Communicating with Clients & Families: Interviewing Skills

1. Communicating with Clients & Families: Interviewing Skills Emily Eckley MS, RD eeast1@utk.edu Celebrating Diversity Conference April 28, 2006

2. Objectives • Describe the steps to take when preparing to interview a client & their family. • List the skills needed to conduct culturally appropriate interviews. • Ask culturally appropriate questions when working with a client & families from another culture. • Describe the cultural influences on verbal and non verbal communication.

3. Plan • Define culture • Discuss components of a culturally appropriate interview • Before the interview • During the interview • After the interview • Skill Building: Case Study

4. Culture • Integrated pattern of human behavior that includes: • Thoughts, communications, languages • Practices, beliefs, values, customs • Courtesies, rituals, manners of interacting and roles, • Relationships & expected behaviors Of racial, ethnic, religious or social group • The ability to transmit the above to succeeding generations National Center for Cultural Competence, 2006.

5. An Iceberg Concept of Culture Dress • Age Race/Ethnicity Gender • Language Eye behavior • Facial expressions Body language • Sense of self Notions of modesty Adapted by the NCCC Concept of cleanliness • Emotional response patterns Rules for social interaction • Child rearing practices Decision-making processes Approaches to problem solving• Concept of justice Value individual vs. group •Perceptions of mental health, illness, disability •Patterns of superior and subordinate role in relation to status by age, gender, class And much more…… National Center for Cultural Competence, 2006

6. An Iceberg Concept of Culture The iceberg concept of culture is widely used and available in the public domain, for example see: Culture Matters www.peacecorps.gov Or www.genderandpeacekeeping.org National Center for Cultural Competence, 2006

7. Culturally Sensitive Interviewing • Before the Session • Develop self-awareness • Increase knowledge of commonly held cultural beliefs & interacting styles of patients/clients • During the Session • Complete an assessment by conducting a cultural interview • After the Session • Make a plan to negotiate between the culture of the patient/client & the medical culture Pachter & Harwood, 1996

8. The First Step – Increase Your Own Awareness • “Know Thyself” • Beliefs • Values • Lifestyles • Practices • Complete Cultural Self-Assessment National Center for Cultural Competence http://gucchd.georgetown.edu/nccc/ Campinha-Bacote, 2003. Pederson, 2002.

9. Ways to Increase Self Awareness • Recognize communication styles • Learn about cultural & linguistic differences • Develop interest in other cultures • Become sensitive to myths and stereotypes • Be able to discuss your own culture • Explore your own values • Learn about relationships Pederson, 2002.

10. Preparing for the Interview • Seek to increase Cultural Knowledge • Process of learning about basic world views of different cultures • World view is: • The set of explanations used by a group of people to explain life’s events • Includes explanations about nature of: • reality • knowledge • reason or logic • relationships Boyle & Andrews, 1995.

11. What Knowledge Is Needed? • History of culture • Roles of: • Education • Money • Values • Attitudes • Behaviors • Communication styles • Language & slang • Resources for teaching & learning • How culture is perceived • Other information Pederson, 2002.

12. How To Prepare • Read • Ask • Engage • Observe • Analyze Meaningful Exchange, 2005.

13. During the Session • Develop & utilize culturally appropriate interviewing skills • Conduct a cultural interview • Client centered interviewing • Understanding a client’s social situation • Navigate the complexities of communicating across cultures

14. Cultural Interviewing Skills • Awareness • Solid knowledge foundation • Clear communication • Sense of humor • Honesty & genuineness • Innovation • Flexibility • Empathy • Respect, value , care, & trust Bauer & Sokolik, 2002

15. Utilizing the Skills • Listen respectfully • Use the teaching & learning techniques of other cultures • Establish empathic rapport with persons from other cultures • Analyze feedback accurately • Develop new ideas • Make it fun! Pederson, 2002

16. Conducting Cultural Assessments • EVERY client should have a cultural interview • Information from the interview should be used to form a culturally relevant treatment plan Campinha-Bacote, 2003

17. Client Centered Interviewing Model • Focuses on client experiences • 4 dimensions of this experience: • Ideas about what is wrong • Feelings, especially fears, about being ill • Impact of problems on own functioning • Expectations about what should be done Stewart, 1995

18. Questions for Client Centered Interviewing • “What do you call the problem?” • “What do you think caused the problem?” • “How bad is it?” • “Why do you think it started when it did?” • “How does it affect your life?” Kleinman, 1978

19. Questions for Client Centered Interviewing • “What kind of treatment do you think will work?” • “What do you fear most about the problem?” • “How can I be of most help to you?” • “What other remedies or treatments for your problem have you used?” Kleinman, 1978

20. Learning More About the Client How Environment has Changed Control Over Environment Social Stressors & Support Networks Literacy & Language

21. How to Learn about Client’s Social Experience • “Where are you from?” • “Why did you decide to come to this country?” • “When did you come?” How Environment has Changed Source: Carrillo, 1999

22. How to Learn about Client’s Social Experience • “How much of a problem is money in your life?” • “Are you ever short of food or clothing?” • “How do you keep track of appointments?” Control Over Environment Carrillo, 1999

23. How to Learn about Client’s Social Experience • “What is causing the most stress in your life?” • “How do you deal with the stress?” • “Do you have family or friends that you can call on for help?” Social Stressors & Support Networks Carrillo, 1999

24. How to Learn about Client’s Social Experience • “What trouble do you have reading your medication bottles or appointment slips?” • “What language do you speak at home?” • “Do you have a hard time communicating what you want to say to your healthcare providers?” Literacy & Language Carrillo, 1999

25. Navigating the Complexities of Communication • Most people assume that the most important aspect of communication is verbal • Much of our meaning is communicated nonverbally • Interpreting nonverbal communication can be challenging when interacting with someone of a different culture Mutha, 2002

26. Verbal Communication • Language • Spoken • Written • Degree of directness • Loudness/Pitch • Appropriate subjects for conversation • Emotional expressiveness Randall-David, 1989

27. Nonverbal Communication • Facial expressions • Gestures • Eye contact • Distance • Touch • Silence • Body movements Randall-David, 1989

28. Ways to Become Actively Involved in the Communication Process • Learn proper forms of addressing in the client’s language • Learn basic words & sentences in the client’s language • Work effectively with interpreter • Use a positive tone of voice • Repeat important information more than once • Reinforce verbal instructions with written materials • Watch the client’s non verbal communication Randall-David, 1989

29. After the Interview • Debrief & analyze • What went right? • What went wrong? • How can I improve? • Seek additional information • Put together ALL the information • Form a plan

30. Forming a Plan • Goal: Negotiate between the culture of the client & the medical culture • Tailor the treatment/intervention to meet the client & family’s needs • Make the client & family feel comfortable & part of the process

31. Wrap Up • We live & work in very culturally diverse environments • Through preparation & directed use of skills, we can work effectively cross-culturally • This is a continual process

32. Skill Building:Case Study

33. Questions???

34. References • Auger S, Colindres M. Latino Cultural Competency Training Curriculum. Raleigh, NC: North Carolina’s Women’s Preventive Health Branch, Division of Maternal & Child Health, North Carolina Department of Environment, Health, & Natural Resources; 1994. • Bauer K, Sokolik C. Basic Nutrition Counseling Skill Development. Belmont, CA: Wadsworth/Thompson Learning; 2002. • Boyle J, Andrews M. Transcultural Concepts in Nursing. Boston: Scott Foresman; 1995. • Campinha-Bacote J. The Process of Cultural Competence in the Delivery of Healthcare Services: A Culturally Competent Model of Care. 4th ed. Cincinnati, OH: Transcultural C.A.R.E. Associates; 2003. • Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. Ann of Intern Med. 1999; 130: 829-34. • Eckley EE, Haughton B. Meaningful Exchange: Enhancing Cultural Competence of Public Health Personnel. Knoxville, TN: Department of Nutrition, the University of Tennessee; 2005. • Georgetown University. National Center for Cultural Competence. Available at: http://gucchd.georgetown.edu/nccc/. Accessed February 20, 2006. • Kleinman A, Eisenber L, Good B. Culture, illness, & care: clinical lessons from anthropologic & cross-cultural research. Ann Intern Med. 1978; 88: 251-8. • Mutha S, Allen C, Welch M. Towards Culturally Competent Care: A Toolbox for Teaching Communication Strategies. San Francisco: Center for the Health Professions University of California; 2002. • Pachter LM, and Harwood RL. Culture and child behavior and psychosocial development. J Dev Behav Pediatr. 1996; 17: 191-198. • Pederson PB, et. al. Counseling Across Cultures. 5th ed, Thousand Oaks, CA: Sage Publications, Inc.; 2002. • Randall-David E. Strategies for Working with Culturally Diverse Communities & Clients. Bethesda, MD: Association for the Care of Children’s Health; 1989. • Stewart M, Brown JB, Weston WW, McWilliam CL, Freeman TR. Patient-Centered Medicine: Transforming the Clinical Method. Thousand Oaks, CA: Sage Publications; 1995.