Understanding cultural competency in a health environment. First Nations and Inuit Health Branch May 2015

Transcription

1 Understanding cultural competency in a health environment First Nations and Inuit Health Branch May 2015

2 Overview Context in Canada Making the case for Indigenous cultural competence as quality improvement Model of cultural competence/humility Individual, organizational, systems, in partnership with Indigenous FNIHB s experience and lessons learned FNIHB Health Canada 2

3 Setting the context Aboriginal peoples have cared for the land now known as Canada for thousands of years prior to contact, and have knowledge systems as complex and scientific as westerneuro based knowledge systems. Culture for Indigenous groups around the world may be one of the most important social determinants of well-being, underpinning sense of belonging, community and health. In Canada today, the population of Aboriginals is the fastest growing in Canada, with numerous court cases affirming their Charter rights. For almost every health and illness statistic, Aboriginal peoples are fairing poorly compared to non-aboriginal Canadians.

4 Defining the challenge In Canada s history, Aboriginal cultures and knowledges have been ignored, disrespected and criminalized - yet this is a history hidden from many Canadians. Many Aboriginal people in Canada have first-hand experience with racism including: Derogatory words Disregard for Indigenous knowledge systems as folklore or myth, less than science Assumption of powerlessness, deficit (expectation we are unemployed, poor, homeless, abusing substances, lack education) Without intentional leadership in healthcare to offset the risk, racism may exist in healthcare and mental health systems. The majority of Aboriginals in Canada actively prepare themselves before going to medical appointments, on how they will respond to racism expected by health professionals.

5 Cultural competence in systems Partnerships between Indigenous and Allies Organizational policies and accountabilities Individual practice/praxis Advocacy and systems change for equity

6 Factors to support individual cultural competence/humility Culture in human interaction History of Canada and Aboriginal peoples, and ongoing impacts Aboriginal current realities, strengths and opportunities Knowledge Values Awareness of own culture, values Capacity and willingness to accept and learn from others ways and beliefs without judgement Awareness of profession s values and beliefs and how they impact on others, and commitment to be part of change Relationship development and collaboration Culturally sensitive practice Self-monitoring and critical self-reflection Skills Wharerata Declaration, RCPSC, FNHMA, Working Together Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice Attributes Recognition of nature and impacts of ascribed privilege and racism Understanding of power dynamics in individual, organizational, societal and political spheres

7 Individual practice/praxis Why? The provider s cultural competence and responsiveness contributes to the client s sense of cultural safety, validation for their unique strengths and challenges What? The knowledge, skills, values and attributes to be responsive to First Nations, Inuit and Métis clients in health and mental health settings. How? Ongoing learning Critically reflective practice in partnership with Indigenous feedback in safety Written into performance management cycles Included in professional competency frameworks and certification Highlighted in national conferences of the profession to set example Modelled by leadership

8 Organizational policies and accountabilities Why? Individual practice cultural competence is supported through organizational contexts, and is only sustainable when supported by the organization. What? Physical environment, policies, leadership and organizational identity create a wrap-around approach for excellence in serving Indigenous clients. How? In partnership with Indigenous organizations and employees Policies which set shared expectation for excellence, including client service quality expectations, HR with accountability measures Representative workforce includes Indigenous at a higher proportion that local Indigenous population, and visible across all levels of the organization Organization champions at senior level Environmental aspects

9 Advocacy for systems change for equity Why? Economical and preventative to adjust whole systems, rather than react and support individual needs. Personal and organizational advocacy are essential to build credibility in Indigenous circles. How? Employees and leaders are seen to be involved in local Indigenous causes and celebrations: Wabano gala, pow wow, volunteer for Aboriginal organizations Organizations lead by example through their support for Aboriginal causes: partnerships with one or many of the numerous Aboriginal organizations in Canada such as the Truth and Reconciliation Commission, etc

10 Partnerships between Indigenous and Allies Nothing for us, without us. The non-indigenous organization walks a fine line to support Indigenous causes, while being careful to avoid undermining (including the perception of undermining) Indigenous decisionmaking and leadership. Given the history of non-indigenous power and colonization, there will be no Indigenous issue solved by non-indigenous alone. It must be in partnership. The process is the product. Relationship is the most important aspect of any approach for cultural competence. The quality of the relationship from the very beginning is the marker for product success.

11 Principled-based training Effective training in cultural competence based in principles that respect both Indigenous and non-indigenous ways of being Indigenous and mainstream knowledges on adult education combine for an andrological approach to training Strength-based - we believe that adults want to learn more to do better, and that all Canadians want to see Aboriginal peoples succeed. Model cultural safety through the team s high quality of training and facilitation, and makeup of half Indigenous and half non- Indigenous Partnerships use opportunities to increase relationship, networking and collaboration between participants, as the Circle is stronger with us all.

12 Lessons Learned Employees want to learn and be more effective. Be transparent about the benefit for participants, and for the organization Cultural competency one of the most difficult topics in adult education, and risks must be managed Classroom safety does not happen by accident, it takes significant skill in adult education and facilitation to manage. Strong emphasis on adult education theory and process - this is not a ppt exercise Build in pre-briefs and debriefs of trainers and facilitators Be ready for the difficult questions This topic may not be led or taught exclusively by non-indigenous trainers. Many participants reflect on the course as transformative not only professionally, but personally.