 |
|
 |
The Third National
Conference on |
|
|
|
October
2 - 4, 2002, Chicago, IL |
|
| 2002 Conference Proceedings | |
|
|
||||||
|
Conference Proceedings continued IV. Overall Conference Conclusions The notion of integrating cultural competence into broader national health care objectives, such as quality, patient safety, effectiveness, and cost-efficiency, was widely discussed at the conference. But underlying these conversations was the tension between the notion of trying to “mainstream” cultural competence under one of these agendas, and simply valuing it for its own sake. Referring to the measurement and evaluation theme of the conference, Bob Ross stated, “Evidence and data are good. They are necessary…[but] they are clearly insufficient to get us there.” Rather, he said, they are “tools and strategies that must be employed as part of a collective approach” to achieving culturally competent care. “To those Americans, those underserved and marginalized Americans who are really struggling with our health care system, who feel lost, and intimidated, and frightened, and terrified, and confused when they walk in concerned about their health, it is really a jungle out there…let us not forget for a moment the number of lives that are being hurt and lost…as we politely wait for the evidence base to mount big enough for some huge epiphany to happen in Washington and Congress.” There are many ways to engage health care systems in the effort to improve quality for culturally diverse populations, and conference presenters and participants report that different approaches work for different audiences. Strategies must be tailored to the most important values of individual stakeholders, and the ultimate utility of these approaches can be measured only by their success in each unique situation. Perhaps the take-home message from the third national conference is that every person who seeks health services should receive care that is not compromised by language or other cultural barriers. As advocates for good health, it is our task to articulate clearly and convincingly—using as many levers as possible—the positive clinical, systemic, and financial benefits to be gained from culturally appropriate heath services. Conference Plenary Presentations V. Conference Plenary Presentations Conference plenary sessions
featured national leaders presenting on the main conference themes. Summaries
of these presentations follow. Keynote Address: Culture and Quality—Joining the Levers Mark Smith, MD, MBA, President and Chief Executive Officer of the California HealthCare Foundation Dr. Mark Smith urged the cultural competency movement to join together with the quality movement in order to bring about real change in American medicine. Such collaboration would shift the focus from statistical differences per se to overall quality-of-care issues. He advised adopting the vocabulary of the quality movement; supporting measurement, accountability, and public reporting; arming patients so that they can help the movement; and reexamining the role and meaning of the terms “race” and “ethnicity.” He compared the cultural competency movement to a lever, positioned to lift the health care system, but not having sufficient force. As he explained, the longer the lever arm—that is, the greater the distance between the fulcrum and resistance force—the more weight the lever can lift. As the cultural competency movement joins forces with the quality movement, the lever arm becomes longer and more effective. The Vocabulary of Quality He suggested adopting the definition of quality developed by the Institute of Medicine (IOM), which has designated six attributes as essential. Quality health care must be: safe, effective, patient-centered, timely, efficient, and equitable. In Dr. Smith’s view, the fact that one group receives more of a procedure than another is not necessarily a quality issue, but it becomes one when it bears on one of these six measures of quality. The Fulcrum: Measurement and Public Reporting Dr. Smith advised using the momentum created by the current era of accountability, quality measurement, and public reporting to further the agenda of cultural competence. “I think the fulcrum…the thing that moves this force, is measurement and public reporting,” he said. Quality measurement resides in two domains: the clinical/technical and patient experience. Providing the best clinical care is crucial. However, Dr. Smith said, “There are aspects of the patient's experience that you can ascertain only by asking the patient, and, increasingly, I think there is recognition, even in the most hard-hearted of circles, that there is a patient experience domain to quality that is equally important, that is valid, no less so because it is the subjective experience of patients.” He gave examples of specific questions that he believes “are indisputably measures of the quality of care…. Some—not all, but some of them—are reasonable proxies for cultural competence of institutions and providers and should be used by this movement for that purpose.” Measurement tools. The Picker survey, which measures patient experience in in-patient care, asks telling questions. Did you have confidence and trust in the doctors treating you? Did doctors talk in front of you as if you weren't there? Did a doctor or nurse explain the results of tests in a way you could understand? Dr. Smith contends that questions such as these can help organizations find areas for improvement. “If you collect the data by race or language and analyze it by race or language, I believe you will find additional areas for improvement.” He thinks standardization of surveys is important for purposes of comparison. For example, if a hospital has an overall satisfaction rate of 80 percent, but that rate is only 40 percent among a certain subgroup, the hospital learns “that's a group that deserves special attention.” Some examples of “powerful levers” would be reports on mortality or on preventive services—mammograms, pap smears, prostate antigen—by race. Far Rockaway, New York, for example, which has a predominantly poor, African American population, was found to have the highest rate of diabetic amputations in the country. “The endocrinologists know there should be no amputations and so do the general internist and the family doctors. An amputation is, until proven otherwise, prima facie evidence of low-quality care.” Patients themselves should understand that they shouldn’t be getting amputations. They should know the yearly tests they need to demand to prevent that outcome. Public reporting. Dr. Smith acknowledged that not everyone will use reports on quality to make health care decisions any more than everyone reads consumer reports before buying a car. However, he listed four reasons public reporting is important:
Among the challenges ahead are making sure that the measures and the data reflect the true mix of the populations; and segmenting that data by population as a way of guiding targeted improvements and as a way of challenging the kind of resistance that always rears its head among professionals who are not used to being publicly graded. “We have begun that process in California by publishing public reports of hospital experiences by name in English, and Spanish, and Chinese. Is it perfect? No. Is it a beginning? Yes. “The keys for this movement,” he said, “are, first, to focus on the quality issues; second, to frame them as quality issues, because … framing them as quality issues will provide more leverage in the health care debates; third, wherever possible to use existing metrics as levers to highlight problem areas.” The Changing Meaning of Race Race and ethnicity are social and not biological categories. Studies should demand a precise definition of racial categories, rather than assigning a patient to a category on the basis of his last name or how he looks. Also, there are growing numbers of mixed-race people. In California, of native-born mothers over 20 percent of births are now to multi-ethnic children. Genomics has the potential to move from the kind of group genetic guesses that racial and cultural phenotypes imply to individual genetic certainty. Black people tend to have different responses than white people to certain kinds of drugs, such as angiotensin converting enzyme inhibitors. But because race is not a biological category, what this consists of is a genetic probability of a certain enzyme being missing in black people. “I guarantee that within three or four years, the precise enzyme [that is missing] will be identified in the same way that G6PD deficiency is now identified,” he said. People will be able to buy a CD that contains their genetic code or their racial mix. “Genetics will change our lives; it will change the way in which we perceive the interaction of race and medicine because it will change…genetic group guesses to genetic individual certainties.” Final Cautions Dr. Smith warned against stereotyping, or presuming to know what an individual of a given ethnicity or culture needs, wants, or deserves. He reminded the audience of the IOM’s definition of “patient centeredness:” respect for and responsiveness to the patient's individual preferences and needs. He urged the audience to “blend this striving for competence, for excellence, for achievement with a notion of inquiry, of humility….The process of understanding what our patients as a whole or as a subdivision thereof, men/women, gays/straight, black/white, Latino/Asian, people who speak English as a first language/people who don't, is not a process of assuming that because you've been to a conference, or because you've passed a test, or even because you care passionately, that you necessarily have got it licked…[nor] that you know ahead of time what it is people want or what’s good for them.” The Role of Language and Culture in Patient Safety Paul M. Schyve, MD, Senior Vice President, Joint Commission on Accreditation of Healthcare Organizations Dr. Paul Schyve explained how cultural competence is a key component of effective communication, which is critical to patient safety. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has focused on patient safety in its effort to reduce the number of “sentinel events,” mistakes that lead to death or disability in patients. Dr. Schyve discussed the root causes of these events and outlined the steps his organization is taking to help health care facilities improve their safety records. The first focus of the joint commission was the right of every patient to high-quality care, regardless of ethnicity. A second focus became patients’ participation in their own care, which is critical to good health outcomes. Now in the third phase, the focus on cultural competence means that patients not only have rights plus an obligation to participate in their own care, but that these issues bear directly on patient safety. Special attention to safety began in 1995, a year when several serious events occurred in hospitals with good reputations: the wrong leg cut off, the wrong side of the brain operated on, fatal overdoses of chemotherapy. The 1999 IOM report, “To Err Is Human,” said that some 44- to 98,000 preventable deaths occur each year in hospitals due to medical errors. And although people have subsequently quibbled about whether those numbers are too low or too high, all agree that these numbers deserve attention. These events have led to public distrust of health care organizations. Analysis of these events showed that communication failures were the first and second most common causes of events that caused death or disability. These failures might be in information technology; or in lack of communication or misunderstanding between caregivers or between caregiver and patient. As Dr. Schyve said, the same responsiveness to changing circumstances that makes humans so creative can also result in error. Any individual can make a mistake, so the systems in which that individual works must be set up to catch those mistakes as early as possible. Some of the systems that were in place in 1995 not only enabled mistakes, but sometimes even forced them. Changing systems requires a culture change within the organization so that people can feel free to talk about things that go wrong rather than feel they are going to be punished. The JCAHO standards list three elements that it looks for as signs of positive cultural change:
Patient Participation Is Key A major goal of the Joint Commission is to increase patient participation. Patients and families are more satisfied with the care they receive when they feel they’ve engaged in successful communication. More importantly, an atmosphere that fosters communication actually affects health outcomes. If the caregivers get the information they need from the patient, and if the patient understands what is being advised, the outcome improves. When patients fully participate in decision-making about their care, they increase their own safety. The patient must be considered a critical member of the health care team, just as the airplane passenger must now join the crew and the pilot in reporting anything suspicious. The patient, like the passenger, needs to know that he or she will not only be heard, but understood and valued. This is how trust is built. Specifically, providers need to recognize and be sensitive to a patient's psychosocial, spiritual, and cultural values, and communicate in a way that is appropriate to the patient’s age, understanding, and language. The Role of the Commission The commission recently created the “Speak Up Campaign,” which encourages patients to participate in decisions about their care. Brochures in both Spanish and English advise patients to choose an advocate if they feel they cannot speak up for themselves. Patients are advised to ask questions, know what their medication is treating, know who is providing the care, and educate themselves about their illness and treatments. Dr. Schyve described changes that the commission is making in its survey process (outlined on the JCAHO Web site). The changes address the fact that any organization has areas of concern in its systems. Rather than have a surveyor do something that the staff can do, such as check refrigerator temperatures, surveyors are finding out before they arrive which areas an organization might need advice about. The organization does a self-assessment every 15 to 18 months, midway through the accreditation cycle, which gives surveyors what they call a “priority focus.” A priority focus might consist of knowing that a significant number of patients in a particular organization come from a specific language, ethnic, or cultural group. Surveyors then make sure that they speak with some of those patients to find out how issues around cultural and linguistic competence are handled. Another change is that surveyors are going to use what’s called a tracer methodology. They're going to spend a lot less time in meetings with staff, instead seeing more patients and tracing the care of that patient. Surveyors can then find the root cause of problems, rather than just provide a list of non-compliance. JCAHO has contracted with one of the major Midwestern universities to help train the surveyors in this new systems analysis approach. Measurement Initiatives The commission’s Office of Quality Monitoring has an 800 number for complaints from staff, patients, or families. Dr. Schyve has not seen many complaints at this point that can be traced back to issues of cultural competence, but he hopes that people will come to understand that those issues are worth calling about. The commission’s advisory committee has proposed collecting ethnicity, language, and race data so that they can measure performance within groups. However, their proposal has been rejected as there are states that don't permit that data to be collected. “My hope would be that that changes because we would be happy to include some of those demographic variables in those measures,” said Dr. Schyve. Finally, his organization is trying to learn more about which cultural and linguistic competence issues it might be able to address through the accreditation process. Such information could help them in educating organizations and setting up standards. He concluded, “We would like to increase the role of our surveyors in consulting around culturally and linguistically appropriate services as part of the survey process. We also would … like to see if we can overcome some of those measurement barriers so that we would all have better, reliable data to look at in terms of racial and cultural and linguistic disparities in care.”
The Institute for Culturally Competent Care: Leveraging Kaiser Permanente's Expertise Nilda Chong, MD, DrPH, MPH; Director, Institute for Culturally Competent Care, Kaiser Permanente Kaiser Permanente’s three-pronged national diversity agenda includes culturally competent care, linguistic services, and workforce diversity. Dr. Nilda Chongdirects the organization’s efforts in the first of these areas through the Institute for Culturally Competent Care. The institute was established to further one of Kaiser Permanente’s broad goals: at every point of contact with the organization, a member will find a sensitive individual who is responsive to his or her needs. Dr. Chong’s work focuses on finding ways to capture and disseminate the expertise that resides within Kaiser Permanente, and promoting the creation of innovative tools that enable providers to share their knowledge with the 11,000 doctors and 23,000 nurses who work in the organization. One of Dr. Chong’s jobs is to look for the “movers and shakers,” people who are doing great work with culturally diverse populations, and designate their organization as a center of excellence in culturally competent care (CCC). The institute serves as the umbrella organization for these centers, facilitating the sharing of expertise, supplying advice, finding resources, and developing training curricula. Once expertise is identified, the institute’s goal is to capture and disseminate it. The institute serves as a repository or clearinghouse of information with an up-to-date inventory of resources. If, for example, a provider has been working with a largely African-American population, that provider’s expertise can be shared across the organization. If somebody in Portland wants to know how to address an issue that’s relevant to the Armenian population, he or she can find others who are working with that ethnic group across the country. Centers of Excellence The first center of excellence, the African-American center in West Los Angeles, was formed in 1999. Now there's a Latino center in Colorado, linguistic services in San Francisco, and a center for members with disabilities in Vallejo, California—an especially important one because it crosses race and ethnicity boundaries. Four new centers were to be launched before the end of 2002: women's health; an Armenian center in Glendale; an Eastern European center; and one for the African-West Indian immigrant, whose lifestyle, diet, and background differ from those of the African immigrant. Kaiser’s first center serves 45 percent African-American members. That organization decided to focus on three of the main clinical entities that impact the health of this population: congestive heart failure, prostate cancer, and sickle-cell anemia. They are slated to publish a sickle-cell resource manual. As with all the centers, the institute commits to providing support and the center commits to sharing expertise across all facilities, usually by creating a specific product. Handbooks are due in mid-2004 from the women’s and disabilities centers. “This is what we have …perceived as the needs of providers. They need things that they can take out of a binder or off a disk and use,” said Dr. Chong. Other products from the centers and the institute are in the works. A few of these are:
Training In addition to these products, the institute is developing a culturally competent care training curriculum with four modules: an introduction to culturally competent care; cultural awareness; cultural knowledge; and cultural skills. The curriculum will lead to an internal certification. The program was set to launch in January, 2003, with a large group of nurses seeking certification. Kaiser is developing models of care that respond to providers’ needs. They hope by validating and sharing providers’ expertise, they will attain higher efficiency. Performance measures are the natural next step. Dr. Chong would like measures that “make culturally competent care a hard science.” She acknowledged the difficulty in measuring member satisfaction when a member is from a different culture, because the definition of satisfaction changes. Dr. Chong, whose mother is Latino and father Chinese, said that Latinos tend to want relationships to be harmonious. “If asked, ‘Did you like the way your doctor treated you?’, the Latino would say, ‘Oh, yes.’ Mainstream culture would say, ‘No, I wasn't satisfied.’ Chinese culture would say, ‘It's never good enough.’” Asking questions in such a way that they elicit a genuine response from a given culture is the challenge in measuring member satisfaction. Dr. Chong concluded by saying
that for Kaiser Permanente, culturally competent care is about increasing
effective communication and increasing treatment adherence. Not only would
office visits and hospitalization costs go down, but Kaiser’s ultimate
goal would also be achieved: improved patient health outcomes. Data, Disparities, and Discomfort: Moving the Cultural Competency Agenda Robert K. Ross, MD, Chief Executive Officer, The California Endowment Dr. Robert Ross began his address by reminding the audience that cultural competency is fundamentally a matter of social justice. In the face of what he sees as government’s hard turn to the right, he encouraged a strong focus on advocacy at the community level. It was activism that won the right to vote for women and people of color, he said, not “data, evidence, and peer review journals.” He urged people to use the tools and strategies of social activism along with scientific evidence in moving the cultural competency agenda forward. Otherwise, as he said, “Most of us who are over the age of 40 will be six feet under” before the goal of equality in health care is achieved. He pointed to tobacco as an example of how long change can take, even when the evidence is clear. The first article establishing a link between tobacco and cancer was published in the British journal Lancet in 1923. It was more than forty years before the surgeon general’s warning on packaging and close to another forty before any significant change in social policy and behavior. While he supports the effort to turn cultural competency into a hard science, he noted that the politeness that seems inherent in building up this evidence base makes him uncomfortable. Every paper seems to end with the need for more study on the issue. He advised the audience not to “merely rest on the laurels of…a stack of papers that say cultural competency is more cost-effective for health care and gives better outcomes for health care. … The disparity that we are talking about is the inability of a very large segment of Americans to be healthy enough to take advantage of the freedoms that this country has to offer.” Dr. Ross pointed out that the closest some people come to the kind of bewilderment many feel in the health care system is when they travel. He described his own experience traveling. Knowing no Italian, he and his wife bought what they thought were first class train tickets from Milan to Venice, only to find themselves lugging heavy bags through a packed car with no seats. He pointed out that this same powerlessness—minus the humor of the travel situation—is what many people feel every time they enter the health care system. In its efforts to support research that will improve cultural competency, the California Endowment will spend somewhere in the neighborhood of four or five hundred million dollars. However, Dr. Ross will be looking for “voices that are missing” from the debate but should not be: the faith community and its leadership, corporate leaders, and grassroots and community-based organizations. For example, his organization made a grant to a neighborhood Economic Development Corporation, whose goal is to train and find jobs for people in its low income, predominantly Latino community. The organization has trained people for jobs in the health care marketplace, so local hospitals are hiring staff from this program. “You have to think about a way to engage community organizations in an issue that they are extremely concerned about, and that is economic development and financial stability for their families. You get them into a market where jobs often have health insurance coverage with them, you're getting folks trained, and you're improving both the diversity and cultural competency of the health care institutions that are hiring the residents,” he said. His hope for the next year is that his and other progressive philanthropies—The Commonwealth Fund, The Robert Wood Johnson Foundation, The California HealthCare Foundation, The W. K. Kellogg Foundation, and many others—along with all those working to further cultural competence will create a center of gravity from which to launch a coordinated, multi-pronged strategy to lead the social justice agenda. He concluded that along with the evidence, pressure to change must be brought to bear on medical schools and other training and professional organizations, Congress, boards of supervisors, mayors, and corporate leaders. “If we politely wait for the evidence to build, we are not going to get there from here, folks. Let's not delude ourselves into thinking that we can be that polite. This is … about power.” Need Meets Opportunity: Current and Future Directions in Research, and Innovations in Cultural Competence Cindy Brach, Agency for Healthcare Research and Quality, USDHHS (Speaking on behalf of Carolyn Clancy, MD, Acting Administrator, Agency for Healthcare Research and Quality) Robinsue Frohboese, JD, PhD, Principal Deputy, Office for Civil Rights, USDHHS Ms. Cindy Brachbegan the closing session by putting health disparity reduction and cultural competence in the same context, noting that her agency views cultural competence as a potential vehicle to eliminate disparities as well as promote effective health care for all. The Agency for Healthcare Research and Quality (AHRQ) assesses the effectiveness of health services by funding and conducting research to develop an evidence base that helps both clinicians and patients evaluate interventions. The organization focuses on improving outcomes, quality, cost, use, and access. It looks at these areas at the level of clinical decision-makers, health systems, and public policy. Its core business is research, including medical error investigation. The agency is required to submit annual reports on the national status of both quality and disparities. Ms. Brach showed slides listing the vulnerable populations that the agency is mandated to follow, along with some of the well-documented disparities that the agency is working to understand. She outlined some of the initiatives the agency has undertaken to better understand the causes of and potential solutions to these disparities. One of the agency’s programs, EXCEED, funds Excellence Centers to Eliminate Ethnic and Racial Disparities. In response to the President's "Initiative on Racial and Ethnic Disparities in Health," the agency funded nine different centers of excellence for five-year programs for a total of $45 million. AHRQ wants the research to go beyond documenting disparities to find root causes and identify strategies to reduce them. The projects include:
Another vehicle the agency uses is the Integrated Delivery System Research Network (IDSRN), a consortium of integrated delivery systems that have research capacity. This network allows the agency to study some of the issues around racial and ethnic disparities while looking at the capacity of health care systems to collect data and undertake studies. The agency is also looking at community-based partnerships to widen their area of study. Ms. Brach described two guides the agency had created with funding from the Centers for Medicare & Medicaid Services (CMS). These practical, step-by-step tools help health plans implement their quality assurance projects. One guide covers oral, linguistic services; the other covers CLAS planning and assessment (www.cms.gov/healthplans/quality/project03.asp). AHRQ believes that its research will help people at many levels: employers who are concerned about the quality of their employees' health care; payers who want quality and value; providers, both at the health plan level or at a group practice level; clinicians; and finally, the patients and consumers. In closing, she noted that there are costs associated with disregarding health care disparities: undermining of quality efforts, limiting of scientific knowledge, and a misallocation of resources for improvement. Dr. Robinsue Frohboese closed the conference by describing her agency’s work to eliminate racial and ethnic health disparities by the year 2010. Congress, health care providers, the research community, communities of color, and local community organizations are all acutely aware of the need for equality in health care. She called for collaboration among all these organizations. She testified before Congress on her department’s progress in addressing the disparities covered in the Institute of Medicine (IOM) report, “Unequal Treatment.” She felt the report was particularly important because it assumed that health disparities exist and looked at why they exist and what can be done to address them. One of the report's major findings, she noted, is the basic tenet that racial and ethnic disparities in health care occur in the context of historical social and economic inequality. The IOM report recognized that cultural and linguistic barriers are a systems-level challenge that needs to be addressed. At all levels in the clinical encounter, in the patient-to-physician encounter, on the individual-to-individual level, bias, stereotyping, prejudice, and clinical uncertainty may contribute to the enormous health disparities in communities of color. The IOM specifically recognized the important role in compliance and enforcement that the Office for Civil Rights (OCR) plays in eliminating racial and ethnic health disparities. OCR has played a significant role in a variety of civil rights initiatives in health care, beginning with the desegregation of acute care facilities and hospitals following the passage of Medicare in the 1960s. Dr. Frohboese said the agency continues to be committed to serve as the USDHHS’s primary defender and promoter of the public's right to nondiscriminatory access to and receipt of services and programs funded by the department. She sees OCR’s role increasing as minority populations increase. The agency works not only from its headquarters in Washington but in ten regional offices and two field offices throughout the country. “We really are in a unique position to reach out to the grassroots and community organizations to apprise people of their rights and also to work with health care providers so they understand their legal obligations,” Dr. Frohboese said. OCR staff collaborate with other components within HHS, such as AHRQ; with the Office of Minority Health and all of the components of the Centers for Medicare & Medicaid Services; and with other public and private entities to get the word out about Title VI and national origin discrimination. They conduct compliance reviews of facilities and health care providers and provide technical assistance. They investigate complaints that allege discrimination on the basis of race or national origin in health care services that receive HHS funds. As the IOM report underscored, their responsibility in this area has become even more important as a result of the Sandoval decision, where the Supreme Court closed off certain types of Title VI cases. OCR is now the sole investigator of those cases. The organization has the authority to enter into resolution or settlement agreements to address Title VI problems or violations that they find, as well as the very powerful tool of withholding federal funds if they find a violation and are not able to get voluntary correction. In the last year OCR has conducted hundreds of public education outreach activities across the country that have focused specifically on Limited English Proficient (LEP) issues. In its work with various states, OCR has been able to expand its efforts beyond just one compliance situation to get much broader systemic relief. Maryland, Virginia, and North Carolina embarked on statewide plans with OCR’s help. In Idaho, the agency formed specific resolution agreements about language access policies in ten different hospitals. One complaint that was identified by the National LEP Advocacy Task Force alleged that the District of Columbia’s family resource and wellness centers failed to provide LEP persons with adequate language assistance in critical health care services, as well as social, educational, and recreational services for children and families. This happened in an area with 17 percent LEP people speaking fifty languages, an area of high need. The Department of Education and OCR worked out a resolution agreement covering all ten of the District's wellness centers and covering everything from the posting of notices on the rights of individuals to free interpreter services, to staff training and quality controls to ensure the competency of staff. The Department of Justice issued guidance on LEP issues that looks at four factors to determine the extent of obligations of health care providers to provide language access services: the number and proportion of LEP persons served or encountered in the eligible service population; the frequency with which LEP individuals come in contact with the program; the nature and importance of the program or service; and the resources available to the recipient and costs. The OCR is republishing its guidance in conformance with these factors after new public input. Dr. Frohboese recommended logging on to the site www.lep.gov. This collaborative effort between the Department of Justice, OCR, and thirty other federal agencies brings together in one-stop shopping information about legal responsibilities, guidance, and includes census and school district data and technical assistance information. Other new services and Web sites in the department include information in alternative languages, particularly Spanish.For example, the health-finder "En Español" provides a Spanish-language Web site that helps consumers track down information in several hundred areas and topics, and links to the NIH MedLine Plus in Spanish. In closing, Dr. Frohboese urged the audience to continue working with her agency as partners in teaching, sharing best practices, and providing technical assistance.
|
||||||
|
|
|
|
|
|
|
| As with the rest of DiversityRx, this section
is a work in progress and we welcome information on other efforts, programs,
and reports that will expand upon the information offered here. Please
let us know if you have other examples to include here. |
||||||
  |
essentials | models and practices | policy | legal
issues | networking |
table of contents | contact us
| who we are |
|||||
 |
 |
|||||
|
DiversityRx is sponsored by: |
 The National Conference of State Legislatures |
 Resources for Cross Cultural Health Care |
 Henry J. Kaiser Family Foundation |
|||
