Summary Report
Newcomers and Health: Community Conversation
1.0 Introduction
Two community collaborative groups, The Windsor-Essex Local Immigration Partnership (WE-LIP) and Go For Health Windsor-Essex (GFH) identified the need to address the provision of health care for newcomers. In various forums and processes of the past, health care has consistently been seen as a gap in services for newcomers.
GFH is a coalition of recognized and respected corporations, community health organizations/agencies and volunteers. The GFH coalition is committed to reducing the high rate of chronic disease, mental illness, and injury through the advocacy and support of healthy living policy development.
Local Immigration Partnership Councils are funded by Citizenship and Immigration Canada, with the purpose of supporting the development of community-based partnerships and planning around the needs of newcomers. January 2009 marked the first meeting of the Windsor Essex local Immigration Partnership Council. The membership now consists of over 45 stakeholders representing the following sectors:
• Education
• Police & Fire
• Healthcare
• Housing
• Employers
• Government
• Settlement & Language Service Providers
• Workforce and Economic Development
Since both groups had similar mandates with regards to newcomers the opportunity to collaborate between sectors was encouraged. Therefore, these groups brought the following organizations together to work towards a common goal. Please see the organizations below:
· Multicultural Council of Windsor and Essex County
· YMCA of Windsor and Essex County
· New Canadians’ Centre of Excellence Inc.
· College Boreal
· Women’s Enterprise Skills Training Inc.
· Windsor Women Working With Immigrant Women
· South Essex Community Council
· Unemployed Help Centre
The objectives of the community conversation were:
· Learn how to increase access, reduce barriers and improve health system experiences for diverse populations;
· Enhance relationships and improve collaboration among health care providers, consumers, families, and newcomer service providers;
· Discuss barriers that may lead newcomers to forego or delay care, leading to more serious health problems and increased future costs to the health system;
· Develop services that are responsive to cultural and linguistic diversity; and,
· Learn and discuss some of the challenges service providers have when working with newcomers.
2.0 Summary of Presentations
The agenda was organized to update participants on some of the initiatives occurring in our community so that participants would have a solid context for the breakout discussions. Four presentations were delivered and each is summarized in the following section.
a) Cultural Competence
The first presentation of the day addressed the importance of being culturally competent. The presentation was delivered by Nigel Couch, Diversity Educator, with the Multicultural Council of Windsor-Essex County. The presentation focused on:
· The need for cultural competence including some statistics of our cultural profile
· Awareness of our own culture and its impact on how we deliver services
· Cultural phenomena affecting health
· Quick tips to assist providers
Some of the key concepts shared were:
· Culture background and bias: We allow our past experiences to change the meaning of the message. Our culture, background, and bias can be good as they allow us to use our past experiences to understand something new, it is when they change the meaning of the message that they interfere with the communication process.
· Culturally Competent Health Care is: The ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs
· Knowing about the more common cultures and religions is important, but not as important as the ability to be able to communicate with anyone across cultures even if you have no experience or understanding of that culture
b) Newcomer Research & Promising Practices
The second presentation of the day was given by Lisa Kolody, Director of Programs and Operations at the Multicultural Council of Windsor-Essex County. The purpose of this presentation was to provide an overview of all the research and projects that have occurred under the auspices of the Multicultural Health program and the Community Partners for Multicultural Health.
The Community Partners for Multicultural Health led by the Multicultural Council is a collaborative of 13 health and newcomer organizations whose objectives are:
• Improve access to health services for newcomers
• Promote healthy behaviors among newcomers to prevent chronic disease, and
• Increase the cultural competence of health professionals.
Another driving force behind the work of the Multicultural Health Program is the “Healthy Immigrant Effect”. The Healthy Immigrant Effect has been demonstrated in research. It states that when newcomers arrive they are in better health than Canadians however over time their health status diminishes and their health equals that of Canadians.
Another component of the Multicultural Health program is the nurse practitioner. The Nurse Practitioner (NP) may see any client of the Multicultural Council and/or their family members. The service is free. An Ontario Health Card or other form of health insurance is not required. The Nurse Practitioner operates at both MCC sites. The services include:
• Diagnosis and treatment of common illnesses and injuries
• Provide health promotion and prevention education to individuals and families
• Prescribe medications
• Order laboratory and diagnostic tests
• Make referrals to family physicians, specialists, and other health care professionals.
The following are three examples of recent projects that were shared with participants:
• “Promoting Mental Health & Injury Prevention to Newcomers”
• Completed assessment through base-line surveys of LINC students and teachers in regards to their knowledge and needs regarding mental health and injury prevention
• Developed “The Educators’ Manual & Curriculum Guide to Mental Health and Injury Prevention for Newcomers” as a resource for LINC teachers
• Delivered the workshop on the LINC PD day to inform the teachers and made the resource available to LINC centers
• Delivered 4 workshops on the topics at HAD 2012 with over 150 students in attendance on the workshops
• Increased awareness of mental health & injury prevention and reduced stigma among newcomer through enhanced education
• Post survey among students showed an increase of knowledge including how to access the help in our community if needed
• “Keeping Newcomers Healthy”- provided brief intervention through education that increased knowledge of healthy behaviours among immigrants that are within each person’s control to modify:
• Developed culturally sensitive modules – workshops and activities in cooperation with peer educators, with a focus on the modifiable risk factors: physical activity, healthy eating/healthy weight, smoking and alcohol consumption
• Delivered 14 educational sessions with 150+ of immigrants in attendance
• Developed “Newcomers Guide to Physical Activity” translated in 4 languages including French
• “Your Health Matters – Cancer Risk Assessment Among Immigrants”– in partnership with Erie St. Clair Cancer Prevention and Screening Program, Faculty of Nursing at the U of W and Canadian Cancer Society.
• 6 peer educators implemented culturally sensitive tools with selected ethnic groups ( 300+ immigrants participated).
• Personal cancer risk assessment cards were in plain language and translated.
• The original YHM survey was modified to be culturally sensitive in asking questions research portion of the project with over 290 valid surveys.
• Research received the ethics approval from Windsor Regional Hospital and the University of Windsor that completed the data collation.
• The project delivered the education on cancer risks that increased knowledge of healthy behaviours that are within each person’s control to modify, such as healthy eating, exercise, smoking and alcohol consumption.
The following summarizes the outcomes that have been achieved over the years as a result of the Multicultural Health Program:
• Primary health care services for newcomers
• Awareness/knowledge among immigrants regarding:
• health promotion and screening
• health and social support services
• Awareness/knowledge among service providers regarding health needs of immigrant community
• Availability of translated resource materials
• Availability of resources for educators working with newcomers
• Partnerships/networks to address the health needs of immigrant community
c) Newcomer Health Survey Results
The third presentation was delivered by Michelle Suchiu and Renee Marentette who are part of the Local Immigration Partnership project team. They shared the results of the Newcomer Health Survey with participants. The sponsor of the survey is Go For Health and it was administered in collaboration with the Local Immigration Partnership. The purpose of the survey was to explore various social determinants of health and identify barriers to accessing health care.
A total of 531 surveys were completed by newcomers, immigrants and refugees attending LINC 3+ language classes across Windsor-Essex County. The survey participants were primarily women (73%), landed immigrants (84%) and represented 107 languages with Arabic being the primary language spoken (35%). The following are some of the highlights of the results:
· 36% hold a postsecondary degree or diploma (including 9% holding a Master or Doctorate);
· 10% reported smoking an average of 10 cigarettes per day;
· 88% reported they do not drink (linked to religious practices of participants);
· 66% reported eating 7 servings of fruits and vegetables per day;
· 41% reported they exercise 1 – 2X per week; however 24% do not exercise at all;
· 42% reported their mental health as good; 24% reported mental health as very good and 22% reported as excellent;
· 87% reported they have a doctor found through a family member or friend;
· 58% utilize walk-in clinics; and,
· 45% reported they use an interpreter at the doctor’s office; 57% stated their interpretation is provided by family.
d) Refugees & Health Care Providers: Unique Challenges for Both Parties
The final presentation of the day was given by Grace Lasala who is the nurse practitioner at the Multicultural Council of Windsor-Essex County. The presentation focused on the challenges that are inherent in the delivery of health care to refugees. The challenges are summarized below:
1. System Challenges
· Basic Provincial Health Care Coverage
· Interim Federal Health Program
2. Individual/Refugee’s Barrier to accessing Health
· Difficulty with language
· Finance
· Transportation
· Lack of Familiarity with Canadian Health Care System
3. Health Care Provider Challenges
· Language Barrier
· Feeling Overwhelmed
· Lack of familiarity with Interim Federal Health program: insufficient reimbursement and time, lack of services
· Lack of training to deliver culturally appropriate care
3.0 Feedback Results from Breakout Sessions
Each table received one set of questions outlined below for discussion:
a) What can be done to increase access to healthcare services for newcomers? /What is needed to increase access to healthcare services for newcomers?
b) What can be done to improve collaboration among service providers? /What is needed to improve collaboration among service providers?
c) What can be done to enhance services so they are more responsive to the health needs of newcomers? /What is needed to enhance services so they are more responsive to the health needs of newcomers?
d) What can be done to develop policies that reflect the health needs of newcomers? /What is needed to develop policies that reflect the health needs of newcomers?
There were more than one table discussing each set of questions. Each table recorded their discussion on a recording sheet which was submitted and forms the basis of the results presented in this report. There were a total of 12 recording sheets submitted. All sheets were reviewed and there were some strong themes that arose out of the feedback regardless of which set of questions a group discussed. Therefore the feedback results are presented according to overall themes. The theme is listed and then descriptions of the suggested solutions are organized below each theme.
Theme 1: Training and resource sharing for health care professionals and between health care, community and newcomer organizations
· Provide cultural competency training in ways that are accessible to the health care professional. Short sessions that are at convenient times (i.e. lunch hour) and are located at the health care site.
· Develop incentive programs for taking cultural competency training, for example, time off and continuing education credits.
· Provide cultural competency training on post-secondary campuses to support our future workforce.
· Provide training on available resources to assist in the provision of supports to the patients/clients. This includes knowing what resources are available within own organization (i.e. language line); other health care organizations/professionals and community resources.
· Regular opportunities for networking among sectors.
· Integrate resource-sharing as part of existing events like Health Access Day. Provide a listing for all the organizations that participate in Health Access Day that describes what they do and any culturally specific programs within each organization.
· Share stories of successful collaborations among sectors. Use case studies to generate solutions that present themselves in our community.
· Have one website that holds all culturally competent health resources and allows for sharing.
Theme 2: Provide health information and education for newcomers in accessible and easy to understand formats
· Information sheets on topics such as Interim Federal Health program, health conditions, risk factors.
· Inform newcomers interpretation is available at the hospitals through language line.
· Develop gender-based educational workshops on health screening and testing, risk factors, child –rearing practices etc.
· Expand peer training models used in past projects especially to educate on health care practices that could be considered taboo.
· Target newcomer groups that are underutilizing or not utilizing health services.
· Health care organizations should list and post in a visible spot the languages that services can be delivered.
· Develop and maintain a list of physicians and nurse practitioners who can speak other languages than English/French.
· Develop a booklet/cheat card of common medical terms in various languages.
· Develop electronic applications on health-related topics and for translation.