Audio transcript (edited)

GILL MUNRO: Good afternoon, everyone. And welcome to today’s webinar, ‘Approaches to Support Child Mental Health in Culturally and Linguistically Diverse Communities’. The webinar is coproduced by CFCA and Emerging Minds. My name is Gill Munro and I work with Emerging Minds National Workforce Centre for Child Mental Health. In today’s presentation we will be exploring the challenges that affect the mental health and wellbeing of children and families from CALD communities. And the barrier they face to accessing and engaging with services. We will also be looking at how practitioners can tailor their approach to work with children and families from CALD communities, to support the mental health and wellbeing needs of CALD children.

So to expand on that, let’s have a look at the learning objectives, just so we can be clear for you about what’s ahead in the next hour. This webinar will focus on working with children and families from non-humanitarian migrant communities, and will support practitioners to understand the factors contributing to child mental health in CALD communities, consider ways to proactively engage with CALD communities to support early intervention and prevention, understand some key principles and practise approaches for building trust and rapport with children and families, and use strengths based approaches to supporting child mental health in CALD communities.

So now let’s recognise and pay respect to Aboriginal and Torres Strait Islander peoples as the traditional owners of the land as the traditional owners of the lands we work, play, and walk on throughout this country. We acknowledge and respect their traditional connections to their land and waters, culture, spirituality, family, and community, for the wellbeing of all Aboriginal and Torres Strait Islander children and their families.

This webinar is part of the series of webinars focused on infant and child mental health that will be facilitated in partnership between CFCA and Emerging Minds in 2022. So there is an upcoming webinar supporting children who have disclosed trauma. And previous webinars include perinatal support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma, supporting children’s wellbeing when working with separating parents, and what is the social model of disability and why is it important in child mental health. And all of these past webinars are available to access via the Emerging Minds and AIFSwebsites. So let’s welcome our presenters. And it’s my great pleasure to firstly introduce Anagha Joshi. Are you there, Anagha?

ANAGHA JOSHI: Hello everyone.

GILL MUNRO: Hi, Anagha. Lovely to see you. Welcome. And maybe you could start by just telling us a little about your role and maybe something that you’re particularly interested in or passionate about?

ANAGHA JOSHI: So I’m Anagha and I’m a Senior Research Officer at the Child and Family Evidence team at AIFS. And my role is involved in knowledge translation. And one of them is also participating and working on webinars as well. And what really draws me to this topic is that although this is a new area of research for myself, I am a migrant myself, and I really resonate with the kind of things that we’re going to be talking about today. And it’s been really great meeting people passionate in this space, like the other panellists who are here today. Thanks, Gill.

GILL MUNRO: Great. Thanks so much, Anagha. Lovely to have you. And then our next participant I’d like to welcome is Julie Ngwabi. Are you there, Julie?

JULIE NGWABI: Yes.

GILL MUNRO: We can see you. Okay. Hi. Can you tell us a little about your role and something you’re particularly interested in maybe at the moment?

JULIE NGWABI: Yes, thank you for that, Gill. So my name is Julie Ngwabi. My role is that of a Senior Child Mental Health Advisor within Emerging Minds. So I’m really passionate really with working with families, with working with children. In particular using that holistic family-focused and systemic approaches just to bring those child positive child mental health outcomes that we need, not just for the child but for the whole family as well.

GILL MUNRO: Great. Thanks so much, Julie. And last but definitely not least we’ve got Zakiyyah Muhammad. Are you there, Zakiyyah?

ZAKIYYAH MUHAMMAD: Hi Gill. Hi everyone.

GILL MUNRO: And I wanted to say Eid Mubarak, Zakiyyah. And to all of our Muslim listeners, welcome. And yeah, I hope everybody’s enjoying a nice feast after a month’s fasting during Ramadan.

ZAKIYYAH MUHAMMAD: Thank you, Gill. Yes, it has been a month of fasting. And so yes, everyone Eid Mubarak all those who have been fasting. So my name is Zakiyyah Muhammad and I’m a private practitioner and psychotherapist and an accredited mental health social worker. And I’m also supporting a program at Marion Headspace at the moment. My passions are really around mental health and parenting and parenting attachment. And really supporting the multicultural and CALD community. And also I suppose looking at resources and building resources.

GILL MUNRO: Lovely. So thank you very much to our presenters. And I’m sure everybody’s giving you a very warm virtual welcome. So we thought we’d begin at the very beginning by actually just exploring that term ‘CALD’. How helpful is it? Is it limiting? What do our participants think of the use of that term? Anagha, would you like to kick us off maybe with the research angle?

ANAGHA JOSHI: Sure. So CALD in the research side is actually taken in a lot of different ways. The terminology can be used in a really broad sense. For example, in a census report on CALD youth, they included people – CALD people are people who are first or second generation migrants, or those who identify themselves as CALD through ethnic origin or ancestry. So it can be really broad sometimes in research. But it can also be quite narrow. And other studies differentiate CALD as having a cultural heritage outside of English speaking countries or Anglo-European backgrounds. Collecting data about CALD status and ethnicity can be useful though. So because it can actually help us understand if there’s any inequities and how we can tailor interventions to certain communities. But we do have to keep in mind thought that CALD is not a homogenous group. And so when we’re talking about our findings related to CALD, we have to remember that it may not reflect all the individuals and families that represent the diversity in CALD communities.

GILL MUNRO: Great. Thanks, Anagha. Zakiyyah, would you like to add something?

ZAKIYYAH MUHAMMAD: Yeah, I would agree with that statement. I think what we have to look at is sometimes we out-grow terms. And I personally think that the term CALD no longer captures exactly what is needed sometimes around research. In my present role, I know that a lot of new arrival communities don’t tap into that box that says CALD. They don’t tick that box, they don’t believe that that term is who they are. And so I think that needs to be looked at. I think that we’ve had other terms previously used in Australia. And really I think probably multicultural or asking people – looking at things in a different way, in a more in-depth way around what CALD is.

We had a meeting recently as part of a social work association, and we had this exact conversation around the term CALD. And we were also looking at I suppose what is happening in the Ukraine. And people from the Ukraine presenting now in Australia, would they come under that CALD category? Or would they not come under CALD category? Because they are culturally and linguistically diverse. But I don’t think that would capture that community either. So I think we’re in a quite interesting space at the moment around that terminology.

GILL MUNRO: Yeah, definitely. Yeah, Julie, did you want to add anything? What do you think?

JULIE NGWABI: Yes. I actually agree with what Anagha and Zakiyyah have said. We really need to have a strong clarity what do we mean by CALD. Both at organisation and individual level and practitioners. Because culture is dynamic. It’s not necessarily static. And CALD means different things to different people as well. And we know that our perceptions and understanding about any concept, they actually affect the way our actions and the way we interact with people. And this has huge implications to service utilisation and to the CALD community as well. And I think clarity is needed at organisational level. It cannot be left just to the practitioner to navigate that term and be able to gain meaning and understanding and to be culturally appropriate to the families that they work with. So both organisations, they need some structures in place that clearly define what CALD is. And they expectation from the practitioners as well.

And as you rightfully put it, CALD, you know, are heterogenous. We are not homogenous. And we interact with our culture differently. And as Zakiyyah said, not everyone who might look like CALD will identify as CALD. So if I am coming to your service with my four year old, personally I identify as a CALD woman. If I am coming to a service identifying as a CALD human, you look at me and say, “This is a CALD mother.” But in reality, I really don’t know what that means to you and your organisation. So it might make me vulnerable. I know why I identify as CALD. I ascribe particular meaning to that. So unless we have dialogue, unless we have clarity, we risk stereotyping people and making dangerous assumptions.

So I will just close this opening by using an example which I recently had as well, from another researcher from Zimbabwe, which really piqued my interest and made me reflect how I see this term ‘CALD’. Just like me, I relate to her experience. She came from Zimbabwe. She’s a researcher here in Australia. Her first child who is a young adult was born and has been raised here in Australia. So she was saying that if you put her daughter behind a screen and ask her questions, “Who are you?” You know, what your hope is, what do you like what you do. You will say. And if the curtain is removed, you might say, “Oh, this is a CALD person.” But based on what you were just hearing without seeing that child, there will be no clue that this is a CALD child.

So I guess my point is that we really need to have clear understanding and clarity to what is CALD. And we do that when we put clearer processes both in organisational level, practitioner level, and considering that person as well. How do they identify. Do they identify as CALD and to what degree as well.

GILL MUNRO: That’s great, Julie. And all of you. Some really interesting points there. Not something we’re going to get exactly to the bottom of but it’s just really good to unpack that use of that term. Let’s move onto the first of our learning outcomes, which was understanding factors contributing to child mental health in CALD communities. And Anagha, again, you were going to kick us off with some of the current research please?

ANAGHA JOSHI: Yeah, absolutely. So I conducted a scoping review and stakeholder consultations to understand what factors affect child mental health in culturally and linguistically diverse communities. And one of the first things I’d like to point out is that there actually still isn't a lot of research on this topic in Australia. And my scoping review really highlighted the need for more research on this topic. But what I have tried to do, as you can see on this diagram here, is I’ve tried to map out the different types of factors that affect child mental health at different levels that an individual child can be affected by it. So the individual child is affected by their family and relationships, the education services environments, as well as socio-political and cultural context. And those are the kind of scenarios which they’re growing up in.

And the factors that relate specific to CALD communities I’ve tried to map out on the side. You can see what came up in the literature as factors that affect children’s mental health at different levels of this diagram. And although it’d be great to go through all of this in detail, I will be writing a paper or two, go through this a bit more, which perhaps keen an eye out for. But for the purpose of the webinar today, I thought it would be really interesting just to focus on a few key findings from the review. And looking at that third circle around services and environment, children from CALD communities often do not present at mental health services, but that does not necessarily mean they have less mental health concerns. So that was one of the interesting findings that we found in the review. And that parents may be only coming for services and support when there’s more overt signs of mental health difficulties, such as ASD.

However, in contract to that, that does not necessarily mean that children from culturally and linguistically diverse communities have fewer or less internalising or emotional difficulties. In fact, data from the Kids Helpline shows that children who identify as CALD are actually increasingly seeking out support through anonymous means.

The second key feature that came up in the literature was the concept of acculturation. And that fits into that central diagram under the individual child. And acculturation is to do with the process by which individuals acquire the culture of a new culture, and also kind of the code of behaviours of a new culture. And that has actually really unique affects on mental health in children in Australia. And associations with culture, whether it be their host culture which is their Australian culture, or their heritage culture, can both provide benefits. One Australian study spoke about how resilience can actually affect experience of acculturation. And that children who adopt to their new culture whilst also maintaining interest in their original culture can have higher resilience and more positive mental health. And although that was just one study, that idea is sot of backed up by international literature.

And the last interesting finding was at that family and relationships circle that you can see in the diagram. And that family conflict and cultural differences with parents have a unique affect on children from linguistically and diverse backgrounds. And more so in fact that children from non-CALD backgrounds. So things like family and relationship issues were commonly identified by children from CALD populations and more frequently so than non-CALD populations. And one of the reasons behind that could be to do with that concept of acculturation and how there may be different rates of acculturation between parents and children. And hopefully we can have a bit of a conversation about that. But I thought that this might just be a staring point for the discussion. And I’ll hand back to you, Gill.

GILL MUNRO: Thank you. And really, I was just going to ask our – Julie, maybe to start, chat a little bit more about that. What sort of role acculturation plays in a child’s mental health and wellbeing?

JULIE NGWABI: I think one of the things that have been highlighted by research is that all parents, regardless of culture, of race, or ethnicity, they want two things really. They want their children to be health and to be happy. I think it’s important to have that at the back of our minds. Even as while talking about the different factors that will impact the mental health or wellbeing of CALD families and children. But to add to what Anagha has said, yes indeed, with acculturation different family members within the same family, they will do so at different rates. The rate and the degree to which they will remain connected to their culture will vary. For example, with children, as they go to school, the acculturate faster, they become socialised as they interact with their peers, as they make friendships. And to what Anagha said as well, that ability for children to learn more than one language can actually enrich their lives, you know, their wellbeing as well. And we know that there’s research which is citing positive results of having more than one language.

But it does become a source of conflict at times within families. So what I will say is that for example, we parent the way we are parented. So if within that same family, that parent – the parents are still parenting the way they learnt from their parents from their culture of origin and stuff like that. On the other hands of which children who are being acculturated, who are learning new cultures, new values, and lifestyle from their peers at school, there becomes a tension. There becomes conflict. Not only between the parent and the child, but parenting styles may differ as well. One parent may decide to remain maybe really conservative to the values of their culture, while the other parent maybe incorporate other cultures with the model way of parenting as well. And that may be a source of conflict between the parents as well. And that’s another factor which would impact on the children’s wellbeing and mental health.

Because we know that adult problems, they impact on the children’s mental wellbeing and their social wellbeing as well. So acculturation is going to both benefit the one in that it enhances, enriches the life of that child as they live between different cultures, learn different things. And it can actually be a protective factor for children. For example, when you are considering issues like bullying, if you’ve got this child who can now speak English well, eloquently, doesn’t have an accent, it’s much easier for them to make friendships, to connect with others. All those things are necessary for their wellbeing and emotional health. But at the same time, the reality is that both CALD families and CALD children, they face discrimination issues such as racism, social injustice, inequalities, and other social disadvantages, which add to the family stress and family conflict and it affects the children as well.

So it creates sources of not only conflict but it impacts the mental wellbeing of the children as well. And the other thing is with these children, when they are caught in that tension or conflict, they want to connect with their peers in the Western dominant culture. At the same time they’ve got maybe parents who are remaining strongly conservative to their culture or religion. We find ourselves with a young person or a child who is caught in between. We find ourselves with a young person who has – like a person with no land really. They don’t really fit well within the dominant culture. Those issues of racism or discrimination will come up from them. They come back home, which is supposed to be a safe and a secure environment, and then there’s that tension at home as well, because of some of the lifestyles or the beliefs that they’ve been picking from their peers.

So it puts the young person in a really, really difficult position. And as you said, Anagha, some of these children, they become proactive in seeking support, maybe from what they’ve heard from school, that oh, there’s Kids Helpline. And then they initiate seeking that support because whatever they might be going through is not something that they might feel confident or comfortable bringing it home. So yeah, I’ll say acculturation has got both benefits and it presents some challenges within the parent/child relationship, within the family as well and within the relationship of the parent as well.

GILL MUNRO: Fantastic. Wow, that gives us some real insight into it. Thanks, Julie. And Zakiyyah, did you want to add anything to the topic?

ZAKIYYAH MUHAMMAD: I recently did a youth forum with the Islamic Society of South Australia. And that Dr Nadeem Memon made a very important point I think around acculturation. And what he was saying was, if you go interstate to communities like Melbourne or Sydney, where they’ve had new arrivals coming into there for a lot longer, so say like the Lebanese community or similar, when you do research on those communities probably the grandparents and the parents have been through the education system there and know the system. Whereas in South Australia, a lot of the communities are a lot more new. So this is the first generation of that community in South Australia. It would be a very, very different system around acculturation. And how that uptake is, because it’s only one generation. Whereas interstate, it would be two, three, or four generations who have lived there previously.

And I think that’s really important when we’re looking around research or looking around how organisations support communities. You can’t always pull the research that’s been done interstate to support families at a local level.

GILL MUNRO: Yeah, that’s so true. Yeah. Actually, following on from that, I wondered if – Anagha, if you’d mind talking to us a little about acculturation for families when they move into regional areas? So we actually have quite a few migrants that move into sort of large regional towns or even not that large regional towns. And I wonder if you could tell us a little about if there’s any research on that? You know, what happens then with children?

ANAGHA JOSHI: Yeah, absolutely. So in terms of – there wasn’t a lot of evidence on this, but there was an Australian study that described how children in regional towns might actually acculturate even faster than any normal kind of metropolitan and urban environments. And actually faster than their parents as well. And that could be because when there are less ethnicities in those areas and less children with migrant backgrounds, they are forced to adapt to the local culture even faster. Whereas parents who might actually be working in fields where there’s similar cultures who are participating in the same type of work, they may not actually be catching on and acculturating as fast as their kids. So that was definitely one interesting finding. And kind of relates to what Zakiyyah was saying about how it’s quite context dependent and depending on where you are in Australia, how far the migrant histories are, that can definitely impact how fast acculturation occurs.

GILL MUNRO: Great. Thanks. We had quite a few questions asking about how you might work with families from cultures where there is stigma around mental health and seeking support. So can we talk a little bit more about that? Maybe Zakiyyah, if you would kick us off on that topic?

ZAKIYYAH MUHAMMAD: I think in regards to speaking to families from CALD backgrounds around mental health, I think what’s really important is the language that you use and the approach that you have. So worked for a few years in children’s services, and there was terms like controlled crying, or feeling down in the dumps, or serve and return. Those terms don’t translate infant mental health. Those words – it’s not that the communities don’t understand. They just don’t understand those terms. And I don’t think there is that much stigma around talking about infant mental health. It’s really how you introduce it.

So previously I was able to access some funding through the Australian Association for Infant Mental Health. And I was linked with five communities. So that was a Pashtun community, Spanish speaking, Syrian, Burmese, and Bhutanese communities. And I met with those communities and we talked a lot about infant mental health, but just looking at different words and introducing it in a different way. I can confidently say all those communities understood what infant mental health was or child mental health. All of them were able to understand how it would look within their own child or children in the community where those children were struggling. They also knew the services to tap into, such as child and family health services and so on. So I think it was just taking the time to meet them where they were at.

One of the statements that we developed from that day, I’ll quickly read it out, and it takes about a minute. So the statement that was developed on the day ways, “In their first 1,000 days of life, without using words, babies have many wonderful ways they express themselves. They can feel emotions, form close and secure relationships, and use these relationships to explore their world. Sensitive caregiving and nurturing supports babies to learn and grow in many ways. Understanding how babies learn best supports them to cope with life challenges. The first 1,000 days is foundational and important for babies developing trusting relationships with others, leading to them valuing their own emotional and physical health. All babies have the right to be loved, to be kept safe from physical and emotional harm, and to sleep well enough for their bodies to grow well.”

Now in English, that statement takes probably a minute. We had it translated into all of those five languages, and videoed. In the Burmese community, it took about five minutes to say that same sentence. And it’s because those words weren’t used. It was put in a different context, they had to give some background to some of the language that was used. But it was like what are they saying? And I was like they’re saying the same statement I’ve just said in English, but to put it in context takes a little bit longer. And I think sometimes that we need when working with new arrival communities. Don’t assume that they don’t know. But just take the time to build the relationship, look at where they’re at, look at the language that they use, and I think that’s what takes the time.

GILL MUNRO: Yeah. Fantastic. Really helpful, Zakiyyah. Julie, did you want to add anything?

JULIE NGWABI: Yeah. I really think those were interesting findings, Zakiyyah. In fact they’re not making assumptions in that language means everything. So one of the things really that’s highlighted in the new National Children’s Mental Health Strategy is that services, in particular mental health services, need to be culturally competent and have an awareness on how mental health is conceptualised in different cultures. So it’s a responsibility to the different organisations and service providers to have that understanding, how is our local CALD community conceptualising and understanding mental health and mental illness? And another thing to highlight is really just generally broadly speaking, CALD or not, mental illness is not well understood across board. And mental health is usually confused with mental health difficulties or illnesses, even amongst professionals.

And we know that unless there is clarity on that, it impacts on the help seeking behaviours. It impacts on service utilisation. It’s got impact, you know, on access and equity and this has got huge implications on mental health promotion, early intervention, early identification. So we really need to promote child mental health literacy across board so that we have the same languages which is understood even within different cultures. And as we said, mental health and in particular child mental health is not fixed. It’s not static. It’s best understood within the continuum. So CALD families and parents, they also have that innate ability to let you know, or to know instinctively when something is not right with their child. So it’s building that support and connecting with them in creating these safe spaces to have those difficult conversations.

And I will emphasis the importance of creating and building relationships to have those difficult conversations, because once you have that as a foundation, you can talk about anything with any CALD person, with any child’s family, and any CALD child. As long as they feel safe and as long as they feel understood.

GILL MUNRO: Yeah, fantastic. Thank you. So let’s move on to our next learning outcome, and that’s considering ways to proactively engage with CALD communities to support early intervention and prevention. So yes, you’ve talked about how we might actually do some of this work, but what sort of – how do we actually engage with these communities in the first place? Maybe Anagha, can you kick us off again there?

ANAGHA JOSHI: Yes. And I think you’re quite right in the idea that we’ve already spoken about as a group about access to services and how children from CALD communities, the access is low. The data and the research definitely support that. And there is clear evidence to show that people from CALD communities are not seeking out services as much as they should be. And definitely more so than non-CALD populations. And that includes child mental health services. And one of the interesting findings from my review was that children were – like I mentioned before, they are increasing finding ways to seek out support in other ways, such as anonymous ways through Kids Helpline. And I wonder whether that could be either that they’re experiencing barriers related – and them and their families are experiencing barriers related to child mental health services. And also whether they are preferring to go through basically bypassing their parents maybe and not feeling as comfortable going through parents to seek out support.

So there’s kind of a few different ideas just to throw out there as to what could be some barriers around why they are seeking out services.

GILL MUNRO: And Julie, you talked a little bit about access and equity. Can you say a little more about what sort of things might be barriers to CALD families seeking services?

JULIE NGWABI: Yeah, I think I’ll also start by saying that one of the things which was clearly highlighted within the strategy is that CALD children – and Anagha, you mentioned that as well, it came up in your research that CALD children are at higher risk of mental health concerns, difficulties, and illness, compared to the other children within the dominant culture. And we know that services that deal with – that service families, children, and adults, are ideally placed really to play a crucial role in intervention and early identification and supporting these families.

But unfortunately CALD families, the children and their parents, they face a number of barriers in accessing and utilising those services. And some of the barriers really which have been identified is just general mistrust of services. And language barriers. And again, this doesn’t apply to every CALD person or community, but it’s some of the barriers which have come up and have been identified in research. Or fear. Including fear of authority. Some of them even their visa status, they make think that if I go to the services, maybe they do not have security with their visa. If I start divulging information about my relationship with my husband, with my child, with the family, all those concerns, you know government people are connected. They’ll start communicating with each other and that might have some implications on our visa security. So they might think it’s much better just to stay away from services, from government departments, at the risk of losing their residency.

And also prior negative experiences and assumptions and stereotypes which are made about CALD families. Why would they want to come back again if they’ve had a negative experience? And also one thing which is huge within the CALD community is word of mouth. If I come with my child to your service and I receive really bad experience – maybe I’m already traumatised from other things – I will be reaching out to Zakiyyah or someone else and saying, “Be careful when you go into that service.” So the reality is that the word of mouth will just spread like wildfire. And coming back to what Anagha and Zakiyyah need organisations at local level, they need to engage with the CALD families and find out what the barriers are. What is it that is hindering them from accessing the service? Then they will have that dialogue and address those misconceptions.

Or maybe through a process of co-design, which is one of the things which is advocated in the strategy as well, that organisations have got responsibility of involving CALD families and children in the process of service planning, service delivery, and evaluation. If you know what the CALD issues are, if you want to know and to make sure that you are culturally competent, you are providing culturally responsive and safe services, you have to engage with the CALD communities. Otherwise you won’t truly have authentic engagement and – yeah, that has implication on the mental wellbeing as well.

And the other thing as well, the system itself is complicated. So for some CALD families, they might need additional support just to navigate this system and to get the support and the services that they need.

GILL MUNRO: Yep. Thanks so much, Julie. And Zakiyyah, did you want to maybe give us some tips or some ideas around how practitioners might proactively do some of this engaging with CALD communities. What sort of things can they do to actually facilitate access?

ZAKIYYAH MUHAMMAD: Yeah, I think you’ve hit the nail on the head. It really is about being proactive. So it’s being visible, it’s being transparent, it’s understanding like what Julie said, word of mouth within any community goes a long way. So if someone had a really good experience, they will recommend you. And if they haven’t, they will definitely let their community know that they haven't had a good experience. It’s about being visible and being transparent. And the sort of clinic – and I suppose one of the other things is meeting people where they’re at. So if community have an event, meet them there. If it’s Harmony Day or a special day, like Independence Day or something similar, it’s about having your service go along and support people where they already feel safe. Where they already feel confident and comfortable.

It’s about I suppose when you’re going to look at working with community, linking in with elders or people within that community who already exist or are already trusted, who can then speak to their community about your service. So there’s lots of different ways. And I think part of it is also the age group. So for younger – those that are older like teenagers and like we talked about acculturation, they have many different ways like Headspace. They know that they can tap into services, they can self-refer, they have more of an idea because I think with teens anyway, infant mental health across the board, not just within CALD communities, is more spoken about. So those stigmas don’t really exist.

But your older children I really think it is about having staff trained to a certain level where they understand, whether it be in schools or in community services. Where they can recognise that there are issues taking place and then approach families, I suppose in a really trusting and transparent way. And from a place of curiosity. And allowing that person or those families not to have that imbalance so much around authority. But to come across as thought you’re having a relationship and an engagement. Headspace have some amazing peer workers. And a lot of them use lived experience to help support their community. So when you look at the work that peer workers do, they’re based from their community, they’ve lived in the community, they know the services that are in the community and the families. And then they go out and work with those people who are needed to be and need to touch base with.

So the peer worker model is an amazing model. Because you have people from those communities working within their own community. And I think that’s an amazing way to go when looking at how to break down some of those barriers and work with people where they’re at.

GILL MUNRO: Great. Yeah, really great. Okay, we’d better move onto our next learning outcome, and that’s understanding some key principles and practise approaches for building trust and rapport with children and families. So we have talked a little about this, but I’ll ask you the question directly again. So what kinds of things do practitioners really need to consider for building trust and rapport with CALD children and families? Zakiyyah, I might as you again. I mean, we talked about taking the time. You know, time seems to be really key in this. Just taking the time. Slow down, listen, and so on. What sort of other things do practitioners need to think about?

ZAKIYYAH MUHAMMAD: I think one of the main things that organisations need to look at is if you’re looking to build KPIs straight away, it doesn’t work in community. Because the first thing you need to be building is trusting relationships. And that takes time. So it’s about saying, “Okay, we’re new with this community. This is a new community. You don’t have to meet those people in a month. What we’re going to do is we’re going to give you that time to introduce yourselves, to be a part of that community, before you start looking at counting numbers.” I think being genuinely coming from a place of curiosity. So being honest and curious about why you’re working with that family, about asking who they are from a place of being humble. I think that’s the luck.

I think be teachable in that relationship. So you may have the skills or some of the practise knowledge, but they’re the professionals in their own family. A lot of how you look at meeting them where they are at it’s going to be a big part of how that relationship is built. And I think one of the things that’s really important is some services will have a cultural consultant. Or a multicultural worker. Or a CALD consultant. And everything goes back to that person. I think it’s really important that even if organisations do have a cultural consultant, that all the staff across the board receive cultural awareness training. And that’s something that takes place continuously. Because otherwise everyone – this person’s the go-to person. And they’re not going to know everything about every culture and every community. We want to train every practitioner who chooses to work within this area. So continually upskill themselves around how to work with the families that they support. And I think that’s a really big thing.

And being transparent. Often they don’t come because they need something specific about infant mental health. It maybe I’ve got a concern about my child. Or it may be that I need some financial support. Or it may be a physical health issue. It’s about no door being the wrong door, but also looking at how you work with them to fix the issues that they have. And still continue building a trusting relationship with them moving forward.

GILL MUNRO: Yeah, that’s great. I love that concept of being humble. Yes, you might be a really practised professional practitioner, but you don’t know everything about these cultures. You probably know very little about them. So yeah, there is that real element of needing to just be a learner as well, I think. But I like what you say about on teams it’s everybody’s responsibility to keep upskilling themselves around CALD issues and so on. Otherwise it must be so tiring for the one CALD member on the team to always be dumped with everything. So yeah, it’s really interesting. Julie, did you want to add anything? Yeah, sort of things that practitioners can do to build trust and rapport?

JULIE NGWABI: Yeah. I will add a few things, but I got back to my point of the importance of approaching this from a systemic point, holistic point of view. Before we say what can practitioners do, at the same time we should be asking what are organisations doing. At Emerging Minds, some of the resources that we have made available to you include a practise paper on how organisations and leaders – you know, where they provide a service which is accessed by families with complex issues and sometimes our CALD families, because of the nature of the problems that they face fall under that category.

So in that paper which is attached in the resources, we highlight the importance of the organisational structures that need to be in place in order to support the practitioners as well who in turn support these complex families. So it needs to be a holistic, systemic approach with the organisation looking at their policies and procedures on CALD issues on their recruitment and retention that there is an expectation that you will work with CALD families and that you need CALD competence. And that there will be supervision provided in that area, reflective practise, ongoing training, and professional development. You know, data collection and evaluation of the local CALD issues. And that continuous process of quality improvement. And then on the other hand as well, if professional practitioners themselves being culturally aware, being culturally competent.

And adding to what Zakiyyah was saying, we cannot overemphasis the importance of relationship building. Even before that therapy, that process invested time I used that word intention of investing, because if you want to gain some positive returns when working with CALD, you cannot bypass this type of relationship building, of creating trust, of creating safe spaces. And some of the easiest things that you need practitioners may need to be aware of is just being aware of power imbalances when working with these families. And be willing to share that power. Zakiyyah mentioned being humble. For you to be humble, for you to learn from their lived experience, for you to see them as [parenting experts. For you to see children with agency and self-determination you have to be willing and be ready to be humble and to learn and to share that power.

And being flexible, even with things such as where the appointment will happen. Some families may be wary of having strangers or professionals coming to their homes. And some families may be wary as well of going to the offices and prefer people through that relationship, through conversations, you can highlight – you know, you can find out what those issues are. What their preferences are. And be accommodative. And if you are not sure, you just ask. If you ask them, they will tell you. And even simple things do I shake their hand, where do I sit, you can have those conversations and be able to come to an agreement.

And also allowing time for them to ask questions. We’ve had questions about some CALD communities, they don’t want to engage with this and that. Just allow them sufficient time. Explain what it is, what service it is that you want to offer. The benefits and stuff like that. And allow them to give their preferences as well. Their choice, their opinion. And give them that time to process the information that you gave them. Some will actually not be willing to give you an answer there and then. They might want to consult with the rest of the family members. They might want to go and consult with their cultural leader or spiritual leader. Because those people are important to them. So just being humble and being curious and willing to learn. And having genuine authentic conversations.

GILL MUNRO: Great. Thanks so much. I feel like we needed two hours for this webinar, to be honest. But we’re up to our last learning outcome and I’m really conscious that we’re now eating into our Q&A time. But I suppose I can assure the listeners that we will be recording – we’ll be talking about this ongoing and recording some of the answers. So let’s quickly move onto our last learning outcome, which is using strengths based approaches to supporting child mental health in CALD communities. And Zakiyyah, could you give us some practical examples maybe of strengths based practise with CALD children and parents? And we’ll need to try and keep this to just a couple of minutes if we can, sorry.

ZAKIYYAH MUHAMMAD: Okay. I’ll quickly dot point. So I use narratives. And narratives I use because people like to tell a story. And most communities I work with are storytellers. So they will talk a lot about an issue and so that works really well. Look at the problem not being the person and make sure you identify that. So the problem isn’t the child. The problem is the issue and the child is and beyond that the child is separate from that. So how you would look at that. Look at, like what Julie said, who else is involved in that relationship. Whether it’s a community elder, whether it’s a spiritual person, and look at if you need to bring that person in so that the family feel more confident and more heard.

Look at culture as individual per family, per person. And that’s really important, no matter how aware you are of a culture or a community, they’re all going to have their own individual cultures. So I always look at coming from a strength-based approach. Narrative therapy works amazingly because you’re really listening and tuning it. Look at behaviours and patterns. And see if you can identify them. Lots of people I think from communities are also quite visual. So I’m not one for putting everything in different languages, because lots of people don’t read in their own language. And so sometimes it’s a visual. Something that’s visual helps, rather than trying to always do something that is in writing. It doesn’t always translate really, really well.

So I think it’s around giving that person a sense of belonging and a feeling that they’re connected. And also I think one of the big ones is you challenging your own assumptions as a practitioner. So don’t go in there thinking that you know everything, but really challenge your own assumptions around how things look. And always promote the good. Like always promote what’s working well. So it’s working well, always promote that. And that’s really come from a strength-based approach. What’s going well, always speak about that, rather than putting that person in a position where they feel as though you’re focused on one area and that’s the one area that isn’t going well. Really explore what is going well. And understand that they’re still the professional in their own family. And you’re coming in to journey alongside and help build strength and strategies and resources.

GILL MUNRO: Great. Thanks, Zakiyyah. Anagha, maybe just quickly, we had some questions about supporting CALD children in school. Do you have any suggestions for teachers on how to support children so they’re not marginalised or treated differently?

ANAGHA JOSHI: Yeah. So there was some interesting research on this. And one was around the importance of transitions in schools. So children who are going into school for the first time, especially when there’s language barriers. Promoting some sort of familiarity during challenges can be considered a strengths-based approach in schools, such as encouraging them to send children to schools with someone that they know, or with other migrant families. Another strategy is encouraging activities that are not purely reliant on language. So to build confidence and pro social skills. So children might want to engage in arts or sport where they can build that confidence in themselves that’s not purely dependent on language. There’s a way to build that skill in that space.

And what I was talking about before about the importance of promoting and allowing children to feel comfortable with dual identities. Because that does form – that can actually provide more resilience in children. It can actually promote resilience. However, our stakeholder consultations also said that we do need to listen to the individual child and see what works with them in terms of how much they want to associate with either culture. And the last one was around prejudice prevention and inter-group attitude promotion as a way to kind of focus on anti-racism strategies in schools. So even those children under 12 are quite young, they do experience racism in Australia. And so in primary school and in schools, finding ways to train children in empathy and building perspective in terms of [pro social] and cognitive skills have been actually shown to be effective in Australian literature, so there’s just some tips from what I’ve come across so far.

GILL MUNRO: Great. Thanks, Anagha. So last question, Julie, how could practitioners support parents to highlight and build upon a child’s strengths?

JULIE NGWABI: Again, it comes back to relationships. Active listening. You know, authentic collaboration with the families and with the parent. We always talk about harnessing the parental wisdom. Working with the parent as an expert. But sometimes parents from the CALD community, they may need some time to familiarise themselves with that concept that yes, I’m a parenting expert. Because when they are working with you, sometimes they might be expecting that you as the professional, as the expert, you are the one who has got to tell them what needs to be doing. But if the engagement is going to be meaningful, if the parent is going to be empowered and supported in supporting their child’s mental health and wellbeing, the parent has to be an active participant as well. They have to see themselves as a parenting expert. They have to see themselves as an equal partner with you, the practitioner.

So to add towards what Zakiyyah has said, cultivating that strength based approach, practising culturally curiosity, when you’re saying, you know, their problem solving capabilities before, their resiliency, how they managed some adversity before, to bring that to the forefront to the parent, that yes, I do have some strengths. Yes, I do have some resiliency. I’ve dealt with adversity before. Whatever it is that is happening with my child with the support of this professional and the people in my community and the people who matter the most to me. You know, I am able to support my child as well.

And one of the things that we talk about is the five practice shift when working with children. Children have to be active participants as well. So practitioners, they support the parents, who support the children as well. Children have to view themselves as active participants in this relationship, with something to bring, where they can view their preferences, their views, their dreams, and their hopes. And taking that into consideration in planning care and monitoring care and evaluating care to make sure that it’s targeted and it’s effective.

GILL MUNRO: Okay. Thanks for that. That was great. So let’s move on to some of the questions form our audience. And the first one I might actually give to you, Julie. And that’s around some of the therapies. So a couple of questions came in around whether some therapies worked better with CALD families than others. And I know Zakiyyah has already talked about narrative therapy, but I wonder if you have anything more to add there?

JULIE NGWABI: Thanks for that question, Gill. What I would say is that we know there are so many therapies out there that are evidence based that have been proven to be effective. And different people will respond differently to different therapies. But what I will say is when we talk about evidence based care, we know that it’s truly attained when we synthesise the three components. Which is utilising the best available evidence from research, and the practise nurse expertise, their skills and knowledge, and the third and equally important component is the person who is actually benefitting from that therapy. That is the service user. So I will say that paying attention to that third component as well is very important, especially when working with the CALD communities. Collaborating with them. Having clear explanation of the goals of the proposed therapy. Giving them choice whether they want to engage with that therapy and why. And allow them to process all that information. And addressing any hesitancy that they might be having before you even begin engaging in that particular therapy.

So I will say that synthesising and paying attention to that third component, which is collaborating with the service users in cooperating their choices and their preferences and well, you will go a long way with any other therapy that has been proven to be effective with working with families and children.

GILL MUNRO: Great.

ZAKIYYAH MUHAMMAD: And can I add to something – what Julie said?

GILL MUNRO: Sure.

ZAKIYYAH MUHAMMAD: Which I think is also really important is that a lot of assessments I use are drawn together or pulled together using Anglo families. And so they’re not suitable for working with CALD communities. And I think a lot of practitioners need to recognise that when you’re going to do an assessment on a family in regard to what it is, whether it’s parenting attachment or suicidal ideation, to look at whether it works with families in community or not. Because not all of them do. Only some of them will. And so they’ll not all capture the evidence. Because to be police, a lot of CALD people will say yes, yes, yes, yes, yes to whatever question you ask. Because you’re the professional. And so what you assess may not be correct. So it’s really about building that relationship and that rapport. And looking at the assessment prior to looking at what therapy you would use.

And that’s why I agree with Julie. Something that’s strength based, something that’s probably narrative where they’re talking a lot and telling their own story. Where it’s not all direct question and answer. Where you ask a question and allow them to explore that in their own mind and in their own situation also.

GILL MUNRO: Yeah, great. Yeah, real food for thought there. Thanks. Zakiyyah, I might ask you this question. And that’s around what are some of the unique issues for families living in regional and remote areas? Can you talk to that a little?

ZAKIYYAH MUHAMMAD: I think that question was going to be for Anagha. But I think for me a little of that – or Julie – I think a little bit of that around rural and remote, what makes it a little bit more difficult is more specifically around having access to services. What services are available locally for families. But also the same as in families is that issue about confidentiality and privacy being upheld. That also may be one.

So I think that for me leads into a question around the use of interpreters. And how that looks with using interpreters. I think for me more recently, looking at utilising interpreters was around everyone moved onto Zoom more recently with COVID. So COVID came along and everyone assumed that they could use Zoom or Teams to work with families who were probably rural and remote also. But there was no training around how to do that. People just assumed and services assumed that everyone could do it. I’ve not seen any training for working with interpreters in a very long time. So although we may have services that are specific to be used like NAATI or whatever, it’s around the individual practitioner and the organisations that they work with upskilling them in regards to how you utilise interpreters well and effectively.

Such as things like give an interpreter a proper brief around what it is that you want to talk about prior to the session, still speaking directly with the guest or the client rather than speaking to the interpreter. How do you manage that on Zoom or Teams? Look at cultural differences. Look at explaining all the technology prior so it makes it as easy as possible. So even if it’s face to face, utilising a normal tone of voice that you usually use and not shouting or speaking really slowly and thinking that will get your point across. So I think for rural and remote and for local, looking at those things, one of the things that within my own practise I think works really, really well is when you find a good interpreter and you’re looking at booking other sessions with a client, is requesting the same interpreter. Because it also helps in building the relationship and building the relationship with that family with the interpreter and yourself.

So don’t just assume that all interpreters have a broad knowledge around every single topic you can talk about. When you’re booking an interpreter, you can say, “This is a medical issue. Do you have anyone specific who knows about medical issues or who knows around mental health.” And so it just takes away another one of those barriers around working with interpreters. So I think that also work well with rural and remote, when you can link in with interpreters, how you do that and how you do it to be successful.

So after the session, also asking the client was this what you wanted, did it work for you? What could we do better next time? And checking in with what makes them feel comfortable. Sometimes it works really well using interpreters from interstate. For example, as it’s a really new and emerging community, because the relationships are going to be so close that they don’t want that information shared. But you are able to say, “Can I have an interpreter from Melbourne or Sydney or Perth or from another state where they don’t know that person.” They’re not going to bump into them at the supermarket. But where it’s just one step removed. So I think it’s things like that that I would really tap into around rural and remote, and also around working with interpreters.

GILL MUNRO: Yeah, great. That’s really great. Thanks, Zakiyyah. And maybe I should have asked you that one, Julie. Did you want to add something? So maybe around both issues. So the unique issues for families living in regional and remote areas, and perhaps also something about using interpreters?

JULIE NGWABI: Yeah, I think based on what Anagha said on her research before, there are reasons why CALD families may chose to go to regional, rural, and remote areas and facilitates acculturation. And we also know that the practitioners and service providers in these areas, who live with these CALD families, they’ve got firsthand information on the inside of these CALD communities that they’ve been working alongside with and supporting them. But I think we have to explore opportunities of capacity building within the regional, rural, and remote area to build on the support that they are already providing to these CALD families. And one of the things already which is actually recommended by the new strategy is recommending services to be culturally competent in working with CALD families, including those in these areas.

And at Emerging Minds, we actually have a number of resources that professionals and practitioners in these areas can access free of charge, just to support the work that they’re already doing with these families in identifying, engaging, and assessing and supporting these families. And the second thing as well is the use of telehealth and digital within the rural areas. But again, we have to be practical, as Zakiyyah said. Some families might need extra support with technology, with internet. So it’s coming up with solutions in the local context, like can these families actually do the telehealth sessions with specialists in our offices where we can support them, where we’ve got the internet, where we can facilitate the connections and stuff like that.

And when it comes to the interpreters, all I can add just it’s important to take – to begin with whether that family actually needs an interpreter. And to get the right one. Because there’s nothing as awkward as hooking in an interpreter on an assumption when that family actually doesn’t need the interpreter. Or bringing the wrong one. So just to clarify in those issues and having those conversations to being with.

GILL MUNRO: Great. Well, we’re just about at the end and we’ve got one more question. And that’s how cultural identify might be promoted as a place of strength and a protective factor when considering and supporting the social and emotional wellbeing of children. Anagha, did you want to talk to that one?

ANAGHA JOSHI: Sure, I can talk about that. The concept of cultural identity came up a lot in our research as well as well as in the stakeholder consultations. And the importance of really supporting children through their dual identities that they have growing up. The one that they’ve come from in conjunction with the one that they’re acculturating to in Australia. And so one of the interesting findings was around how children who actually have that resilience are often those who have that appreciation and kind of respect and pride about both cultures that they came from, as well as where they are.

However, an important caveat to that was really that it really depends on the individual child. And so what is most effective for the child has to really be determined at the individual level, even though at a more research level or a data level it suggests a certain trend. But that is not always applicable to the individual person. So really having those conversations, either in schools or in practise, are really important to be curious about how children perceive what their culture is, whether they find that nice balance between the two, and being curious about how that – you know, and that I feel is a really strength based approach that practitioners can think about when thinking about children from multicultural communities.

GILL MUNRO: Great. Thank you so much, panellists. That actually brings us to the end of our webinar. And it’s just been absolutely fascinating and a pleasure to listen to you. I feel like I’ve learnt a lot today and I hope everybody else has too. So I’d just like to thank you all individually. So thank you so much, Zakiyyah Muhammad.

ZAKIYYAH MUHAMMAD: Thank you very much for having me.

GILL MUNRO: And thank you, Julie Ngwabi.

JULIE NGWABI: Thank you so much, Gill.

GILL MUNRO: And Anagha Joshi, for the research angle. That was just great. Thank you.

ANAGHA JOSHI: Thank you. Thanks everyone. And so nice to work alongside such talented people. Thank you.

GILL MUNRO: Okay.

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Slide outline

1. Approaches to support child mental health in culturally and linguistically diverse communities

2. Approaches to support child mental health in culturally and linguistically diverse communities 
Anagha Joshi, Julie Ngwabi and Zakiyyah Muhammad

3. Learning outcomes

This webinar will support practitioners to:

• Understand the factors contributing to child mental health in CALD communities.
• Consider ways to proactively engage with CALD communities to support early intervention and prevention.
• Understand key principles and practice approaches for building trust and rapport with children and families.
• Use strengths-based approaches to supporting child mental health in CALD communities.

4. Acknowledgements

We recognise and pay respect to Aboriginal and Torres Strait Islander peoples as the Traditional Owners of the Lands we work, play, and walk on throughout this Country. We acknowledge and respect their Traditional connections to their Land and Waters, culture, spirituality, family, and community for the wellbeing of all Aboriginal and Torres Strait Islander children and their families.

5. Webinar series

CFCA and Emerging Minds webinar series: Focus on infant and child mental health

Upcoming webinar:

• Supporting children who have disclosed trauma.

Previous webinars include:

• Perinatal support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma.
• Supporting children’s wellbeing when working with separating parents.
• What is the social model of disability and why is it important in child mental health?

6. Housekeeping

• Send through your questions via the question box at any time during the webinar.
• All our webinars are recorded.
• The slides are available in the handout section on the webinar platform.
• The video, audio, transcript and presenters’ responses to additional questions will be posted on our website and YouTube channel in the coming week.

7. Presenters

• Anagha Joshi 
  Senior Research Officer, Child and Family Evidence team, AIFS
• Julie Ngwabi 
  Senior Child Mental Health Advisor, Emerging Minds
• Zakiyyah Muhammad 
  Psychotherapist and Mental Health Social Worker
• Gill Munro (Facilitator) 
  Practice Development Officer, Emerging Minds

8. In what ways is the term ‘CALD’ both helpful and limiting of practitioner’s understanding of people’s experience?

9. (1) Understanding the factors contributing to child mental health in CALD communities.

10. Factors affecting the mental health of children from culturally and linguistically diverse backgrounds

Alt text: Stacked circles infographic

• Individual child: acculturation, adaptation and resilience.
• Family & relationships: intergenerational conflict, family orientations and parenting styles.
• Socio-economic, political & cultural context: migration difficulties and racism.

Findings from a scoping review on factors affecting child mental health in culturally and linguistically diverse communities in Australia, mapped onto the social determinants of health inequalities framework adapted from Dalgren G, Whitehead (1993)

11. (2) Considering ways to proactively engage with CALD communities to support early intervention and prevention.

12. (3) Understanding key principles and practice approaches for building trust and rapport with children and families.

13. (4) Using strengths-based approaches to supporting child mental health in CALD communities.

14. Q & A Discussion

15. Feedback survey

Thanks for joining us.

A short feedback survey will pop up as you leave the webinar. If you could spare 5 mins to answer it, we would greatly appreciate it.

We will continue answering your questions offline and post this extra content online with the recording of the webinar.