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?