n. 504666-LLP-1-2009-1-IT-LMP
WP 9
Coordinated by
ASL NAPOLI 2 NORD
Report compiled by CRIA
Date:
Compiled by:
Sent to:
15/01/2012
CRIA
All partners
Nature: Report
Level: CO
Deadline: 15/01/2012
WP 9 – CRIA – Evaluation of Training
Projecto financiado com o apoio da Comissão Europeia.
A informação contida nesta comunicação vincula exclusivamente os autores, não sendo a
Comissão responsável pela utilização que dela possa ser feita.
n. 504666-LLP-1-2009-1-IT-LMP
INTRODUCTION
The general aim of WP9 is to test innovative protocols for building and guiding inter-professional and
intercultural team work in the healthcare services for migrant users (with a focus on mental health and
women’s health).
There were different experimental stages to the protocol:
1) The design of the practical experimentation;
2) The establishment of a methodology and tools for assessment of the practical experimentation by
operators.
National context in which the training is delivered:
Cultural mediation in Portugal emerged with the entry of Portugal in the then European Economic
Community (now European Union), in the 1990s. Since then, the figure of the mediator has been
increasingly broadening out into new dimensions, projecting itself as a professional profile which has
emerged to deal with the needs of welfare intervention, particularly in less favourable socio-economic
contexts.
Although the socio-cultural mediator has been institutionalized, by standardizing criteria for
recruitment and training, provided in the 105/2001 Act, there is still a long road that lies ahead.
However, in recent years, this kind of training has been gaining ground asserting itself as a core activity
to meet the social needs of young, more disadvantaged people, particularly those from “ethnic
minorities”. The High Commission for Immigration and Intercultural Dialogue (ACIDI, I.P.) is a
Public Institute whose main mission is to support the integration of immigrants through interministerial strategies. ACIDI has created, in 2004, a network of National and Local Immigrant Support
Centres, to propose integrated interventions, in collaboration with representative immigrant
associations, social partners, and various public administration agencies and services. For instance, the
Health Support Centre provides a team of socio-cultural mediators in order to improve the access to
health services. However, it is still unclear if and how immigrants, especially when undocumented,
receive health care. Due to the legacy of Portuguese colonialism, most of the immigrant population
comes from former colonies and is therefore able to communicate in the official host country language.
For this reason, mediation is usually conducted by Portuguese citizens with linguistic skills who don’t
necessarily possess specific training or formal qualifications; individuals designated by the immigrant
WP 9 – CRIA – Evaluation of Training
Projecto financiado com o apoio da Comissão Europeia.
A informação contida nesta comunicação vincula exclusivamente os autores, não sendo a
Comissão responsável pela utilização que dela possa ser feita.
n. 504666-LLP-1-2009-1-IT-LMP
community, without specific training or formal qualifications to do so; health service professionals
(physician, nurse, etc.) with linguistic skills; people who undergo a brief training at an association; and a
patient’s family member. The regime in which mediators operate in Portugal varies between a member
of staff, an external individual consultant or a volunteer from associations that promotes immigrant
causes. In Portugal, translation services offered to immigrants depend on volunteers and a group of
translators created by the Portuguese section of the High Commission for Immigration and
Intercultural Dialogue, although this group is not particularly focused on health issues and most of the
service is provided by phone. With regard to training, it has been considered urgent by ACIDI to find a
common matrix for training courses on mediation, which would allow a profile of a mediator to be
defined and, as a result of this, to establish prerequisites and selection criteria for the carrying out of
these tasks. Suggestions have been made, in these last years, for regulation at the level of training, which
would make it possible to accompany the work carried out, but also to create spaces for ongoing
training and the exchange of experiences. With regard to the field of action of socio-cultural mediation,
it may be concluded that in Portugal this is greatly connected to less affluent communities, often in
contexts of social exclusion. It has been shown, however, that the figure of the mediator is not limited
to one ethnic or cultural origin, nor to specific fields of action, since mediation can be extremely useful
in various areas of social intervention, such as housing and health, amongst others, where knowledge of
the different cultural codes of the users may bring about greater efficacy in social intervention.
Although ‘mediation’ may already be used by various professionals in different areas, the concern to
pay attention to the specific nature of socio-cultural mediation has been highlighted, since this kind of
mediation requires particular techniques and procedures for which specialised training is paramount. It
has also been suggested that it could be possible for pilot experiments to take place, training for sociocultural mediation, suitably followed up in other fields of action, such as health, justice or internal
administration.
Brief description of protocol and beneficiaries:
Beneficiaries were interpreters, cultural mediators, mental health and women’s health professionals, as
well as social and medical services staff.
Training plan and delivery:
The training programme started on 2th of November and ended on 7th December of 2011, in a total of
40 hours (5 days of training x 7 hours + 5 hours of individual working). It took place in the auditorium
of the ACIDI (address: R. Álvaro Coutinho, 14, Lisbon).
Trainers:
Chiara Pussetti (Ph.D. Cultural Anthropology, University of Torino, 2003) is presently senior associate
researcher of the Centre for Research in Anthropology (CRIA/ISCTE/IUL) and Associate Professor
WP 9 – CRIA – Evaluation of Training
Projecto financiado com o apoio da Comissão Europeia.
A informação contida nesta comunicação vincula exclusivamente os autores, não sendo a
Comissão responsável pela utilização que dela possa ser feita.
n. 504666-LLP-1-2009-1-IT-LMP
in Medical Anthropology at University of Lisbon. She has conducted ethnographic fieldwork on the
island of Bubaque, Arquipelago of Bijagós, Guinea Bissau, since 1993, focussing on the local discourses
on emotion and affliction. Since 2003 she conducted research on the emotional experience of
displacement and the strategies of suffering and cure of African immigrants in Portugal. Her
publications include several books and articles published in Italy, Portugal and Brazil.
Francesco Vacchiano is Clinical Psychologist and PhD in Cultural Anthropology. He is presently fellow
researcher at the CRIA/ISCTE-IUL and member of the Frantz Fanon Centre of Turin (Italy) for the
Mental Health of Migrating People. He joins clinical and research experiences on migration and health,
refugees, institutional encounters and borders. He works as trainers of health and social workers in
Portugal, Spain, Italy, Switzerland and Morocco. He published several articles on migration,
subjectivity, institutions and a book on the etnhopsychology of migration.
Carla Moleiro is Assistant Professor at the Social and Organizational Psychology Department (DEPSO)
at ISCTE-IUL and a researcher of CIS. She obtained her PhD in Clinical Psychology at the University
of California, Santa Barbara, USA, 2003. She specialized in Clinical Psychology at the University of
Lisbon, and as a psychotherapist at the Portuguese Association for Behavioral and Cognitive Therapies
(APTCC). She has developed clinical work on complex disorders, dual diagnoses and personality
disorders. She is currently working on mental health and migration, and with clients from ethnic and
sexual minorities (i.e. LGBT).
Elizabeth Challinor is senior associate researcher at the Centre for Research in Anthropology – UM
Portugal. Her research areas include medical anthropology and the anthropology of development
(participation, gender, state-civil society relations). She has carried out fieldwork in Cape Verde (1996-7,
2005, and 2007) and is currently working in Porto amidst the Cape Verdean Diaspora (2008-2012)
addressing issues of identity and power in Cape Verdean migrant experiences of birth, parenthood and
citizenship.
Maria Cristina Santinho possesses a Master in Anthropology (1985-1989), with specialization in
Cultures and Ideologies at the Escuela Nacional de Antropologia e História (National School of
Anthropology and History) of Mexico City. She obtained her PhD in Medical Anthropology with a
WP 9 – CRIA – Evaluation of Training
Projecto financiado com o apoio da Comissão Europeia.
A informação contida nesta comunicação vincula exclusivamente os autores, não sendo a
Comissão responsável pela utilização que dela possa ser feita.
n. 504666-LLP-1-2009-1-IT-LMP
dissertation on Asylum Seekers and Refugees in Portugal. She attended a Post-Graduate Course Refugee
Trauma: Global Mental Health at the University of Harvard (2008/2009). She is currently a researcher at
CRIA (“Centro em Rede de Investigação em Antropologia and CEA (Africa Study Centre) – ISCTE
University – Lisbon, Portugal, and also teaches anthropology at the Department of Psychology Lusófona University. She is also President of the NGO “GIS - Group Migration and Health”.
Trainees:
The training was attended by 25 participants, ranging from social workers, nurses, and training
instructors to intercultural mediators. All of them are involved in local institutions catering to
immigrant users. We contacted ACIDI and the Amadora Hospital, which are the main social actors in
the Great Lisbon Area for the question of immigrants’ health, organizing three different meetings to
explain the project and the related training and giving them T-SHARE brochures and public protocols.
A specific training protocol was then established in accordance with ACIDI. Each centre advertised the
training among its collaborators. Thanks to this process, the professionals who joined the training were
the most interested and dedicated ones. Belonging to different services, the involved trainees can use
the skills learnt during the training in different clinical contexts and with a variety of users. This is an
important point because it allows us to assess the effect of the training in different contexts of
intervention and it also enables us to divulge the contents of the course across a wider range of public
services. The different services were all represented in the course with more than one person; an
important factor to achieve the objective of creating little intercultural teams in the different services
involved. At least two people per unit attended the training.
Themes of training:
The program was built around different sessions, reflecting relevant themes in the intercultural health
care context, such as migration studies and local health care systems, introduction to the AMC
perspective (Clinical Medical Anthropology), the role of social determinants in migration, right and
accessibility of healthcare services for migrants and asylum seekers in Portugal, the relation between
mental health and culture, anthropology of maternity, parenthood and birth, confrontation of different
WP 9 – CRIA – Evaluation of Training
Projecto financiado com o apoio da Comissão Europeia.
A informação contida nesta comunicação vincula exclusivamente os autores, não sendo a
Comissão responsável pela utilização que dela possa ser feita.
n. 504666-LLP-1-2009-1-IT-LMP
educational models, attachment and motherhood, definition of the concept “culture”, mediation in
maternity and childhood in the healthcare context. These themes were presented by different trainers,
reflecting the interdisciplinary nature of the program and addressing the diversity of the professionals`
needs.
The presented topics were scheduled as follows:
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Day 1 – Introduction: Ethics, cultural mediation and public services
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Day 2 – Migration, Health and Anthropology: Medical Pluralism; Biomedicine as cultural
system; Critical analysis of concepts of body, identity, and gender. Medical anthropology, social
suffering and illness. Illness narratives.
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Day 3 – Cultural Mediation and Women’s Health and Maternal Care. Migration and family,
Anthropology of motherhood; growing up in an anthropological perspective; Anthropology of
childhood. Genital cutting and cultural construction of gender. Cultural mediation in hospital and
women and child health.
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Day 4 – Cultural Mediation and Mental Health. Etnopsychology and migration, Transcultural
psychiatry, Refugees, Trauma and Violence.
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Day 5 – Case supervision
Methodology:
In the training, lessons drew on on some of the most important authors in medical anthropology and
ethnopsychiatry. Restrictions on the number of participants and the consequent small audience
facilitated the transfer of contents and the exchange of opinions and personal experiences among the
operators. At the end of each lesson, there was a time reserved for the discussion of the issues raised
and the possibility to share some work experiences. This moment had been very useful to shift from
theoretical concepts to their actual application in everyday situations.
Moreover, multimedia technologies were used as teaching materials (power-point, ethnographical
documentaries, movies): they have the value of immdiately showing the audience what the trainer is
speaking about, also involving the trainees at an emotional level. This material also provides a safe
learning environment in which to initiate critical debates, allowing participates to articulate and
WP 9 – CRIA – Evaluation of Training
Projecto financiado com o apoio da Comissão Europeia.
A informação contida nesta comunicação vincula exclusivamente os autores, não sendo a
Comissão responsável pela utilização que dela possa ser feita.
n. 504666-LLP-1-2009-1-IT-LMP
exchange different points of view, compare experiences and formalize new ideas about their
professional practice.
Assessment:
Each day of training was evaluated by the trainees anonymously, using a grid, rated on a Likert scale
from 1 (poor) to 5 (very good). The domains assessed included: global evaluation; meeting of trainee’s
expectations; utility for professional role; duration of training; dynamics of activities; quality of
contributions by group of trainees; group atmosphere; relationships among trainers and trainees; quality
of training materials.
In general, each day of training was assessed very positively, with overall evaluation of each day ranging
from 4.17 (Day 3) to 4.39 (Day 2). All training days were evaluated above 4, with a total average of 4.30.
The domain that was evaluated as least positive was the “quality of contributions by group of trainees”
(4.18), while the domain that was most positively evaluated was the “utility for professional role” (4.58).
Overall Assessment at the End of Training:
At the end of training, an extended questionnaire was delivered to all the participants. This included
closed-ended questions regarding the overall rating of the course, but also a larger section of openended questions inquiring about the most positive aspects of training, the least positive, suggestions for
improvement and so forth.
The overall rating of the course (on a scale from 1 to 10) was 8.83, ranging from 6 to 10. These results
reflect the positive evaluations of the course conducted each day.
In the open-ended questions it is possible to reach the following conclusions:
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Areas of most interest: a lot of trainees responded “all of the topics were interesting”; mental
health and anthropological models were the two most mentioned; maternity and female genital
mutilation were also commonly listed.
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5 Most positive aspects of training: practical cases; the competence/knowledge of trainers;
communication ability and clarity in transmitting ideas; empathy and quality of relationship
WP 9 – CRIA – Evaluation of Training
Projecto financiado com o apoio da Comissão Europeia.
A informação contida nesta comunicação vincula exclusivamente os autores, não sendo a
Comissão responsável pela utilização que dela possa ser feita.
n. 504666-LLP-1-2009-1-IT-LMP
between trainers and trainees; relevance/interest/utility of training contents; participation by
the group and openness for discussion.
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5 less positive aspects of training: need for more cases; having more time; more depth in some
themes.
Regarding the two main domains of T-Share, trainees were asked to highlight particular aspects of the
training content, to make sure that there was an actual learning process. Hence, the trainees responded
that:
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3 Most Useful Ideas for Women’s Health and Maternal Care: importance of understanding the
culture; importance of understanding the uniqueness of the experience of the woman; taking
into account cultural differences in parental practices; importance of team work; relevance of
intercultural training for health professionals.
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3 Most Useful Ideas for Mental health Care: importance of the history of the patient;
knowledge of different models for intervention, including biomedical interventions;
understanding of the influence of social factors, cultural aspects, and political/power issues;
importance of communication (e.g. active listening) and follow up of patients (e.g. referrals).
WP 9 – CRIA – Evaluation of Training
Projecto financiado com o apoio da Comissão Europeia.
A informação contida nesta comunicação vincula exclusivamente os autores, não sendo a
Comissão responsável pela utilização que dela possa ser feita.