Navigating the influence of Culture in Problem Gambling: Challenges & Strategies

Transcription

1 Navigating the influence of Culture in Problem Gambling: Challenges & Strategies Rani Srivastava, RN, PHD June 2018 ONTARIO PROBLEM GAMBLING & BEHAVIOURAL ADDICTIONS PROVINCIAL FORUM Please do not reproduce or distribute without written approval from Author / Publisher

2 AGENDA 1 Setting the context 2 Culture & Cultural Competence From barriers to Building Blocks Lessons Learned & Key Insights Discussion Q & A 2

3 1 Context & Objective 3

4 Guiding Principles for our conversation 1. We ALL have knowledge to contribute 2. Listen with your ears, eyes, and hear Listen to explore and understand, not to agree or disagree Listen to your own responses 3. Don t judge its not about right and wrong 4. Be Respectful 5. Share your views without worrying about being politically correct 6. Modified VEGAS rule

5 INTRODUCTIONS Who is in the audience? Clinicians Educators Policy Makers Researchers Businesses Community agencies / groups Other 5

6 How would you describe your experience and expertise with working across cultures? A. Mostly uncomfortable /unsure B. Fairly comfortable C. Good working knowledge D. I got this E. I m a good resource for other 6

7 Through participation in this workshop participants will be able to: Describe the core elements of Cultural Competence Explore key elements of own personal and professional culture Discuss strategies to transform cultural barriers into building blocks 7

8 Key References: Ontario Resource Group on Gambling, Ethnicity and Culture (2010). A Guide for Counsellors Working with Problem Gambling Clients from Ethno-cultural Communities sites/default/files/guideforcounsellorswor kingwithproblemgamblingclientsfromethn o_culturalcommunities.pdf RNAO (2007). HWE Best Practice Guidelines Embracing Cultural Diversity in Health Care: Developing Cultural Competence. Available from Srivastava, R. (2007) The Healthcare Providers Guide to Clinical Cultural Competence. Toronto: Elsevier 8

9 Culture, Cultural Competence & Gambling 9

10 Culture is Commonly Understood Learned Traditions Unconscious Rules of Engagement

11 CULTURE: The system of shared beliefs, values, customs, behaviors, and artifacts that the members of society use to cope with their world and with one another, and that are transmitted from generation to generation through learning.

12 Culture

13 Key aspects: Culture as Patterns AND Culture as Power Understand intersectionality as part of cultural identity Culture exists at the micro (self), meso (team / organization), and macro (organization / society /profession) Barriers & Enablers exist at all levels recognize /leverage

14 What do we mean by Cultural Competence? Does NOT meant expertise in a culture or even mastery of cross cultural work Competence is the ability of an individual to do a job properly or effectively - Involves Knowledge, Skill, Judgement and ability to apply that in issues /interactions etc

15 An Integrated Approach: Recognizes the influence of Patterns (Cultural Ways Of Being) Recognizes the influence of POWER, PRIVILEGE & the DYNAMICS OF DIFFERENCE Recognizes the impact of exclusion /marginalization Focus on Self as or more critical than the focus on the Other Culture is NOT a barrier to be overcome but a leverage point Places of marginalization are also places of strength & resilience

16 Cultural Identity Culture Culture

17 Difference & Cultural Identity Social Context Privilege / Marginalization Social Identity Self ascribed Social Identity Ascribed by others Cultural Identity Exclusion, Inclusion, Belonging How is difference experienced? Which differences matter?

18 ABCDE of Cultural Competence AFFECTIVE Dynamics of difference BEHAVIOURAL COGNITIVE

19 ABC(DE) of Cultural Competence HEALTH EQUITY Culturally Congruent Care Optimal Health Outcomes

20 Affective Domain: Awareness -Of culture and it s impact -Of inequities and disparities -Of own biases, beliefs, wisdom and it s limitations - Of personal / professional & organizational culture -Of own power, privilege, ways of being and doing Humility Genuine curiosity and desire to learn Understand Dynamics of Difference

21 Culture Sensitivity... Who you are speaks so loudly, I can t hear what you are saying Emmerson

22 How do others see You?

23 Skills Establishing Relationship & Trust Communication Assessment Bridge the gap Be an Advocate Be an Ally Navigating Difference Making the invisible visible ABC of Cultural Competence AFFECTIVE BEHAVIOURAL COGNITIVE

24 ABC of Cultural Competence AFFECTIVE Knowledge Generic Knowledge Specific Knowledge BEHAVIOURAL COGNITIVE

25 Culture knowledge is also about. unlearning The opposite of a fact is falsehood, but the opposite of one profound truth may very well be another profound truth. Niels Bohr

26 You don't see something until you have the right metaphor to perceive it. Thomas Kuhn

27 Culture Knowledge (in relation to RG) Which cultural groups more vulnerable to gambling? What are the factors that influence that vulnerability? - Values and Beliefs - Help Seeking Behaviours - Process of Acculturation - Minority Group status - Sense of belonging - Barriers to access & care

28 Cultures differ on their style and attitude towards: Conflict Decision Making Disclosure & Privacy Approaches to knowing - What is considered credible - Who is considered to be credible Communication [style, meaning of expressions Individualism / Collectivism

29 Equality & Equity Equality: treat all same Equity: customize for = Outcome

30 Environment / Culture Resources People - Guides, supporters, allies, - Resistors, challengers Organizations and community groups Policies, Processes, Politics Professional guidelines Differentiate received wisdom from knowledge

31 Strategies to transform barriers into building blocks 31

32 Bridging the Gap KEY VALUES 1. Inclusivity Who s not here; who s not heard; differential impact 2. Respect Understand things from a viewpoint different than yours Respecting is not agreeing 3. Value Differences Not right or wrong ; expand your mindset and toolkit 4. Equity Always keep the Goal in mind; Make the invisible structural and systemic barriers visible 5. Commitment Visible results take time 6. Resilience Can be very Challenging - recognize the strengths and the opportunities ; Tap into personal, professional, organizational, and social resources

33 Assessment: Understanding Explanatory Models Some Questions to Consider: How is the issue understood? What does good xxx look like? How do you become healthy? Stay healthy? What gets in the way of staying healthy? Who should /could be involved in your (family member s) care planning / decisions

34 Stories & Exemplars

35 Key Insights / Lessons Learned 37

36 Summary: Key Messages: Everyone has a culture that shapes our interactions Culture exists at the level of individual, group, society Culture is dynamic Culture of the health provider and health system matter as much as the culture of the client Always seek to understand what is below the water line Create SAFE spaces for SENSITIVE conversations Expect and acknowledge differences - Unique strengths of others - Limitations of one s approach

37 Summary: Key Messages: From Awareness to Application (Rani s insights) Avoid judgements... Alter your perspective Self awareness, self accountability Vigilance for miscommunication Courage to explore differences willingness to share your experience and intention Learn the art of apology and humility Be open to new ideas, new ways of approaching something Use your power and privilege to empower others

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