Re-visioning cultural competence in community health services in Victoria

There are few studies exploring the need to develop and manage culturally competent health services for refugees and migrants from diverse backgrounds. Using data from 50 interviews with service providers from 26 agencies, and focus group discussion with nine different ethnic groups, this paper examines how the Victorian state government funding and service agreements negatively impact on the quest to achieve cultural competence. The study found that service providers have adopted 'one approach fits all' models of service delivery. The pressure and competition for resources to address culturally and linguistically diverse communities' needs allows little opportunity for partnership and collaboration between providers, leading to insufficient sharing of information and duplication of services, poor referrals, incomplete assessment of needs, poor compliance with medical treatment, underutilisation of available services and poor continuity of care. This paper outlines a model for cultural consultation and developing needs-led rather than service-led programs.

Towards cultural competence : Australian Indigenous content in undergraduate psychology

This paper discusses the development and preliminary analysis of psychology undergraduate courses on cultural competence in relation to Indigenous Australians. The paper summarises the process that led to the formation of draft curriculum guidelines for psychology academics, including the need to critically examine the assumptions and history of Western psychology in relation to Indigenous peoples, the inclusion of non-conventional teaching and learning methods, staff and institutional support, and appropriate staff development. The paper then discusses the responses of students to one of the courses developed from these guidelines. The courses were well received by students and although they do not in themselves teach professional psychological skills in working effectively with Indigenous people, they provide a solid basis for the development of such skills. Because this is a relatively new area, it is likely that there will be much refinement of these courses in coming years.

Promoting "critical awareness" and critiquing "cultural competence" : towards disrupting received professional knowledges

There is a compelling argument that universities should be committed to advancing the Indigenous agenda. With respect to social work, as well as to nursing, psychology, and allied health, this commitment is often translated into a single goal: that graduates should be ‘‘culturally competent’’. While acknowledging that there can be tactical advantages in pursuing this goal the current paper develops a practical critique of the expectation that cultural competence is an unproblematic ‘‘add on’’ to professional education. Using a single case study as an example*how the subject ‘‘individual development’’ is transmitted as a monocultural and unproblematic formation*we argue that it is impossible to learn to work cross-culturally without developing a capacity for reflective self-scrutiny. Less likely to be a flag of convenience than ‘‘cultural competence’’, an allegiance to ‘‘critical awareness’’ prompts the interrogation of received knowledge, for example how human development and personhood is understood, as well stimulating an engagement in the lifelong process of reflecting on one’s own ideological and cultural location.

Journalists, remote Indigenous sources and cultural competence

This is the report of the Australian news media and Indigenous policymaking 1988-2008 Australian Research Council Discovery Project.

Moving towards increased cultural competency in public health research

There has been a renewed focus in recent decades on collaborative approaches in community-based public health research and interventions. This is an important grounding for addressing the needs of culturally and linguistically diverse (CALD) communities. But how well do we as researchers prepare for the complexities of working with CALD communities? And what sort of support do we need to meet the challenges of the task? Cultural competence refers to the extent to which researchers, practitioners and organisations have the necessary skills, knowledge, attitudes and policies to work effectively in cross-cultural situations. The shift towards cultural competence in public health is evidenced by the development of policies and guidelines by government bodies and leading research institutions in countries such as Canada, the United States, Australia and New Zealand. This chapter will draw on these guidelines, on models of cultural competency used in welfare and health service delivery, and on collaborative research approaches. A framework for moving towards cultural competence in public health research and health promotion interventions will be discussed, drawing case study examples from the co-authors' community-based experiences. This will highlight the complexities but also the importance of adopting culturally competent strategies in public health research and health promotion interventions. The need for supporting government and funding structures will also be proposed .

An exploration of the notion and nature of the construct of cultural safety and its applicability to the Australian health care context

Cultural safety has been promoted by its New Zealand proponents as an effective process for managing cultural risk in health care and improving the cultural responsiveness of mainstream health services when delivering care to culturally diverse populations. Its effectiveness in this regard has not, however, been comprehensively investigated. A key purpose of this study was to explore and describe what is known and understood about the notion of cultural safety and its possible application to and in Australian health care domains. Findings from the study indicate that the notion of cultural safety is conceptually problematic, poorly understood, and underresearched and, unless substantially revised, cannot be meaningfully applied to the cultural context of Australia.

Cultural respect encompassing simulation training: being heard about health through broadband

BACKGROUND: Cultural Respect Encompassing Simulation Training (CREST) is a learning program that uses simulation to provide health professional students and practitioners with strategies to communicate sensitively with culturally and linguistically diverse (CALD) patients. It consists of training modules with a cultural competency evaluation framework and CALD simulated patients to interact with trainees in immersive simulation scenarios. The aim of this study was to test the feasibility of expanding the delivery of CREST to rural Australia using live video streaming; and to investigate the fidelity of cultural sensitivity - defined within the process of cultural competency which includes awareness, knowledge, skills, encounters and desire - of the streamed simulations. DESIGN AND METHODS: In this mixed-methods evaluative study, health professional trainees were recruited at three rural academic campuses and one rural hospital to pilot CREST sessions via live video streaming and simulation from the city campus in 2014. Cultural competency, teaching and learning evaluations were conducted. RESULTS: Forty-five participants rated 26 reliable items before and after each session and reported statistically significant improvement in 4 of 5 cultural competency domains, particularly in cultural skills (P<0.05). Qualitative data indicated an overall acknowledgement amongst participants of the importance of communication training and the quality of the simulation training provided remotely by CREST. CONCLUSIONS: Cultural sensitivity education using live video-streaming and simulation can contribute to health professionals' learning and is effective in improving cultural competency. CREST has the potential to be embedded within health professional curricula across Australian universities to address issues of health inequalities arising from a lack of cultural sensitivity training. Significance for public healthThere are significant health inequalities for migrant populations. They commonly have poorer access to health services and poorer health outcomes than the Australian-born population. The factors are multiple, complex and include language and cultural barriers. To address these disparities, culturally competent patient-centred care is increasingly recognised to be critical to improving care quality, patient satisfaction, patient compliance and patient outcomes. Yet there is a lack of quality in the teaching and learning of cultural competence in healthcare education curricula, particularly in rural settings where qualified trainers and resources can be limited. The Cultural Respect Encompassing Simulation Training (CREST) program offers opportunities to health professional students and practitioners to learn and develop communication skills with professionally trained culturally and linguistically diverse simulated patients who contribute their experiences and health perspectives. It has already been shown to contribute to health professionals' learning and is effective in improving cultural competency in urban settings. This study demonstrates that CREST when delivered via live video-streaming and simulation can achieve similar results in rural settings.

The dynamic interplay of news media and bilingual education policy in Australia's Northern Territory 1988-2008

his study investigates the dynamic interplay between news media and the Northern Territory’s policy of bilingual education for indigenous children living in some remote communities. It provides evidence to support the argument that the media-related practices of a range of policy actors resulted in policy processes being shaped to a significant degree by ‘media logic’. The research is based on depth interviews and uses the spoken words of participants to gain access to the local experiences and perspectives of those invested in developing, influencing and communicating the bilingual education policy. Through the analysis of more than 20 interviews with journalists, public servants, academics, and politicians as well as indigenous and non-indigenous bilingual education advocates, I have identified a range of media-related practices that have enabled policy actors to penetrate the policy debate, define problems for policymaking and public discussion through the news media, and thereby exert particular forms of influence in the policy process. The study also provides a ‘southern theory’ analysis of the Yolngu public sphere and a Bourdesian understanding of the journalism sub-field of indigenous reporting in the Northern Territory. It shows that issues of physical and cultural remoteness and the need for journalists to develop cultural competence are the hallmarks of this reporting specialization. It also identifies marked differences in journalists’ relationships with government, academic and indigenous sources and how these differences play out in the way participants understand the production and reception of media texts. This research makes an innovative contribution to Australian Journalism Studies by demonstrating how indigenous epistemologies and knowledges offer fresh perspectives and insights about news media and indigeneity that can be brought into balance with northern theories to build what Connell (2007) has called ‘southern theory’. This dovetails with another key outcome, which is the development of an academic form of journalism that serves indigenous peoples’ self-determinist aims for scholarly research, based in indigenous perspectives and research methodologies.

Exploration of the Australian Early Development Index for children with language backgrounds other than English

The Australian Early Development Index (AEDI) is a teacher-administered measure that indicates if children are starting school with the developmental capacity to take advantage of the school learning environment. A key question that arises for schools, communities, and policy makers is how valid the AEDI is for children from a Language Background Other Than English (LBOTE). This study investigated how adequately the AEDI captures the cultural variety of different behaviours and different ways of learning. The study also examined the cultural inclusivity and relevance of the AEDI materials (e.g., teacher training guidelines; administration manual). Ten focus groups (n=84) and various community consultations were conducted with early childhood education and development professionals, representing key service providers, and school personnel. The findings from these studies led to the following recommendations: For LBOTE children, the AEDI should ideally be completed in collaboration, for example, between the child’s teacher and a multicultural consultant. The teacher guidelines for the AEDI need to be enhanced with respect to issues pertaining to LBOTE children, and the AEDI should include additional domains, such as cultural competence and home based/first language skills. Finally, teacher preparation and the AEDI administration guidelines need to clarify and emphasize the intent of the AEDI.