Culturally and Linguistically Appropriate Healthcare Services
Linguistically and Culturally Responsive Care Elizabeth Stanger Regional Coordinator, Language...
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Transcript of Linguistically and Culturally Responsive Care Elizabeth Stanger Regional Coordinator, Language...
Linguistically and CulturallyResponsive Care
Elizabeth Stanger
Regional Coordinator, Language Services, Cross Cultural Health & Diversity
Outline
• Demographic information
• 3 dimensions of service provision• Accessibility• Responsiveness• Comprehensiveness
• Enablers, Challenges & Opportunities
BC Immigration Trends
• 1991-2001 BC received 425,000 immigrants
• Most immigrants settle within VCH region
• 9/10 come to Vancouver
Top Immigrant Source Countries
• 62% of immigrants come from:– China– Hong Kong– Taiwan– India– Philippines
Top Immigrant Languages• Cantonese• Mandarin• Punjabi• Vietnamese• Russian• Spanish• Farsi (Persian)• Japanese• Korean
BC Refugee Trends
• Government-Assisted Refugees 03-05
1,580 in total– Age 19-64 - 950– Age 0-18 - 625
BC Refugee Trends• Top source areas
– African (Sudan, Somalia, Congo, Eritrea, Ethiopia)– Middle East
• Top source countries– Afghanistan (23%)– Sudan (18%)– Iran (13%)– Colombia (9%)– Indonesia (7%)
BC Refugee Trends
• Do not speak English upon arrival
• Top languages– Middle Eastern (Dari, Pushto, Farsi, Arabic)– African (Acholi, Lotuho, Lopit, Lokoya,
Kiswahili, Oromo, Amharic)– Spanish– Vietnamese (not their first language)– Indonesian (Banda Aceh)
BC Refugee Trends
• All begin their health care at Bridge Clinic
• Complex medical conditions
• Complex social and mental health needs
Health Status & Immigrant status
• VCH is the wealthiest health region• But the greatest proportion of both the
rich and the poor– Immigrants/refugees earn less than
Canadian-born– more immigrants/refugees than Canadian
born live in poverty and are among the “working poor”
Health Status & Immigrant status
• VCH is the healthiest region in BC
• “Healthy immigrant effect”– But immigrants’ health status declines the
longer they live in Canada – Refugee health status – complex health and
mental health issues
3 Dimensions to culturally/linguisticallyresponsive service provision
• Accessibility
• Responsiveness
• Comprehensiveness
Accessibility
• Language
• Literacy
• Other access barriers
Language Statistics
• 187 languages spoken in Vancouver
• 50,000 do not speak English or French
• 135,000 speak a language other than English at home
• Over 50% of children speak a language other than English at home
• 1 in 5 face a potential language barrier
Literacy
• Literacy – English and mother tongue
• Health literacy– Knowledge of western allopathic tradition
• Health service literacy– Knowledge and expectations of the health
system
Language Access Programs
• Interpreter Services
• Translated Health Education Materials
• Quality standards for interpretation (1996)
• Translation guidelines (1998)
Interpreter Services
• Current Projects– Community Mental Health Interpreter
Services (pilot)– Translation of child immunization histories– Refugee Interpreter Training/Support
Project (in process)
Translated Patient Education Materials
• Over 300 translated materials
• New regional database for access by patient or providerhttp://vch.eduhealth.ca
Responsiveness
• Cultural and linguistic competence – between patient and provider– in the program– in the organization
Models of Program/Service Responsiveness
• Ethno-specific program/service
• Bridging program/services
• “Multiculturalizing” a mainstream program/service
* A combination of these approaches is needed
Ethno-specific• Healthiest Babies Possible
– Vietnamese, Spanish, Aboriginal
• Diabetes education sessions– Cantonese, Mandarin and Farsi (Persian)
• Adult Day Centres – Chown, Chieng and L’Chaim
• “Language designated” positions– Chinese, Punjabi and Spanish community
health nurses
Bridging
• Cross Cultural Health Brokers– Palliative, perinatal and mental health
• Settlement Health Worker
• Bridge Clinic
“Multiculturalizing”
• Cross Cultural Mental Health
• Community engagement consultations– Hip Fracture Project– Palliative Care Re-design– Mental health services re-design
Comprehensiveness
• meeting the full spectrum of a community’s health needs– what is currently missing?– emerging needs?
Some efforts underway…..
• Substance use and mental health– for Punjabi-speaking community
• Ethnic minority seniors – Geriatric mental health
• Your comments?
• Your questions?