Improving language awareness in mental health care by engaging clinicians of language diverse patients

Background: Despite the diverse linguistic profiles of patients at inner city hospitals, language barrier between patients and clinical staff remains neglected. Reasons may include lack of awareness of language barrier by clinicians and silencing of barriers by organizational practices and management priorities. From prior research, inpatient psychiatry nurses and medical students are least likely to seek the help of interpreters when faced with patients that don’t speak English or French. Reasons for these practice patterns are unknown.

Objectives: Developing previous work, this study aims to clarify the quality of language barriers in clinical settings, focusing especially, but not uniquely, on the work of nurses and medical students, to (1) document clinician awareness of language barriers in their patients; (2) explore how awareness of language barriers can be enhanced professionally and institutionally; (3) evaluate the discourses reinforcing language barrier in clinical practice; and (4) assess whether promoting awareness of language barrier results in a measurable increase in documentation of language dynamics in patient charts and a corresponding increase in clinician satisfaction working with language diverse patients in clinical mental health settings.

Hypotheses: We hypothesize that after focus groups on language barrier over one year on psychiatric services, measurements at Time 1 compared to Time 2 will show (1) a statistically significant increase of clinician awareness of language barriers as measured by mentions of language issues in patient charts and (2) greater clinical satisfaction working with language diverse patients.

Research Methodology and Study Population: The study is divided into two phases, each of one-year duration. Phase 1 will consist of Time 1 ratings during the first year of mentions of language issues in 250 hospital charts of patients with diverse mother languages. A baseline clinician satisfaction survey of working with language diverse patients will be administered to 50 clinicians. After these ratings have been completed, a series of focus groups will be conducted in the last six months of year 1 with clinicians and hospital managers to explore experiences, perspectives and suggestions to improve clinical communication. Phase 2 will consist of follow up focus groups during the first six months of the second year to investigate whether clinician awareness of language barriers has affected individual and team practice i.e. to determine if any change has taken place. After the focus groups are complete, Time 2 ratings of mentions of language issues in 250 patient charts will be conducted, and a follow up clinician satisfaction survey of the same 50 clinicians will be administered, both as in Phase 1.

Data Analysis: Descriptive statistics will be calculated for each study variable. Measures that are scored dimensionally (i.e., clinician satisfaction ratings) will be assessed using Analysis of Variance (ANOVA). Measures that are scored categorically (i.e., language mentioned in chart yes/no) will be assessed using standard Chi-Square tests. Where power considerations allow, analyses will control for confounders that show influence on the pattern of results. Potential confounders include clinician type, clinician experience (years), language ability of patients and clinicians, and duration of time of patients in Québec. Focus groups will be audiotaped and transcribed, then analyzed using the qualitative software MAXQDA for constant emerging themes. This will provide a comprehensive understanding of the construct of language awareness and its associated elements in clinical mental health settings.

Relevance: Linguistic diversity is a fact in clinical care settings. This study will help to bridge the gap between patients who are linguistically diverse and their clinicians’ lack of awareness of linguistic diversity and how it may compromise quality of care.

The Law 2 on Palliative and End-of-life Care in Quebec: Getting a Grip on the Challenges associated with Providing Quality of Care to English-speaking Population

Even after the adoption of Bill 2 in Quebec and Bill C-14 in Canada, only very limited efforts were made to adequately educate civil society on these matters. Furthermore, unlike the cannabis law where there was widespread media attention to the multiple issues at stake, the media coverage of Bill 2 has largely focused on medical assistance in dying. This has overshadowed the importance of palliative care. In fact, Bill 2 has led to misrepresentations about the continuum of palliative care services and its access. While Bill 2 in Quebec and Bill C-14 in Canada are available in both official languages and despite selected associated activities to inform civil society in both languages over the past three years, investigator’s field experience and that of expert colleagues reveal that English-speaking health care professionals, caregivers, volunteers, patients, and the population in general do not have ready access to the information.

The present research proposes: 1) Integrative scoping review of best practices related to knowledge translation, literacy and capacity building of frontline health care providers, as well as to reach out to members in reference to chronic and palliative care (year 1); 2) Four focus groups with health care professionals involved in Chronic and Palliative Care and End-of-Life Care at the CIUSSS Centre Sud de l’Île de Montréal and CIUSSS Centre Ouest de l’Île de Montréal. 3a) Five individual interviews with heath care providers involved in Chronic and Palliative Care and End- of-Life Care. Also researchers will develop and pilot-test throughout the focus groups and individual interviews, an easy readily available and accessible training program in English for palliative health care providers, namely physicians, nurses, advanced practice nurses (infirmières de pratique spécialisée (IPS), social workers, field-based nurses and physicians (non-governmental organisations) with adapted support documents in English. 3b) Five individual interviews with experts involved in Chronic and Palliative Care and End-of-Life Care are planned (year 2). Also researchers will develop and validate an interview guide with supporting documents that promote a better understanding of the four components of Bill 2, palliative care resources in English and how to access them; participatory approaches, knowledge exchange and knowledge transfer workshops will be proposed for this purpose.

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Outputs:

1. Vissandjée, B., Fernandez, I., Durivage, P., Freitas, Z., Savignac, P., & Van Pevenage, I. (2021). COVID-19, promotion and provision of palliative care: reaching out, accounting for linguistic diversity. Global health promotion, 28(2), 87–90. https://doi.org/10.1177/1757975921989995

2. Lapierre J, Croteau S, Gagnon M-P, et al. Télésanté en contexte de pandémie et de déconfinement : pratiques infirmières innovantes et partenariats pour des communautés équitables, sécuritaires et durables. Global Health Promotion. 2021;28(1):89-97. doi:10.1177/1757975920980720

3. Unknown. (2020, 6 Februrary). Maîtriser la loi 2 sur les soins palliatifs et de fin de vie au Québec : les défis des proches aidants anglophones avec une littératie de santé faible. 6th International REIACTIS Conference ‘‘Inclusive Society and Aging’’, Metz, France.

4. Fernandez, I. Des soins palliatifs équitables et de qualité : intervenir selon une sensibilité aux diversités linguistiques et aux trajectoires d’immigration. En ligne [Zoom]. Colloque étudiant et jeunes chercheur.es SHERPA/CREDEF. 4 juin 2021.

Linguistically- and Culturally-Sensitive Psychotherapy: Evaluating an Approach to Assessment and Treatment

The Centre for Clinical Research in Health (CCRH) successfully established a university- funded state-of-the-art research clinic at Concordia University (of which the principal investigator is co-founding member). The clinic is launching an evidence-based, culturally-sensitive psychotherapy program for migrants with anxiety and/or depression. This larger project provides investigators with a valuable opportunity to evaluate the effectiveness of language-sensitive mental health interventions in a real-life clinical setting.

It is therefore proposed to: (1) Integrate research tools (developed with previous Dialogue McGill funding) into the assessment battery completed by all clients completing the treatment protocol used with migrant clients at CCRH. (2) Use qualitative techniques to study video-recordings and transcripts of actual clinical sessions to study the consequences of language discordance on effective communication and treatment. (3) Use quantitative analysis techniques to test whether potential problems identified by the assessment battery are linked to problematic features of actual clinical interactions. Hypotheses are: H1: Indices related to better functioning in a given language will predict fewer in-session communication difficulties when the treatment is conducted in that language. H2: Fewer in-session communication difficulties will predict more rapid symptom improvement.

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Outputs:

1. Unknown. (2020, May). Cultural scripts for normalcy and deviancy: A mixed-methods approach to understanding mental illness in new contexts [Presentation]. Interacting Minds Center, Aarhus, Denmark

2. Unknown. (2019, November). Linguistically- and Culturally-Sensitive Psychotherapy: A Proposal [Presentation]. Centre for Clinical Research in Health, Montreal, Quebec.

Portrait of perinatal and infant health in Arabic speakers of Quebec

This project follows project 2018-2019 entitled: “Stillbirth among Arabic speakers: Comparison with Francophones and Anglophones in Quebec”.

This project aims to evaluate the perinatal health of Arabic speakers in Quebec compared with Francophones and Anglophones. Specific objectives include: year 1: To investigate preterm birth in Arabic speakers; year 2: To study infant mortality in Arabic speakers. Instability in several Arab countries in recent years has led to massive migration of Arabic speakers to Quebec. In 2016, nearly 6,000 Syrian migrants settled in the province. This minority may have special needs in regards to perinatal health. In a recent study funded by HCALM, we demonstrated that Arabic speakers from Arab countries had a high risk of stillbirth compared with Francophones and Anglophones in Quebec (under review). Inequality in other perinatal health indicators has however not been studied.

This knowledge gap is particularly concerning for preterm birth and infant mortality. Preterm birth and infant mortality are the two most important indicators of perinatal health in populations and are routinely used for surveillance. European studies have shown that preterm birth and infant mortality are more prevalent in migrants from North Africa and in refugees. Despite these concerning trends, rates of preterm birth and infant mortality in Arabic speakers, the largest foreign language group in Quebec, remain unknown. In the context of increasing diversity, we propose to study inequality in preterm birth and infant mortality between Arabic speakers and Francophones / Anglophones in Quebec. We hypothesize that Arabic speakers have a higher risk of adverse infant outcomes due to limited healthcare access, communication barriers, cultural and socioeconomic differences, or behavioral factors.

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Outputs:

1. Bolster-Foucault, C., Bilodeau-Bertrand, M., Djeha, A., & Auger, N. (2021). Infant mortality among Arabic-speakers in Quebec, Canada, 1989-2017. Journal of immigrant and minority health, 23(2), 215–221. https://doi.org/10.1007/s10903-020-01115-1

2. Bernier, J., Bilodeau-Bertrand, M., Djeha, A., & Auger, N. (2021). Ramadan exposure during early pregnancy and risk of stillbirth in Arab women living in Canada. Paediatric and perinatal epidemiology, 35(6), 689–693. https://doi.org/10.1111/ppe.12761

3. Tith, R. M., Bilodeau-Bertrand, M., Lee, G. E., Healy-Profitós, J., & Auger, N. (2019). Fasting during Ramadan Increases Risk of Very Preterm Birth among Arabic-Speaking Women. The Journal of Nutrition, 149(10), 1826–1832. https://doi.org/10.1093/jn/nxz126

Improving language awareness in mental health care by engaging clinicians of language diverse patients

Despite the diverse linguistic profiles of patients at inner city hospitals, language barrier between patients and clinical staff remains neglected. Reasons may include lack of awareness of language barrier by clinicians and silencing of barriers by organizational practices and management priorities. From prior research, inpatient psychiatry nurses and medical students are least likely to seek the help of interpreters when faced with patients that don’t speak English or French. Reasons for these practice patterns are unknown.

Developing previous work, this study aims to clarify the quality of language barriers in clinical settings, focusing especially, but not uniquely, on the work of nurses and medical students, to (1) document clinician awareness of language barriers in their patients; (2) explore how awareness of language barriers can be enhanced professionally and institutionally; (3) evaluate the discourses reinforcing language barrier in clinical practice; and (4) assess whether promoting awareness of language barrier results in a measurable increase in documentation of language dynamics in patient charts and a corresponding increase in clinician satisfaction working with language diverse patients in clinical mental health settings. Investigators hypothesize that after focus groups on language barrier over one year on psychiatric services, measurements at Time 1 compared to Time 2 will show (1) a statistically significant increase of clinician awareness of language barriers as measured by mentions of language issues in patient charts and (2) greater clinical satisfaction working with language diverse patients.

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Outcomes were curtailed by the COVID-19 pandemic.

A Pilot Test of the Edinburgh Postnatal Depression Scale for Cree (EPDS-Cree)

It all begins with an idea. Maybe you want to launch a business. Maybe you want to turn a hobby into something more. Or maybe you have a creative project to share with the world. Whatever it is, the way you tell your story online can make all the difference.

Don’t worry about sounding professional. Sound like you. There are over 1.5 billion websites out there, but your story is what’s going to separate this one from the rest. If you read the words back and don’t hear your own voice in your head, that’s a good sign you still have more work to do.

Be clear, be confident and don’t overthink it. The beauty of your story is that it’s going to continue to evolve and your site can evolve with it. Your goal should be to make it feel right for right now. Later will take care of itself. It always does.

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Outputs:

• Unknown. (December 12, 2019). Cross-Cultural Adaptation and Validation of the Edinburgh Postnatal Depression Scale for Cree (EPDS-Cree). Presentation to Mental Health Advisory Panel, Cree Board of Health & Social Services of James Bay. Montreal,