FINDING THE RIGHT HELP: Barriers and pathways to treatment for culturally diverse clients. Connie Donato-Hunt - ATCA symposium - 29 August 2012

Transcription

1 FINDING THE RIGHT HELP: Barriers and pathways to treatment for culturally diverse clients Connie Donato-Hunt - ATCA symposium - 29 August 2012

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3 Cultural diversity in Australia According to the 2011 ABS Census: 27% of Australians were born overseas 16% born in predominantly non-english speaking countries. 20% were Australian born with at least one parent born overseas. 19% spoke a language other than English at home.

4 Born overseas in a predominantly non-english speaking country Source: ABS 2011 Population and Household Census. Interactive mapping

5 Specific risk factors Adjustment and acculturation: Culture shock, language, literacy, social isolation, marginalisation, unfamiliar expectations, disadvantage, unemployment, skills, retraining, discrimination. Loss and trauma: Family separation, persecution, violence, fear for friends/family, loss of community, cultural bereavement.

6 Underrepresentation Despite lower use, data suggests that CALD clients are still underrepresented in services. 87% of AODTS NMDS episodes in involved clients born in Australia. 95% preferred English 1% preferred Indigenous languages 1% preferred another language 3% Not stated/described

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8 Overview of key barriers Accessibility is the opportunity or ease with which consumers or communities are able to use services in proportion to their need. (Whitehead, 1990)

9 Overview of key barriers Because of the health provision nature of our services, it is essential that applicants be able to speak and understand English. (Drug and alcohol service manager, 2007)

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11 Case study - Priya Priya was arrested for drug related crimes. He is currently a member of a therapeutic community. Priya is 30 years old.

12 Barrier 1 Stigma and shame I ve cut them [family] off because I don t want to bring them into this world...they don t know how to act in that world I don t want to bring any more trouble to my parents, let them live their life and just get this over with. (Priya, 2009)

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14 Barrier 1 stigma & shame Strategies: Understand expectations to build a better life, to honour the sacrifices of migration and resettlement. Address separation or ostracisation (from family or community) where it has occurred in response to disclosure of illicit drug use.

15 Barrier 2 - Coexisting issues I m from a third world country...a lot of civil war, lot of terrorist attacks...all the shit I ve seen, I used weed to numb it out, or forget about it... I had no friends, didn t know English...there was nothing...so isolated. (Priya, 2009

16 Barrier 2 - Coexisting issues Strategies: Understand psychological problems and don t lump us all together. All the agencies lump us as all in the same category, and we re not. (MA, 2009) Provide assistance for mental health. Coordinate care for specific needs, address needs holistically.

17 Case study - Daniel Daniel is a client of a community based residential mental health program. He was referred following admission to a hospital based mental health unit. Daniel is 19 years old.

18 Barrier 3 Fragmented care The first service would be my local doctor when I was first suffering from symptoms of psychosis and depression he didn t really understand he sort of referred me to services that weren t suitable for my illness...i just think I could have been treated by my local doctor a lot earlier before it got too intense (Daniel, 2009)

19 Barrier 3 Fragmented care Strategies The importance of no wrong door and referral. Be more involved role in the referral process to assist in clients overcome barriers of language and not understanding the system.

20 Barrier 4 Individualist approaches When I first moved in here they kind of kept me from my family for a little bit because they wanted me to live more independently, but my family, because it s such a big part of my life, I really struggled without my family. (Daniel, 2009

21 Barrier 5 Individualist approaches Strategies: Involve family where appropriate. Try to understand where people are coming from e.g. collective v individualist. Make adjustments. Link with bilingual / bicultural health professionals. Don t make assumptions about clients culture & behaviour if you get a new client and you re not aware of their culture look into it, get educated and be respectful. It s okay to ask questions if you re unsure; just do it in a polite way. (TO, 2009)

22 Communication barriers JOSHUA GORCHOV

23 Interpreter services underutilised Survey of 50 drug and alcohol workers, combined caseload of 1,482 current clients mix of service types Language indicators Number Percent Speaks a language other than English (n=1425) Mainly speaks a LOTE at home (n=1445) Prefers to speak a LOTE (n=1462) Does not speak English well (n=1442) Requires an interpreter (n=1462) 76 5 Review of 14 AOD NGO services in Sydney in 2007 only 2 clients had used an interpreter in the last 12 months.

24 Interpreter services available Health Care Interpreter Services state funded. Translating and Interpreter Services (TIS) National Free interpreting services to non-english speaking citizens and residents communicating with: Medical practitioners providing Medicare services Non-profit, non-government, community-based organisations for case work and emergency services Pharmacies for the PBS medications Other services local government, trade unions

25 Some communication strategies Utiliseinterpreter services wherever possible. Include budget in funding applications. Find out what strategies the client uses (they deal with language barriers daily). Non-verbal communication (silence, eye contact) Give space for observation. Have translated material available. Don t assume literacy or numeracy in another language.

26 Overview of key barriers If something significant happens or something is going down sometimes, no matter what you say in English, it s better in your own language said. (CALD client, 2009)

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28 What is effective? Participants attributed positive experiences to flexible, individualised and personal service delivery. Clients identified empathy, positive communication, a caring approach and workers not being judgemental. If a person comes in and they don t feel that they got some empathy and some support in their first contact, I don t think they re likely to come back. That s why I never followed it up after [service], I just went away thinking, Well this person doesn t give a shit. (QM, 2009)

29 Some things to be mindful of When working cross culturally: Try to be aware of your own assumptions Try to understand others assumptions Why do people hold the views they hold? What beliefs / values are influencing their behaviour? Don t be afraid to ask questions Modify and adapt your approach

30 And in the end There is still some way to go in building clear pathways to services for people from a CALD background with drug use and mental health issues. Hopefully this discussion has provided further understanding for improving service access and outcomes.

31 Acknowledgements Colleagues at DAMEC, particularly Ian Flaherty. Research partners at NCPIC John Howard & Anthony Arcuri SBS documentary Once Upon a Time in Cabramatta Episode 3, used with permission.

32 Contact Thank-you for your interest. Contact: Connie Donato-Hunt Or DAMEC, Rachel Rowe