Culturally Responsive Service Delivery learnings from the Qld Transcultural Mental Health Centre

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Culturally Responsive Service Delivery
learnings from the Qld Transcultural Mental
Health Centre

• Rita Prasad-Ildes
• Manager
• Qld Transcultural Mental Health Centre
• 175 Melbourne st South Brisbane
• Ph 3240 2833
• rita_prasad-ildes_at_health.qld.gov.au

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Culturally responsive service delivery (in mental
health care)

• Overview
• Framework discussion of processes learnings
• 4 Dimensions Model of cultural competency
• Building on current multicultural practices

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High Quality (Mental Health) Services
Policy Service Design Framework
Workforce Development Education Training
Research Evaluation
Community Engagement
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High Quality (Mental Health) Services

• Specialist
• Multicultural Support
• Community development
• Consumer and carer support
• Support of clinicians in mainstream
  services
• Mainstream service design
• Specialist services for particular
  populations
• Education and training
• Transcultural research
• Policy advice

Policy Service Design Framework
Workforce Development Education Training
Research Evaluation
Community Engagement
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What are the deficiencies in service delivery to
multicultural communities?

• Lack of cultural competence in the workforce
  (attitudes, knowledge and skills)
• Lack of culturally appropriate service delivery
  models (Eg. Organisational outreach))
• Lack of wholistic approaches fragmentation and
  compartmentalising issues eg children, youth,
  adults services (Funding models)
• Lack of meaningful CALD consumer input into
  planning and development processes

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Definition of cultural competence

• A set of congruent behaviours, attitudes and
  policies that come together in a system, agency
  or among professionals and enable that system,
  agency or those professions to work effectively
  in cross cultural situations.
• (Cross et al 1989)

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Common responses

• Access
• Outreach Information sessions
• Multilingual resources
• Temporary Access Projects
• Multilingual signage

• Equity
• Cross cultural training for staff
• Use of interpreters/bilingual workers (policies
  procedures)
• Integration of Specialist programs/models

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To become culturally competent

• A system needs to
• Value diversity
• Have the capacity for cultural self assessment
• Be conscious of the dynamics that occur when
  cultures interact
• Institutionalise cultural knowledge
• Adapt service delivery so that it reflects an
  understanding of the diversity

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Various approaches to achieving cultural
competence or becoming culturally responsive

• Mandated approaches legislative frameworks or
  prescribed performance measures (eg MAPS in Qld
  govt)
• Mandatory training and monitoring
• Educative approaches emphasising building
  awareness, knowledge and skills

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Cultural competence a shift in thinking and
approach

• An approach that combines mandatory measures and
  incentives is most effective
• Accountability and performance measures
• Persuasive leadership
• Applying existing tools
• Systematic change management strategies
• Using available evidence of what works

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A model Dimensions of cultural competency

• Interplay between 4 dimensions

System Organisation Profession Individual

• Underpinned by
• Knowledge
• Conviction
• Capacity for Action

Each level supports the next
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4 dimensions (Eisenbruch et al 2001)

• Systemic policies and procedures, monitoring
  mechanisms, resources, CALD community engagement
  in planning processes
• Organisational management is committed, staff
  are supported with training, cultural competency
  is core business

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4 dimensions continued.

• Professional Specific professional cultural
  competency standards, education and training,
  ongoing professional development
• Individual Attitudes, knowledge and behaviours,
  individuals feel supported to work with diverse
  communities, clients

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Defining Characteristics of a Culturally
Appropriate (Mental Health) Service

• Types of services offered are determined by needs
  of the population
• Service needs are jointly defined by consumers,
  carers, community, professionals and government
• Those who may require the service
• know of its existence
• regard it as being appropriate to their needs
• can gain easy and timely access
• can communicate adequately with service providers
• have access to the full range of services that
  are appropriate to their needs
• are treated with respect and without prejudice

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Defining Characteristics of a Culturally
Appropriate (Mental Health) Service

• The service responds effectively to presenting
  needs
• Outcome indicators demonstrate that the service
  is achieving the clinical and other goals of
  service providers and recipients
• The quality of outcome is not substantially
  influenced by factors such as English fluency or
  membership of any particular ethnic or social
  group
• Community, consumer, and carer representatives
  are involved in the continuing evaluation, and
  redesign where necessary, of the service
• Minas IH, 1991

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Where to begin?

• Define problems
• Identify causes
• Generate possible solutions
• Have a process for deciding which solutions are
  likely to be effective, feasible and affordable,
  politically acceptable
• Build programs that are the implementation of
  these solutions
• Evaluate the solutions / programs

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High proportion ofinvoluntary admission
Late presentation
Low skills of Clinical staff
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High proportion ofinvoluntary admission
Late presentation
Low skills of Clinical staff
Stigma in communities
No time from work to train
Training courses not available
Dont know of clinical services
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High proportion ofinvoluntary admission
Late presentation
Low skills of Clinical staff
Stigma in communities
No time from work to train
Training courses not available
Dont know of clinical services
Skills not valued by employer
MHS too overloaded
No funds for Training programs
Community education not available to NES
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High proportion ofinvoluntary admission
Effect
Late presentation
Low skills of Clinical staff
Stigma in communities
No time from work to train
Training courses not available
Dont know of clinical services
Skills not valued by employer
MHS too overloaded
No funds for Training programs
Community education not available to NES
Causes
Program Objectives
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Key Learnings (processes)

• Organisational Readiness to invest resources,
  time, people, relationship building
• People champions at every level (champions not
  project officers)
• Partnerships Collaboration (partner with a
  multicultural service)
• Integrated training approach (no one-offs)
• Systems and policies/procedures
• Integrated planning approaches to ensure
  sustainability eg strategic, operational
• CALD Community/consumer engagement

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What can mainstream services do to improve
multicultural service delivery?

• Design culturally appropriate programs (not
  projects!) incorporating language services, and
  culturally appropriate approaches.
• Partner with multicultural organisations.
• Improve cultural competence of staff.
• Research, document and share learnings (and
  failures too!)
• Consult and seek meaningful input from CALD
  consumers using your services