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 As you can seen the population of the US is changing. We have all had to deal with this. But when you think about culture it is so much more than just race or ethnicity. It encompasses many other aspects of who we each are. The National Center for Cultural Competence defines culture as… As you can see, culture encompasses many different aspects of human behavior. One important thing to remember is that one very large aspect of culture is that is gets passed down from generation to generation. As you can seen the population of the US is changing. We have all had to deal with this. But when you think about culture it is so much more than just race or ethnicity. It encompasses many other aspects of who we each are. The National Center for Cultural Competence defines culture as… As you can see, culture encompasses many different aspects of human behavior. One important thing to remember is that one very large aspect of culture is that is gets passed down from generation to generation.

5. An Iceberg Concept of Culture One way to think about culture is to think about it as an iceberg. Above waterline – can see Below waterline – can’t see Must explore what is below the waterline to work effectively with our clients. One way to think about culture is to think about it as an iceberg. Above waterline – can see Below waterline – can’t see Must explore what is below the waterline to work effectively with our clients.

6. An Iceberg Concept of Culture

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

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/

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

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

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

12. How To Prepare Read Ask Engage Observe Analyze

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

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!

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

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

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?”

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?”

20. Learning More About the Client

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?”

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?”

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?”

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?”

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

26. Verbal Communication Language Spoken Written Degree of directness Loudness/Pitch Appropriate subjects for conversation Emotional expressiveness

27. Nonverbal Communication Facial expressions Gestures Eye contact Distance Touch Silence Body movements

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

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???

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