Who is this resource for?

This resource is for health practitioners working within the New Zealand health system. It is a supplement to the training programme Working with CALD Families – Disability Awareness and is available through the CALD website www.caldresources.org.nz. It offers additional culture-specific information and is intended for use by participants who have completed either the Face-to-Face or on-line elearning training programme. CALD module 1 on 'Culture and Cultural Competency', and CALD module 2 on 'Working with Migrant Patients' are pre-requisites for the CALD training on disability, and for accessing this resource.

What it aims to do

This document aims to provide some culture-specific information for health practitioners who have an understanding of the key issues in working with CALD families with disability. It is not a stand-alone document and does not provide information on general disability issues.

Whilst the focus of this resource is on differences and similarities across specified cultures, it is important to note that practitioners are not expected to become experts in the practices and values of every, or any culture, but to implement cultural competence skills in interacting with people of diverse origins. Research indicates that CALD service users value individualised care over specialised ethnic services; interventions can best be tailored within an understanding of their cultural context (Garwick et al, 1998).

This resource is in part a research document, and in part a guideline for practitioners based on the research and principles covered in the aforementioned training programme. It includes video and audio components intended to illustrate some of the issues covered.

Much of the information in this resource reflects traditional cultural perspectives that may not be relevant to some families, to migrant or second-generation clients, or to the younger generation. It cannot be stressed strongly enough that in order to avoid stereotyping, the information needs to be used as context ONLY.

Background for this resource

This information is presented within the framework used for the training programme 'Working with CALD Families �Disability Awareness'. It is based on an understanding of the following key issues:

1. Definition of disability provided by New Zealand Ministry of Health and used in this training
   "People with a physical, intellectual or sensory impairment or disability (or a combination of these) that is likely to continue for a minimum of six months and result in a reduction of independent function to the extent that ongoing support is required".
2. Models of disability
   Traditionally healthcare for people with disability has been driven by the medical model, which views a person with disability as having something wrong with them, and therefore in need of a 'cure'. Since the 1980's there has been a move towards the Social Model where the focus is placed on how a person with disability can be supported to live the life they choose. Internationally the aspiration is towards the Human Rights based approach, which strives for inclusion and equality for people with disability.
3. Multiple Challenges for CALD clients with disability
   CALD clients with disability face enormous challenges. Some of these are inherent in attitudes within their own culture, and others created by cultural difference and ability difference to the mainstream culture into which they have migrated.
4. Key issues when working with culture and disability
   Cultural perceptions about disability, explanations about causes of disability, the nature of care people receive traditionally.
5. Cultural barriers to accessing disability healthcare
   Some cultural factors affect access to healthcare. These include neglect, the broader challenges of migration, challenges specific to refugees, unfamiliarity with a new health system, sense of shame about disability, power of traditional beliefs and practices.
6. Infrastructural barriers to accessing healthcare
   Attitude of health professionals and system professionals, language and literacy, signage, availability of information in various formats, unfamiliar health system, achieving engagement and follow-up in treatment, providing family-centred care, economic factors.

How it is organised

Section I (Middle Eastern, South Asian and other Muslim based cultures) provides an overview of disability and the Muslim perspective since Muslims form the majority in the countries in this section. This information about Islam and disability may be applied to other cultures that are predominantly Muslim and shaped by Islamic practices. Pakistan is included in this section because of its Muslim population, however it shares similar cultural traditions with India (Section II).
Culture-specific information is summarised in the Middle Eastern, South Asian and African Table.

Section II (Indian culture) presents information on Indian culture and disability. India is separated from the South Asian countries in section I since it is not a Muslim based country and underlying religious values are relatively different.
Culture-specific information is summarised in the Middle Eastern, South Asian and African Table.

Section III (Somali, Sudanese, Ethiopian and Eritrean cultures) focuses on disability and cultures in the Horn of Africa, for although predominantly Muslim, the cultures of these countries differs significantly from those of the Middle East. The information on disability and Islam from Section I can be applied to Muslims in this group. Information for countries in this section is provided separately as practices and circumstances vary significantly across these cultures).
Culture-specific information is summarised in the Middle Eastern, South Asian and African Table.

Table 1 This page contains the Middle Eastern, South Asian and African Table.

Section IV (East Asian cultures) provides information on disability in Chinese culture and other cultures that share the Chinese heritage of Confucianism, Taoism and Buddhism.
Culture-specific information is summarised in the Asian Cultures Table.

Table 2 This page contains the Asian Cultures Table.

Quiz Test yourself with this self-practice culture quiz.

Guidelines are offered under Toolbox at the end of each section, and throughout as 'Implications for Practice'.

The CALD 'Yellow Man' is an alert to notable issues.

How to use this resource

<Add instructions>

Icons to help you navigate through the resource:

	This NEXT button is located at the bottom right corner of the page and it is for moving to the next resource page. NB: if you are using a tablet device please note that (a) this NEXT button is located in the middle right hand side of the device; and (b) you can alternatively swipe the page from right to left with your finger to move to the NEXT page.
	This PREV button is located at the bottom left corner of the page and it is for moving to the previous resource page. NB: if you are using a tablet device please note that (a) this PREV button is located in the middle left hand side of the device; and (b) you can alternatively swipe the page from left to right with your finger to move to the PREV page.
	This button is located at the bottom left corner of the pages. It is for you to exit the resource.
	This BOOKMARK PAGE button is located at the bottom left hand side of the page next to the exit button. You can bookmark a page by clicking on this BOOKMARK PAGE button. Once you have bookmarked a page, the button will change its name to “REMOVE BOOKMARK”.
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	This button activates a response to an activity or provides an answer or more information about an activity. If you see this button on a page, please click it instead of the NEXT button.
	This operates as a standard video player (play/pause). Please make sure the volume on your computer is “ON” and also check the volume on the video player is 100%.
	This operates as a standard audio player (play/pause).
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	This indicates a self-reflective moment.