Communicating Communicating with Clients & with Clients &

Families: Families: Interviewing SkillsInterviewing Skills

Emily Eckley MS, RDEmily Eckley MS, RD

eeast1@utk.edueeast1@utk.edu

Celebrating Diversity Celebrating Diversity ConferenceConference

April 28, 2006April 28, 2006

ObjectivesObjectives Describe the steps to take when preparing to Describe the steps to take when preparing to

interview a client & their family.interview a client & their family.

List the skills needed to conduct culturally List the skills needed to conduct culturally appropriate interviews.appropriate interviews.

Ask culturally appropriate questions when Ask culturally appropriate questions when working with a client & families from another working with a client & families from another culture.culture.

Describe the cultural influences on verbal and Describe the cultural influences on verbal and non verbal communication.non verbal communication.

PlanPlan Define culture Define culture

Discuss components of a culturally Discuss components of a culturally appropriate interviewappropriate interview Before the interviewBefore the interview During the interviewDuring the interview After the interviewAfter the interview

Skill Building: Case StudySkill Building: Case Study

CultureCulture

Integrated pattern of human behavior that Integrated pattern of human behavior that includes:includes: Thoughts, communications, languagesThoughts, communications, languages Practices, beliefs, values, customsPractices, beliefs, values, customs Courtesies, rituals, manners of interacting and Courtesies, rituals, manners of interacting and

roles, roles, Relationships & expected behaviors Relationships & expected behaviors

Of racial, ethnic, religious or social groupOf racial, ethnic, religious or social group

The ability to transmit the above to The ability to transmit the above to succeeding generationssucceeding generations National Center for Cultural Competence, 2006.

An Iceberg Concept of An Iceberg Concept of CultureCulture

Dress • Age Race/Ethnicity Gender • Language

Eye behavior • Facial expressions Body language • Sense of self

Notions of modestyConcept of cleanliness • Emotional response patterns Rules for social interaction • Child

rearing practices Decision-making processesApproaches 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

Adapted by the NCCC

An Iceberg Concept of An Iceberg Concept of CultureCulture

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.orgNational Center for Cultural Competence, 2006

Culturally Sensitive Culturally Sensitive InterviewingInterviewing

Before the SessionBefore the Session Develop self-awarenessDevelop self-awareness Increase knowledge of commonly held cultural Increase knowledge of commonly held cultural

beliefs & interacting styles of patients/clientsbeliefs & interacting styles of patients/clients

During the SessionDuring the Session Complete an assessment by conducting a cultural Complete an assessment by conducting a cultural

interviewinterview

After the SessionAfter the Session Make a plan to negotiate between the culture of Make a plan to negotiate between the culture of

the patient/client & the medical culturethe patient/client & the medical culture

Pachter & Harwood, 1996

The First Step – The First Step – Increase Your Own Increase Your Own

AwarenessAwareness ““Know Thyself”Know Thyself”

BeliefsBeliefs ValuesValues LifestylesLifestyles PracticesPractices

Complete Cultural Self-AssessmentComplete Cultural Self-AssessmentNational Center for Cultural National Center for Cultural CompetenceCompetencehttp://gucchd.georgetown.edu/nccc/http://gucchd.georgetown.edu/nccc/

Campinha-Bacote, 2003.Pederson, 2002.

Ways to Increase Self Ways to Increase Self AwarenessAwareness

Recognize communication stylesRecognize communication styles Learn about cultural & linguistic Learn about cultural & linguistic

differencesdifferences Develop interest in other culturesDevelop interest in other cultures Become sensitive to myths and Become sensitive to myths and

stereotypesstereotypes Be able to discuss your own cultureBe able to discuss your own culture Explore your own valuesExplore your own values Learn about relationshipsLearn about relationships

Pederson, 2002.

Preparing for the Preparing for the InterviewInterview

Seek to increase Cultural KnowledgeSeek to increase Cultural Knowledge Process of learning about basic world views of Process of learning about basic world views of

different culturesdifferent cultures

World view is:World view is: The set of explanations used by a group of The set of explanations used by a group of

people to explain life’s eventspeople to explain life’s events Includes explanations about nature of:Includes explanations about nature of:

realityreality knowledgeknowledge reason or logicreason or logic relationshipsrelationships

Boyle & Andrews, 1995.

What Knowledge Is What Knowledge Is Needed?Needed?

History of cultureHistory of culture Roles of: Roles of:

EducationEducation MoneyMoney ValuesValues Attitudes Attitudes Behaviors Behaviors

Communication stylesCommunication styles Language & slang Language & slang Resources for teaching & learningResources for teaching & learning How culture is perceived How culture is perceived Other informationOther information

Pederson, 2002.

How To PrepareHow To Prepare ReadRead

AskAsk

EngageEngage

ObserveObserve

AnalyzeAnalyze

Meaningful Exchange, 2005.

During the SessionDuring the Session

Develop & utilize culturally Develop & utilize culturally appropriate interviewing skillsappropriate interviewing skills

Conduct a cultural interviewConduct a cultural interview Client centered interviewingClient centered interviewing Understanding a client’s social situationUnderstanding a client’s social situation

Navigate the complexities of Navigate the complexities of communicating across culturescommunicating across cultures

Cultural Interviewing Cultural Interviewing SkillsSkills

AwarenessAwareness Solid knowledge foundationSolid knowledge foundation Clear communicationClear communication Sense of humorSense of humor Honesty & genuinenessHonesty & genuineness InnovationInnovation FlexibilityFlexibility EmpathyEmpathy Respect, value , care, & trustRespect, value , care, & trust

Bauer & Sokolik, 2002

Utilizing the SkillsUtilizing the Skills

Listen respectfullyListen respectfully Use the teaching & learning Use the teaching & learning

techniques of other culturestechniques of other cultures Establish empathic rapport with Establish empathic rapport with

persons from other culturespersons from other cultures Analyze feedback accurately Analyze feedback accurately Develop new ideas Develop new ideas Make it fun!Make it fun!

Pederson, 2002

Conducting Cultural Conducting Cultural AssessmentsAssessments

EVERY client should have a cultural EVERY client should have a cultural interviewinterview

Information from the interview Information from the interview should be used to form a culturally should be used to form a culturally relevant treatment planrelevant treatment plan

Campinha-Bacote, 2003

Client Centered Client Centered Interviewing ModelInterviewing Model

Focuses on client experiences Focuses on client experiences

4 dimensions of this experience:4 dimensions of this experience: Ideas about what is wrong Ideas about what is wrong Feelings, especially fears, about being Feelings, especially fears, about being

illill Impact of problems on own functioningImpact of problems on own functioning Expectations about what should be Expectations about what should be

donedoneStewart, 1995

Questions for Client Questions for Client Centered InterviewingCentered Interviewing

““What do you call the problem?”What do you call the problem?”

““What do you think caused the problem?”What do you think caused the problem?”

““How bad is it?” How bad is it?”

““Why do you think it started when it did?”Why do you think it started when it did?”

““How does it affect your life?”How does it affect your life?”

Kleinman, 1978

Questions for Client Questions for Client Centered InterviewingCentered Interviewing

““What kind of treatment do you What kind of treatment do you think will work?”think will work?”

““What do you fear most about the What do you fear most about the problem?”problem?”

““How can I be of most help to you?”How can I be of most help to you?”

““What other remedies or treatments What other remedies or treatments for your problem have you used?”for your problem have you used?” Kleinman, 1978

Learning More About the Learning More About the ClientClient

Social Stressors & Support Networks

Literacy & Language

How Environment has Changed

Control Over Environment

How to Learn about Client’s How to Learn about Client’s Social ExperienceSocial Experience

““Where are you from?”Where are you from?”

““Why did you decide to come Why did you decide to come to this to this country?”country?”

““When did you come?”When did you come?”

Source: Carrillo, 1999

How Environment has Changed

How to Learn about Client’s How to Learn about Client’s Social ExperienceSocial Experience

““How much of a problem is money in your How much of a problem is money in your life?” life?”

““Are you ever short of food or clothing?”Are you ever short of food or clothing?”

““How do you keep track of How do you keep track of appointments?”appointments?”

Control Over Environment

Carrillo, 1999

How to Learn about Client’s How to Learn about Client’s Social ExperienceSocial Experience

““What is causing the most stress in your What is causing the most stress in your life?”life?”

““How do you deal with the stress?”How do you deal with the stress?”

““Do you have family or friends that you Do you have family or friends that you can call on for help?”can call on for help?”

Social Stressors & Support Networks

Carrillo, 1999

How to Learn about Client’s How to Learn about Client’s Social ExperienceSocial Experience

““What trouble do you have reading your What trouble do you have reading your medication bottles or appointment slips?”medication bottles or appointment slips?”

““What language do you speak at home?”What language do you speak at home?”

““Do you have a hard time communicating Do you have a hard time communicating what you want to say to your healthcare what you want to say to your healthcare providers?”providers?”

Literacy & Language

Carrillo, 1999

Navigating the Navigating the Complexities of Complexities of CommunicationCommunication

Most people assume that the most Most people assume that the most important aspect of communication is important aspect of communication is verbalverbal

Much of our meaning is communicated Much of our meaning is communicated nonverballynonverbally

Interpreting nonverbal communication Interpreting nonverbal communication can be challenging when interacting with can be challenging when interacting with someone of a different culturesomeone of a different culture

Mutha, 2002

Verbal CommunicationVerbal Communication LanguageLanguage

SpokenSpoken WrittenWritten

Degree of directnessDegree of directness

Loudness/PitchLoudness/Pitch

Appropriate subjects for conversationAppropriate subjects for conversation

Emotional expressivenessEmotional expressiveness

Randall-David, 1989

Nonverbal Nonverbal CommunicationCommunication

Facial expressionsFacial expressions GesturesGestures

Eye contactEye contact DistanceDistance

TouchTouch SilenceSilence

Body movementsBody movements

Randall-David, 1989

Ways to Become Actively Ways to Become Actively Involved in the Involved in the

Communication ProcessCommunication Process Learn proper forms of addressing in the client’s Learn proper forms of addressing in the client’s languagelanguage

Learn basic words & sentences in the client’s Learn basic words & sentences in the client’s languagelanguage

Work effectively with interpreterWork effectively with interpreter Use a positive tone of voiceUse a positive tone of voice

Repeat important information more than onceRepeat important information more than once Reinforce verbal instructions with written Reinforce verbal instructions with written

materialsmaterials

Watch the client’s non verbal communicationWatch the client’s non verbal communicationRandall-David, 1989

After the InterviewAfter the Interview Debrief & analyzeDebrief & analyze

What went right?What went right? What went wrong?What went wrong? How can I improve?How can I improve?

Seek additional informationSeek additional information

Put together ALL the informationPut together ALL the information

Form a planForm a plan

Forming a PlanForming a Plan

Goal: Negotiate between the culture Goal: Negotiate between the culture of the client & the medical cultureof the client & the medical culture

Tailor the treatment/intervention to Tailor the treatment/intervention to meet the client & family’s needsmeet the client & family’s needs

Make the client & family feel Make the client & family feel comfortable & part of the processcomfortable & part of the process

Wrap UpWrap Up

We live & work in very culturally We live & work in very culturally diverse environmentsdiverse environments

Through preparation & directed use Through preparation & directed use of skills, we can work effectively of skills, we can work effectively cross-culturallycross-culturally

This is a continual processThis is a continual process

Skill Building:Skill Building:Case StudyCase Study

Questions???Questions???

ReferencesReferences Auger S, Colindres M. Auger S, Colindres M. Latino Cultural Competency Training Curriculum. Latino Cultural Competency Training Curriculum. Raleigh, NC: Raleigh, NC:

North Carolina’s Women’s Preventive Health Branch, Division of Maternal & Child Health, North Carolina’s Women’s Preventive Health Branch, Division of Maternal & Child Health, North Carolina Department of Environment, Health, & Natural Resources; 1994. North Carolina Department of Environment, Health, & Natural Resources; 1994.

Bauer K, Sokolik C. Bauer K, Sokolik C. Basic Nutrition Counseling Skill DevelopmentBasic Nutrition Counseling Skill Development. Belmont, CA: . Belmont, CA: Wadsworth/Thompson Learning; 2002. Wadsworth/Thompson Learning; 2002.

Boyle J, Andrews M. Boyle J, Andrews M. Transcultural Concepts in Nursing. Transcultural Concepts in Nursing. Boston: Scott Foresman; 1995. Boston: Scott Foresman; 1995. Campinha-Bacote J. Campinha-Bacote J. The Process of Cultural Competence in the Delivery of Healthcare The Process of Cultural Competence in the Delivery of Healthcare

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Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. approach. Ann of Intern MedAnn of Intern Med. 1999; 130: 829-34. . 1999; 130: 829-34.

Eckley EE, Haughton B. Eckley EE, Haughton B. Meaningful Exchange: Enhancing Cultural Competence of Public Meaningful Exchange: Enhancing Cultural Competence of Public Health PersonnelHealth Personnel. Knoxville, TN: Department of Nutrition, the University of Tennessee; . Knoxville, TN: Department of Nutrition, the University of Tennessee; 2005.2005.

Georgetown University. Georgetown University. National Center for Cultural Competence. National Center for Cultural Competence. Available at: Available at: http://gucchd.georgetown.edu/nccc/http://gucchd.georgetown.edu/nccc/. Accessed February 20, 2006. . Accessed February 20, 2006.

Kleinman A, Eisenber L, Good B. Culture, illness, & care: clinical lessons from Kleinman A, Eisenber L, Good B. Culture, illness, & care: clinical lessons from anthropologic & cross-cultural research. anthropologic & cross-cultural research. Ann Intern Med. Ann Intern Med. 19781978; ; 88: 251-8. 88: 251-8.

Mutha S, Allen C, Welch M. Mutha S, Allen C, Welch M. Towards Culturally Competent Care: A Toolbox for Teaching Towards Culturally Competent Care: A Toolbox for Teaching Communication Strategies. Communication Strategies. San Francisco: Center for the Health Professions University of San Francisco: Center for the Health Professions University of California; 2002.California; 2002.

Pachter LM, and Harwood RL. Culture and child behavior and psychosocial development. Pachter LM, and Harwood RL. Culture and child behavior and psychosocial development. J Dev Behav Pediatr. J Dev Behav Pediatr. 1996; 17: 191-198. 1996; 17: 191-198.

Pederson PB, et. al. Pederson PB, et. al. Counseling Across Cultures. 5Counseling Across Cultures. 5thth ed, ed, Thousand Oaks, CA: Sage Thousand Oaks, CA: Sage Publications, Inc.; 2002. Publications, Inc.; 2002.

Randall-David E. Randall-David E. Strategies for Working with Culturally Diverse Communities & ClientsStrategies for Working with Culturally Diverse Communities & Clients. . Bethesda, MD: Association for the Care of Children’s Health; 1989. Bethesda, MD: Association for the Care of Children’s Health; 1989.

Stewart M, Brown JB, Weston WW, McWilliam CL, Freeman TR. Stewart M, Brown JB, Weston WW, McWilliam CL, Freeman TR. Patient-Centered Patient-Centered Medicine: Transforming the Clinical MethodMedicine: Transforming the Clinical Method. Thousand Oaks, CA: Sage Publications; . Thousand Oaks, CA: Sage Publications; 1995. 1995.