PRE-COMPETENCY QUESTIONNAIRE

NB: Before registering for the various workshops in the Cultural Competency Training Program for Improved French-Language Health Services, each participant must complete this questionnaire.

Cultural Competency team thanks you for taking the time to fill out the questionnaire below.

Please note that our workshops will be offered for the period from February to March 2015.

For year 2015, find below institutions which will receive the training:

1. Hospitals: (March 2, from 2:00 p.m to 5:00 p.m)
• Doctors
• Managers/senior managers
Location: St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8

2. Long-term care (March 27, 2015 from 8:30 a.m to 2:00 p.m)
• Managers/senior managers
• Case managers
Location: Les Centres d’Accueil Héritage, 33 Hahn Pl, Toronto, ON M5A 4G2

3. Community health centers :( March 4, 2015 from 9:00 a.m to 4:00 p.m)
• Nurses
• Managers/senior managers
• Doctors
Location: La Passerelle-IDÉ, 2 Carlton Street, West Mezzanine, Toronto, ON M5B 1J3

4. Mental health and addiction: (March 19, 2015 from 2:00 p.m to 5:00 p.m)
• Doctors
• Case managers
• Trauma counsellors
Location: CAMH, 33 Russell Street (Room 2029), Toronto, ON, M5S 2S1

5. Community health centers :( March 25, 2015 from 2:00 p.m to 5:00 p.m)
• Nurses
• Managers/senior managers
• Doctors
Location: Women’s Health in Women’s Hands, 2 Carlton Street, Suite 500 Toronto, ON M5B 1J3

6. Hospitals: (April 2, from 1:00 p.m to 4:00 p.m)
• Doctors
• Managers/senior managers
Location: Toronto East General Hospital, 825 Coxwell Avenue,Toronto, ON M4C 3E7

Please click here to register: https://fr.surveymonkey.com/s/registEn

For any question, please contact Dramane by email at: dramane@passerelle-ide.com or by phone at: 416-934-0588 ext. 252.

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* 1. Your organization name:

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* 2. Address of your organization:

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* 3. Your work place

Hospital

Community Health Centre

Long Term Care Centre

Mental health Services

CCAC

Other (please specify)

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* 4. Your role within your work place

Doctor

Nurse

Laboratory Technician

Physiotherapist

Respiratory Therapist

Auxiliary

Health Care Officer

Intern

Intake Worker

Receptionist, Telephone Operator

Volunteer

Medical Interpreter

Communication Services

Psychologist

Social Worker

Counsellor

Therapist

Administrative

Manager

Pharmacist in Hospital

Medical secretary

Other (please specify)

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* 5. Your cultural background

Canadian origin (specify province in comment field)

Francophone

Newcomer (1 to 3 years)

Immigrant (Specify number of years in comment field)

Member of an ethno-cultural community

Comment

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* 6. Number of years of professional practice in Canada

Up to 5

6 to 10

11 to 20

More than 20

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* 7. Number of years of professional practice outside Canada

Up to 5

6 to 10

11 to 20

More than 20

Never practice outside Canada

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* 8. LHINs Geographical location of the organization you work for

Toronto East

Toronto North

Toronto Centre

Toronto West

Toronto South

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* 9. Please tell us about your experience in the area of cultural diversity within Francophone communities

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* 10. Where does the clientele your organization serves come from?

Africa (specify):

Caribbean (specify):

Asia (specify):

Europe (specify):

Middle East (specify):

Other:

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* 11. Which group do you serve?

Youth

Women

Seniors

Men

Children

Francophones

Special Needs Individuals (specify)

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* 12. The following groups are represented among the staff at the institution where I work:

Canadian origin

Francophone

Newcomer - Member of an ethno-cultural community

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* 13. What types of services do you offer to clients?

Physical health care

Mental health care

Diagnosis services (laboratory, radiology, etc.)

Rehabilitation care

Administrative services

Home care services

Long-term care

Other (please specify)

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* 14. What challenges do you face when delivering health care or services to Francophone clients?

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* 15. What tools, strategies, resources have you used to overcome such challenges?

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* 16. Have you attended training(s) in cultural competency?

Yes (please specify)

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* 17. What is your level of interest in participating in cultural competency training focusing on the realities of Francophone communities?

Low

Medium

High

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* 1. Your organization name:

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* 2. Address of your organization:

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* 3. Your work place

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* 4. Your role within your work place

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* 5. Your cultural background

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* 6. Number of years of professional practice in Canada

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* 7. Number of years of professional practice outside Canada

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* 8. LHINs Geographical location of the organization you work for

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* 9. Please tell us about your experience in the area of cultural diversity within Francophone communities

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* 10. Where does the clientele your organization serves come from?

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* 11. Which group do you serve?

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* 12. The following groups are represented among the staff at the institution where I work:

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* 13. What types of services do you offer to clients?

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* 14. What challenges do you face when delivering health care or services to Francophone clients?

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* 15. What tools, strategies, resources have you used to overcome such challenges?

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* 16. Have you attended training(s) in cultural competency?

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* 17. What is your level of interest in participating in cultural competency training focusing on the realities of Francophone communities?

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* 18. What are your objectives regarding a cultural competency training?