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To begin I would like to acknowledge the traditional owners of the land on which we meet, the Wurundjeri people of the Kulin nation, their elders past and present.

WHAT I’LL BE TALKING ABOUT

A bit about my agency

The need for culturally responsive service provision

Cultural Competency as a framework for the context of culture

The impact of literacy – and learnings from health literacy

Some examples of CEH work that has a cultural competency and health literacy framework

Firstly, thank you for inviting me to speak today and thank you for coming to hear me. The context of culture is a topic that I think is sufficiently vague enough to allow me to speak about what I want, and I do appreciate that.

Unfortunately a lot my talk, particularly the examples are within a health setting. That is because it is where CEH mainly works. That should be OK because the methodology and the content are transferrable – from a health setting to a justice setting. And for today I will focus on the areas of most similarity.

Early intervention and prevention – in a health setting that is health prevention.

And another reason the learnings transferrable are that we work within a very broad understanding of health – one’s that include the principles of social justice. We are guided by the social determinates of health – that is:

The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries1.

The other thing you will notice as I move along my talk, is that the onus for getting it right – is on us. We are the one’s getting paid to deliver a service, to do a job. It is our role to ensure that the refugee

1 http://www.who.int/social_determinants/en/

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or migrant client are fully engaged and informed in a culturally competent and appropriate way.

CEH’S MISSION

So, who are CEH?

At CEH our mission is to improve the health and wellbeing of refugee and migrant communities. We do this not by providing services to members of these communities but by building the capacity of service providers to work with refugee and migrants directly. We also work with refugee and migrant communities on education and advocacy on health and wellbeing issues.

Primarily we are funded through the Victorian government to deliver three programs; one in the area of problem gambling; one in the area of sexual health, HIV, hepatitis and BBVs/STIs; and the third works with service providers – hospitals, community health, government services and so on. We have an extensive training program, a library, as well as undertake research, and innovative programs/projects.

GALBALLY REPORT - 1978

I want to spend a fair amount of time talking about cultural competency as I do think of that as the solution … but before I do that I probably need to spend a bit of time defining the problem.

Given that I am working within that ‘building capacity’ service delivery space I’ve been thinking a lot about good, culturally competent service delivery.

If we did what would it look like - a service that is crafted in such a way that a person’s cultural and language differences become enablers in their service delivery and not barriers.

And while today is not about a history lesson, I do think it’s important to have a look back into the history books to understand how the debate for a more culturally relevant service provision started and where we are at today.

Multicultural service provision really came out of the Galbally report in 1978. After over 30 years of post-war migration the policy of assimilation was no longer working.

During the 1950s and 1960s, there was a growing awareness that Government services needed to respond to the growing complexities

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of community needs, including, the needs of large numbers of migrants.

It was recognised that governments has to define more clearly ideas about the relationship between the receiving society, and newcomers.

Assimilation was seen as outdated, ineffective and undesirable. By the mid-1970s 'multiculturalism' had evolved as the dominant policy approach to address Australia's cultural diversity2.

The Galbally report reviewed existing settlement services, and outlined a program of action. The review was based on four guiding principles:

1. All members of our society must have equal opportunity to

realise their full potential and must have equal access to

programs and services;

2. Every person should be able to maintain his or her culture

without prejudice or disadvantage and should be

encouraged to understand and embrace other cultures;

3. Needs of migrants should, in general, be met by programs

and services available to the whole community but special

services and programs are necessary at present to ensure

equality of access and provision; and

4. Services and programs should be designed and operated in

full consultation with clients, and self-help should be

encouraged as much as possible with a view to helping

migrants to become self-reliant quickly3.

2 http://www.immi.gov.au/media/publications/multicultural/issues97/macpape3.htm accessed 28 July 2008 3 http://www.immi.gov.au/media/publications/settle/_pdf/chap01web.pdf accessed 25 July 2008

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I know that multiculturalism has changed, developed and adapted since its inception. It has also been the victim of many government and bureaucratic directions.

To me what is evident that we still have a limited understanding of the impact of a person’s language and culture to their participation in some of our biggest institutions – health, justice and education, despite countless studies and reviews both in Australia and overseas.

And this is evident in the limited requirements and systems we have put in place to: identify, record, plan and implement cultural diversity within our service systems.

Without identifying, and acknowledging, the cultural and linguistic requirements of each client, as part of their service, within the service system, we are relegating diversity to the second tier – part of the things we will deal with when we get time to do it.

It also means, an inconsistent level of service. Agencies and individuals within agencies that have an ideological commitment to delivering a quality cultural diverse service, have developed innovation that ensures a client-centered response.

And that, ladies and gentlemen is the problem.

There is no funding or reporting incentive for responding to the cultural, or linguistic needs of the client – there is a problem and there is no carrot or stick to respond to it. It just sits there waiting for our goodwill.

So, while there is not a lot of government movement in this area – if you scan for the latest trends and buzz words in the area of multicultural service delivery there are three components:

1. Cultural Competency 2. Language Services 3. Health Literacy

I don’t really want to go into the issue of language services. Hopefully I will take the fact that as you are here as you know how important it is it engage with professional interpreters and translators at all the appropriate ways – and if not, please ask me when we open up the discussion.

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I do want to focus on cultural competence and health literacy. There are a number of reasons for that. They are important concepts that place what we do in Victoria and Australia into an international context, and, while the benefits of working within a cultural competence and literate way will benefit refugee and migrant communities – it is also a framework that includes all disadvantage. It’s a framework that identifies the most marginalized from the service and incorporates change.

I keep talking about health literacy – but it could be justice literacy – it’s a concept about comprehension and informed choice. But more of that in a few minutes.

Let’s start with Cultural Competency.

CULTURAL COMPETENCY

CEH has been working in the area of cultural competency for a number of years. We like it because it’s a systems approach to responding to culture and difference.

Cultural competency is a way an organization can structure itself to better respond to diversity, and to disadvantage.

While there are clear benefits for migrant and refugee communities, a culturally competent organization will directly address the access and equity barriers experienced by all people.

Cultural competence requires that organizations:

• have a defined set of values and principles, and demonstrate behaviours, attitude policies and structures that enable them work effectively cross-culturally.

• have the capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge, and (5) adapt to the diversity and cultural contexts of the individuals, families and communities they serve.

• incorporate the above in all aspects of policy making, administration, practice, service delivery and systematically involve consumers, families, and communities.

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(Adapted from Cross, 1989)4.

And why is it important?

Cultural competency is one of the main ingredients in closing the disparities gap.

That is because culture and language influence:

belief systems;

how illness, justice and causality are perceived; (both by the patient/consumer and the behaviors of patients/consumers who are seeking assistance and their attitudes toward health care providers;)

the delivery of services by the provider who looks at the world through his or her own limited set of values, (which can compromise access for patients from other cultures. )

Currently in Australia we haven’t done very much in the area of cultural competency. There are no policy or funding requirements, or any government principles or directions to do so.

CEH been working with an American model that we adapted to an Australian setting. It has identified seven domains or seven areas of activity within a service system, where responding to cultural diversity should be present and visible5.

7 DOMAINS OF CULTURAL COMPETENCY

1. Organizational Values 2. Governance 3. Planning, monitoring & evaluation 4. Communication 5. Staff development 6. Organizational infrastructure 7. Services and intervention

My argument is that without addressing these seven areas within the one organization you will not be able to effectively engage with refugee and migrant communities. I know this message is a bit hard core – and most people don’t want to hear it.

4 http://www.minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=11 23/6 5:50pm 5 http://www.ceh.org.au/culturalcompetence.aspx

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But just tweaking things around the side – which is how most of us operate - is not sustainable. Communities are sick of putting in and giving to us, the funded service providers, and then the worker leaves or the priorities change, or the funding disappears. The same issues and problems keep going around like a roundabout. I am arguing that we should try structural change to break the cycle.

And I know that there is no additional money or funding requirement for cultural competency, but there is a growing body of work that is does make a difference.

I’ll give you an example of work we did within cultural competency that produced some tangible difference.

WESTERN REGION HEALTH CULTURAL COMPETENCY AUDIT

In 2008, CEH undertook a cultural competency audit of Western Region Health Centre. Over a 12-month period we conducted an intensive document review, interviewed 32 people and conducted 8 focus groups. The review is confidential but the executive summary can be found both on our website and theirs.

One of the recommendations that emerged from this work was the notion of introducing a greater emphasis on self-reflective practice for staff when working in cross-cultural situations.

The findings indicated that although staff demonstrated a high level of awareness of, and sensitivity to, the various cultural backgrounds of their client populations, little attention appeared to be given to their own cultural self-awareness and the impact of this on their practice and consequently on the health outcomes of their clients.

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CROSS CULTURAL SELF-REFLECTIVE SUPERVISION GROUP So CEH developed up a model ‘Cross cultural self-reflective supervision group’ and we’ve been working with WRHC to pilot it. The aims of this group are three-fold to:

Provide staff with a forum to share, discuss and explore issues arising from their cross cultural practice in a facilitated and supportive environment

Increase participants’ awareness of the impact of culture on service usage and provision (both from clients and self)

Provide participants with strategies to competently and appropriately negotiate cross cultural service provision

Every month a group of counselors come together in a facilitated discussion. The model is being evaluated and will be detailed on our website around the middle of the year.

What I like about this example is that it’s not a flagship project, but it’s very important. It feeds into existing organizational ways of doing things. It’s giving more skills to the workers, and does not place the expectation of change just on the client. It was also an activity that keeps the agency on the continuum of continuous improvement.

It also directly addresses notions about ‘the context of culture’. When CEH delivers training – and we do a lot of that – one of the first concepts that we try to explore is that it’s not just the client or community that has ‘culture’. We all have our own culture and that culture influences how we work. Sometimes the message gets through, other times it’s more of a struggle.

But if we have a structure – cultural competency – from where we can explore culture and it’s impact within service delivery and organizational values and communication – then we can change our organization to allow more space to make a person’s language and culture an enabler within service delivery rather than barrier.

The role of cultural competency audits, self-audits and action plans are gaining momentum. Late last year CEH undertook an audit for our organization, and are just building on our plan. We are working with Melbourne University on a self-audit tool that hopefully will be available on line in a year or so. Otherwise there are lots of good American ones if you search the internet.

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The project that we are doing with Melbourne Uni – The McCaughey Centre is very interesting. A couple of years ago a women called Elisha Riggs undertook a PhD about oral health within refugee communities. Her PhD found that the barriers to communities accessing oral health services were two-fold:

Low levels of oral health literacy That is that they didn’t know about regular health checks, or the impact of sugar on the teeth, or the need to brush teeth after eating. In fact her research found that there were a number of examples of young children from refugee backgrounds were having all their teeth pulled out at 3 or 5 years old, waiting years for their adult teeth to grow.

Cultural competency of dental services That is, if they did make it to a dental service their experience of culturally sensitive service delivery was so bad they wouldn’t go back.

And this is a really important lesson – that undertaking early intervention and prevention is not enough. To many times, a project falls down because all the attention has been to get them to the door. No-one has thought about what happens next. That’s what cultural competency does.

America’s Cultural Competency

Last year I went on a bit of a fact-finding mission in the US, birthplace of cultural competence. And it was interesting! Now I would never advocate that we adopt their systems, particularly health, but there are some useful learnigns.

In health, the American government does not provide the bulk of their services that is left for the health insurance companies. The only areas they do provide services is Medicare and Medicaid. That is, for the over 65 and the highly, highly disadvantaged.

So unlike Australia, there are very few levers the government can apply. One is a government framework.

CLAS STANDARDS

The Federal government has developed a framework of cultural competency, and that sits within Office of Minority Health, Department of Human Services where they have developed the CLAS

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standards – the National Standards on Culturally and Linguistically Appropriate Services (CLAS)6.

The 14 standards are organized by themes:

Culturally Competent Care (Standards 1-3),

Language Access Services (Standards 4-7), and

Organizational Supports for Cultural Competence (Standards 8-14).

I like the CLAS standards because they are a clear indication of what the government expects from its services. And agencies and people within agencies can use them as leverage to change how things are done.

At this time it’s also worth taking a look at some work that is happening in some of the different states across America. A few States, those with high cultural diversity, have chosen a different lever to operationalise cultural competency - within education and legislation. Currently there are only 5 States that have legislated for cultural competency and another 6 where it is in consideration – but what they have chosen to put in is interesting.

Now for some reason that I never thought to ask, the legislation only relates to the health sector. But it still has relevancy for the service sector in general.

CALIFORNIA LEGISLATION

I’ll use California as an example, in 2006 they passed the CALIFORNIA ASSEMBLY BILL 1195 - Cultural and Linguistic Competency.

The requirement of Bill 1195 is that: continuing medical education activities with patient care components are to include curriculum in the subjects of cultural and linguistic competency.

And its intent is to encourage health professionals, and the Continuing Medical Education sector, to meet the cultural and linguistic concerns of a diverse patient population through appropriate professional development.

6 http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15

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It is the expectation that all continuing medical education (CME) planners and speakers participating in CME activities incorporate linguistic and/or cultural competency issues relevant to the topic of their presentation. Suggested approaches to meet this requirement are as follows:

1) Include relevant information on differences in prevalence, diagnosis, and treatment of medical conditions in diverse populations.

2) Apply linguistic skills to communicate effectively with the target population. This may include linguistic translations of common terms in your topic area.

3) Utilize cultural information to establish therapeutic relationships.

4) Incorporate pertinent cultural data in diagnosis and treatment of your topic.

5) Include cultural and ethnic data to the process of clinical care in your lecture.

6) Include recommendations for appropriate cultural and linguistic resources (websites, handouts, reference cards, patient education, tapes/CDs/handbooks, local resources, etc.) in handout materials. Resources are available at http://cme.ucdavis.edu.

A CME planner may offer specifically designed and focused activities within a larger program, or incorporate the elements suggested above into relevant sessions.

Now, I know that nothing there is new to us – these are topics and themes that we work on, we have the Australian context and more complex work has been done in Australia. The difference is that while here the work is done on the fringes of services, there, they are developing a series of drivers that will impact a whole generation of practitioners.

When I did a bit of web searching around the justice system and cultural competency what I discovered is that the only local stuff is to do with the indigenous community. And in the States, the debate is growing about the need to include cultural competency within legal education – particularly including education within a practice setting. It seems that like here the health sector is doing a bit more right now.

But what I like about the American response to cultural competency is that they federal government have put up an ambitious expectation

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in the CLAS standards and then have created a space for continuous education for cultural competency as a professional requirement.

When practitioners have to learn about cultural competency within their undergraduate courses – and then is reinforced with continuing education - it has to make a difference.

I do want to acknowledge that where it falls down, and the weakness of the American System, is in the implementation. And that is where the health insurance companies take over. But again the economic argument for cultural competence is growing, and so is their interest in this space.

Health Literacy

Health literacy is also another emerging area of activity for CEH. And while I keep talking about it in a health context it is also very relevant within your work … we could call it justice literacy.

And no, it’s not about the reading and writing skills. It’s structured around comprehension – and the ability for an individual to make an informed decision. It is about us framing the information in a way that has both a cultural and individual meaning for the person we are communicating with. And then enabling them to take that information to make their choice. I think this concept is just as important in justice because so much of the information that you work with needs to be understood by the client and community.

Health literacy works on comprehension, decision-making and empowerment. It addresses more than the communication interaction and has the opportunity to look at the whole person.

So, when I am talking about health literacy I am thinking big:

Health literacy requires knowledge from many topic areas, including the body, healthy behaviors, and the workings of the health system. Health literacy is influenced by the language we speak; our ability to communicate clearly and listen carefully; and our age, socioeconomic status, cultural background, past experiences, cognitive abilities, and mental health. Each of these factors affects how we communicate, understand, and respond to health information. For example, it can be difficult for anyone, no matter the literacy skills, to remember instructions or read a medication label when feeling sick7.

7 US Department of Health and Human Services. National Action Plan to improve Health Literacy. May 2010

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So, if I was to put into a justice framework it would be similar.

Justice literacy requires knowledge from many topic areas, including the body, healthy behaviors, and the workings of the justice system. Justice literacy is influenced by the language we speak; our ability to communicate clearly and listen carefully; and our age, socioeconomic status, cultural background, past experiences, cognitive abilities, and mental health. Each of these factors affects how we communicate, understand, and respond to justice information. For example, it can be difficult for anyone, no matter the literacy skills, to remember instructions or read a medication label summons when feeling sick.

Another similarity is we are both targeting vulnerable population groups – and looking at the systems and structures that need to change to support them. And based on the strategic plan of Victorian Legal Aid we are both undertaking a lot of early intervention and prevention work – where justice literacy can sit very nicely.

Justice literacy can also sit within the individual communication between practitioner and client. In fact in the States, where it started, that’s how health literacy began. With doctors sick and tired of patients continually turning up and never getting better. They realized that the patients were not understanding so started breaking down the communication.

According to the ABS’s 2006 survey on health literacy 60% of Australian’s are health illiterate, which is a huge number in itself8.

The fact that 75% of people born in a non-English speaking country are also health illiterate, means that the issue is even more urgent with this population group.

Health Literacy is a good thing – to be literate is to understand what is happening to your body, understand what your practitioners and clinicians are telling you, what your options are for your health status and what the best choice is for you based on your health beliefs and the consequences of those decisions.

It doesn’t mean the person will make the right decision, just an informed one.

Health literacy isn’t all about communication, but it does identify the role of culture in communication. It also recognizes how we need to

8 http://abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/4233.0Main%20Features22006?opendocument&tabname=Summary&prodno=4233.0&issue=2006&num=&view= Accessed 10 October 2011

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be developing systematic responses – a reference back to cultural competency.

Here’s an example.

A few years ago CEH worked with a health promotion agency on a program they had developed as an early intervention for chronic disease management – that is a behavior changing program for people diagnosed with early on-set diabetes. Our work was on assisting the agency make the curriculum more health literate for the participants. One of the questions within the course was ‘dreams – what do I want my future to be like?’ the problem was that when we focus tested this concept within two ethnic communities they didn’t think of their health in ‘dream terms’ so the concept was foreign. They responded that dreams are unattainable so they didn’t understand why they were being asked about unattainable things.

They told us that they didn’t know how to respond nor conceptualize the question. So they ignored it. Now, within the space of chronic disease self-management goal setting is essential.

This is a great example of how some basic concepts being missed would result in the whole program being ineffective. It’s not about the language but the construction of the concept.

And let me say that the program was developed through research – there was a strong evidence base that this program worked overseas – it just the research didn’t factor in health literacy of a migrant population. And with 60 – 75% or the population health illiterate we need to be thinking in those terms.

Image if the ABS did a survey on justice literacy, I wonder what the results would be.

Literacy good practice argues that all written material should target a grade 5 level. This is recognition of the relationship between low health literacy and education – which is an example of the connection to health inequity - unfair and unavoidable differences in health status between population groups.

There is a body of work to consider about all the communication encounters that a person faces within a service environment. And the other factors prevalent that can be blockers in the communication encounter. Health literacy is also about the way-finding; the receptionists and even the incidental conversations that happen in the corridor.

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Going back to the teeth tales project – getting them through the door is one thing, getting them to come back a completely different thing.

In 2008 a study of health literacy practices in community settings was released by the American Commonwealth Fund9.

This study wrote about an agency that identified that the posters on the wall were intimidating. That having all this written information around the community health center became a reason for people to feel intimidated and disconnect from the whole agency and their health. The service responded by taking away any posters and instead provided each person with a clipboard, paper and a pen – and the person became the owner and creator off all the information that they would take home. The service turned the written language from a blocker to an enabler.

The point I am making is that we need to be systemic about how we consider the barriers to effective engagement, and we also have to consider how much change we within a system can manage.

Whether that system be our own organisation or the legal system.

Much of the work CEH undertakes is within a partnership, and so I would like to finish off today by talking about some partnership projects and approaches that we have adopted. CEH works within the partnership model because there’s only about 22 staff there so it’s going to be very hard for us to change the world alone. But there’s also other reasons for that:

• We don’t want to work in a vacuum or just preach to the converted;

• Our specialization is building the capacity of service agencies so we need to work with the service agencies;

• We want to make real change and address real life problems • There are many good people and good agencies out there

doing great work – and a partnership approach can enhance that.

9 http://www.commonwealthfund.org/Publications/Fund-Reports/2008/Jan/Health-Literacy-Practices-in-Primary-Care-Settings--Examples-From-the-Field.aspx

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Many of our partnership have included with both service providers and community agencies and leaders. And in this situation the best advice I can give is that the relationship part takes a long time! I would like to show you a DVD from a project that CEH undertook with a number of partners some years ago. It’s a good one as it’s been undertaken from a health literacy framework – that is getting the target group to construct meaning to the message. The project is based on the understanding that there is a lack of meaningful information available for people from culturally and linguistically diverse backgrounds about hepatitis C related issues. The project started with the Arts and Culture Program at NRCH – The organisation CEH sits under – but as the project developed it moved to CEH, though the creative component stayed with the arts and culture team. Primary it as a series of videos developed for Vietnamese-Australians at risk of hepatitis C – young people, prisoners and post-release and juvenile justice. The project has worked across sectors and organisations, across cultures and languages and even subcultures within the Vietnamese-Australian community. Vietnamese-Australian inmates of Fulham Correctional Centre (Sale, Victoria) participated in the development of concepts, scripts and creative treatment for a short video Together We are Strong (Doan Ket La Suc Manh) which is narrated in Vietnamese with English subtitles. PLAY TOGETHER WE ARE STRONG – 6 MINUTES What’s important is that no-body but Vietnamese prisoners could have made that DVD. They are the best to depict Vietnamese prisoners in a way that under represent them or make them into a characterization of themselves. They will know how much of the western and how much of the Vietnamese to include to keep the relevance for the target audience. They alone can ensure the success of the message.

The other example from CEH comes from the problem gambling program, MGHP:

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Health literacy is about creating meaning and explaining so that the client or consumer can make their own informed decision. This isn’t easy particularly as we bring along our own cultural assumptions.

Problem Gambling has a strong cultural links. How we react to gambling and problem gambling is very culturally determined. If you study every culture in the world I am betting you will find that they each have some type of gambling – even if it is banned or forbidden by the powers that be. Whether it’s two spiders climbing a wall or pokier machines or tattslotto, if you look around enough you will find something.

In Victoria we have a very distinct notion of gambling – we have responsible gambling and harmful gambling. We have legal gambling and illegal gambling. We have services that can help you gamble and others that help you if you have a problem. It’s complicated.

At our MGHP program we work closely with the Gambler’s Help services across the State to support them in developing and responding to ethnic community needs on education and prevention around problem gambling. And much of what we do has to do with levels of gambling literacy – new communities here do not know the lay of the land.

Gambling is a government endorsed activity – that means something. In our culture gambling is more than tolerated, it’s part of the culture. But it can be dangerous, particularly for disadvantaged communities.

We regularly work with communities to develop social marketing campaigns about problem gambling. We use a health literacy model where we provide information for them to make the decisions.

It’s collaborative and developmental.

First up we identify an ethno-specific or multicultural organization that is interested in exploring problem gambling in their community. Then we approach the relevant gambler’s help agency. Usually these projects are regionally based so that’s pretty easy.

Then there’s the first stumbling block comes as we slowly and painfully sign a series of MOU’s outlining the roles and responsibility for each signatory. The other thing is that we pay the ethno-specific agency for their participation.

The theory is that CEH and the gambler’s help agency get paid by Office of Gaming and Racing – so all the partners should get paid.

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Next we set up a taskforce – members are identified and invited by the three partner organizations. We seek community leaders, service providers that are directly involved with that community. For some that will be settlement workers, others it is aged care workers. It depends on the community and their settlement. And it’s always different. On a few taskforces we have had representatives from legal aid – because for that community it was relevant.

Next is information sharing.

The community leaders (who also get paid) talk about their community, its structure and its problems. The Gambler’s Help agency talk about what is gambling and what is problem gambling, the other service providers add in their experiences with the community. The ethno-specific agency is the secretariat working on issues between meetings and ensuring participation during meetings and CEH drives and funds the project.

Once the education and relationship building part has started we develop a social marketing campaign. It’s based on collaboration – with the unique understanding of where the community is at the moment and what they need to support their communities’ knowledge on gambling and problem gambling.

Now, at the beginning almost all the communities are not that interested in problem gambling. There is the shame component. For others it is so engrained with the communities’ culture that they feel they have the structures to support their members. For other communities their other problems are so great that they don’t have time for our nonsense.

And in a way I agree with them – many times what we have to tell them is all about us – it’s our issue and not theirs, and this is particularly strong in early intervention and prevention. And that’s where leverage comes into it – how we turn their agenda and our agenda into a mutually beneficial agenda.

Many times, particularly emerging community members get caught up in gambling because of significant other problems where the gambling is really just one of the symptoms. By working with a taskforce that is multi-dimensional and includes within it competing priorities, we can develop a complex and multi-level analysis of the situation and response.

One that includes social isolation, financial difficulties or language barriers. When we work with communities we need to construct the

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solutions to respond to their concerns. With one community we sponsored a soccer tournament. Another community we developed a calendar list all the culturally relevant activities in the area.

As part of the social marketing campaign they develop a tag lines and the visual for each of the collateral we develop.

I would like to show you some of the posters, so that you have an idea of how the communities have managed to ‘cut through’ from our complex messages to impact their communities.

What’s very interesting is that how most of these posters would not work within a general Australian context. This alienates me as much as some of our advertising alienates them.

CONCLUSION

When I was asked to give this presentation I said that I don’t know enough about the justice system. I was worried that I would be talking apples and you wanted to hear all about oranges.

But after looking at the strategic plan – I discovered a lot of synergies.

• uphold rights and due process • focus on early intervention and prevention • build the capacity of clients to resolve their future problems

without legal assistance • deliver a wide benefit to the community

Cultural competency is the space where services should be delivered.

Adapting a health literacy framework - changing it into a justice literacy framework - for the early intervention and prevention work will help you become more focused on the information, communication and comprehension barriers of refugee and migrant communities.

Because there’s a lot more money and a lot more services within the whole gamut of health there is a lot to learn. Both from the successes and the failures.

But also, we are talking about the same population groups – the list of people you will be targeting because of disadvantage:

• Aligning our services with priority client groups and their needs, focusing on people who are poor, children and young people, women and children experiencing, or at risk of, family violence, culturally and linguistically diverse (CALD)

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communities, people in State custody, people with mental health and disability issues, and indigenous people

This is probably a very good argument for us all working with less of a silo attitude.

When I was in the states people were talking about health literacy, numeracy literacy, financial literacy … the list kept getting longer. Today I am adding justice literacy.

At one stage I turned around to people and asked them if they thought there was something wrong with our education system because there seems too much that we haven’t understood.

Obviously with migrants and refugees it’s easier to understand because they weren’t educated here. For other disadvantaged population groups they too had disrupted schooling or mental health issues. But we are talking about 60% of the population!

I think that there is something about our culture that does not enable us to fully comprehend what we need to make to make an informed decision.

And because of this there is an onus on service providers – of every disciple – to communicate effectively. And I think this is a responsibility that we don’t understand very well.

I do think cultural competency and health literacy are a good starting point – and I also that if we consider the groups that we are working with and we start to ask them some very good questions, and we begin to learn from their point of view we will be working together much more.

You asked me to talk about the context of culture – I replied that it’s everywhere. My culture, your culture, the client’s culture, organizational culture.

I guess I should add that it is their culture – that should be at the heart of the response. The challenge is to find out where that is.

Thank you.