the rights of VCH to govern its health services delivery area. VHC acknowledges the link between increasing cultural competency of health care service providers and the inclusion of Aboriginal perspectives of healing and wellness with improved access to health care services, increased accountability to Aboriginal communities and better health outcomes for Aboriginal people. The overarching focus of this strategic framework will be to increase cultural competency of all VCH staff and organizational structures while building avenues to incorporate Aboriginal perspectives of health. Cultural Competency Plan In 2010, Aboriginal Health Strategic Initiatives began work on a cultural competency plan (CCP) for VCH. The objective of this plan (CCP) was meant to help achieve the goal of the AHSI Health and Wellness Plan for increased positive health outcomes and health access for Aboriginal people. The CCP plan originally had three main sections: cultural competency training; regional policies and protocols for service delivery and the creation of a cultural service model. These sections addressed the areas of education, professional practice, health literacy, community engagement, human resources and 5 Draft VCH Cultural Competency Policy 6 Accessible Health Care: A Response Framework for a Culturally Evolving Community: AMSSA Multicultural Health Fair: Sasso / Stanger (2004) 7 Cultural Competency & Responsiveness Concept Paper. Kahui Tautoko Consulting (Canada) Ltd. Oct Vancouver Coastal Health First Nations and Aboriginal Culturally Competent and Responsive Strategic Framework Backgrounder and Next Steps

5 cultural services. Since then, the plan had grown to include numerous other initiatives and goals. Over the years, VCH has collaborated with the Squamish and Tsliel watuth Nations in holding cultural awareness days and has plans to work with all of the 14 Nations which VCH provides services for to hold similar days. With the signing of the Partnership Accord, the VCH CC plan now includes the development of a Culturally Competent and Responsive Framework to guide all of VCH programs and services, including areas such as Quality Improvement, Human Resources, Communications, Community Engagement, Research and Data management and program development. Cultural competency is a long-term developmental process that helps to achieve all four of VCH's stated goals to: provide the best quality of care; promote better health for our communities; optimize our workforce and use our resources efficiently. Additionally, it assists VCH in the development of a Strategic Framework focused on Quality and Safety, Care Experience, Innovation and People. Cultural Competency is a key strategy in reducing health inequities and integrally linked to VCH s People First strategic lens, PHC s Person and Family Centred Care strategic lens, and to the approach advocated by the Ministry of Health, Patients as Partners, for primary and community care. It also helps to further define VCH s Partners in Care statement which outlines what people in our care can expect from us FRAMEWORK PURPOSE The Framework will assist VCH to reduce potential barriers, deliver improved services to First Nations and Aboriginal people, and provide consistency in developing VCH s ability to meet the needs of First Nations and Aboriginal people. The Framework will be a high level document that will inform the development of structural and clinical processes for the improvement of the health status of First Nations and Aboriginal people and builds on previous VCH s accomplishments and goals. 8 VCH/PHC draft cultural competency policy. Revised April 19th, Vancouver Coastal Health First Nations and Aboriginal Culturally Competent and Responsive Strategic Framework Backgrounder and Next Steps

6 5. FRAMEWORK RATIONALE The framework s rationale: Culture influences health beliefs, practices, values and expectations for and access to care. A variety of patient populations experience decreased patient safety, poorer health outcomes and lower quality care based on, for example, race, ethnicity, language, disability and sexual orientation. When cultural, communication, mobility and other patient needs go unmet, health care organizations put themselves and their patients at risk for negative consequences. Culturally competent services can reduce access barriers, increase the quality and safety of services, positively impact patterns of service utilization, improve clinical outcomes and decrease disparities in health status. An organizational commitment to cultural competency supports the systems, policies and management needed to develop cultural competency at the service delivery level GOAL OF FRAMEWORK This Strategy will guide VCH in becoming a culturally competent organization by the transformation of practice and service delivery. The ultimate goal, fitting with VCH True North Goals (figure 1) will be to improve Vancouver Costal First Nations and Aboriginal patients and community members experience with culturally competent care provided by Vancouver Coastal Health and, thereby, increasing access and addressing health inequities. 7. NEXT STEPS Culturally competent services can reduce barriers, increase the quality and safety of services, positively impact patterns of service utilization, improve clinical outcomes and reduce disparities in health status 10 A. Establishment of a VCH working group to guide the development of the strategic framework. B. Alignment of vision and mission statements with VCH, VCC, and FNHA. C. Development of Values and Principles The values and principles will need to be developed and should encompass the work established by the Aboriginal Health Practice Council 11 : The inclusion of Indigenous health practices alongside mainstream health care is a part of culturally Vancouver Coastal Health is committed to improving the health of First Nations and Aboriginal people and this can only be done in partnership with the community. The Partnership Accord will strengthen the relationship we have with First Nations and will foster greater selfdetermination for First Nations communities over their health care. We look forward to finding creative solutions and approaches as we embark on this new relationship. (Dr. David Ostrow, President & CEO of Vancouver Coastal Health) 9 VCH/PHC Draft Cultural Competency Policy 10 Anderson L. et al 2003 culturally competent health care systems: a systematic review. American journal of preventative medicine. 24(3.Suppl.1) Aboriginal Leadership in Health Care. VCH Aboriginal Health Practice Council, Vancouver Coastal Health First Nations and Aboriginal Culturally Competent and Responsive Strategic Framework Backgrounder and Next Steps

7 competent healthcare practice. Aboriginal health care practitioners are an essential part of delivering culturally competent health services for Aboriginal populations. Aboriginal people are central in the identification, development and delivery of health services to Aboriginal people. Value of Self Reflection and on-going professional development Value of Cultural Differences and Diversity D. Further Development of the Four Key Areas of Interventions The outline of the Culturally Competent and Responsive Framework has been approved by the VCH Aboriginal Health Operations Council and the FNHA Vancouver Coastal Caucus. This draft, based in part on the FNHA Wellness Model, establishes four key areas of interventions: Land is the foundation of which First Nations and Aboriginal people centre their cultural identity around. Cultural Competency of VCH board, management and staff is the foundation in improving access and health outcomes for First Nations and Aboriginal people. In a family, each family member has their roles and responsibilities. For VCH, this means having culturally appropriate structural and clinical processes and policies in place for VCH staff. Communities are families coming together to address the wellness of all. VCH has culturally safe environments that increase access and safety for Aboriginal and First Nations people. Nations are communities that work together to achieve specific goals. VCH and First Nations and Aboriginal communities work together to improve the health status of their people. Each of these four interventions will have their own specific goals, outcomes, action plan and evaluation process. The following are examples of VCH s current work in each key intervention: 1. Culturally Competent Board, Management and Staff: Examples: PHSA online indigenous cultural competency training In-Service workshops for VCH staff Nation specific cultural specific days AHSI Cultural Competency Forum a one day educational opportunities for VCH staff and community members to learn about First Nations and Aboriginal. 5 Vancouver Coastal Health First Nations and Aboriginal Culturally Competent and Responsive Strategic Framework Backgrounder and Next Steps

8 2. Culturally Appropriate Structural and Clinical Processes: Examples: Acknowledgement of First Nations territories Specific policies such as the Ceremonial use of traditional tobacco and smudging medicines Aboriginal Health Practice Council Aboriginal Health Operations Council 3. Culturally Competent Environment: Examples: Sacred Space at Hope Pavilion Blessing of new facilities such as Gibson s new mental health facility 4. Culturally Safe Organization: Examples: Establishment of Aboriginal Health Steering Committee Signing of Partnership Accord E. Development of Evaluation and Communication Plan 6 Vancouver Coastal Health First Nations and Aboriginal Culturally Competent and Responsive Strategic Framework Backgrounder and Next Steps

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