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Workshop
E-4: Innovative approaches to meeting the needs of diverse populations
Removing
Barriers to Health for Newly Emerging Latino Populations
Designing and Implementing Culturally Competent Programs
This presentation explores how communities with a new emerging Hispanic
or Latino population can develop access to primary, urgent and specialty
health care services, especially for uninsured populations. During the
last four years, the Hispanic population has become the fastest growing
minority population in Dayton Ohio, a mid size, urban area. This presentation
will focus on the lessons learned over the last four years, as the agency
has:
- successfully integrated the Latino population into an existing system
of free clinics staffed by volunteer health professionals,
- created and placed kiosks containing information on 150 local health
resources and 180 health information topics in Spanish and English in
locations throughout the county,
- provided cultural competency training to health professionals including
first responders, and
- created a health education program for Hispanic women and their families—aimed
increasing healthy eating, activity levels, access to health screenings,
and primary care.
In serving a new population, we have learned the importance of formulating
new partnerships and overcoming barriers. To increase access to our clinics,
Reach Out of Montgomery County entered into an exciting partnership with
the local council of the League of United Latin American Citizens who
recruited persons to act as volunteer interpreters. In delivering care
through our clinics, we also discovered the importance of having a bilingual
case manager who could help this population access other specialty care
services and primary care.
We also learned that health professionals have equally as many concerns
regarding cultural differences. We are constantly learning and sharing
information about challenges facing the Latino population. Many challenges
remain on filling the demand for interpreter services. To address these
issues, we learned to provide training to all health professionals, including:
medical students, residents, physicians, nurses, and first responders.
In a rather segregated community where low income African Americans
and Appalachian populations have always experienced disparities in accessing
care, Reach Out of Montgomery County has also learned that they must educate
business leaders, government officials, public health systems and other
community members regarding the needs of this special population. The
development of a kiosk project called Rotary HEALTHLINKS assisted with
this effort by placing 8 terminals in various locations throughout the
community. This project grew out of an active relationship between the
Rotary Club of Dayton, Reach Out of Montgomery County and an array of
other agencies including local colleges.
While we met primary health care needs, we were still struggling with
the need to provide health education, unique to the issues facing Latinos
in our community. This led us to another joint venture with a neighborhood
development group called East End Community Services. Together we began
developing health education programs for the Latino women and sought funding
through the Ohio Commission on Minority Health. This program is called
Milagro de Mujer or the “miracle of women.”
Lesson learned is that a health disparity population needs an “extra”
voice to help them access healthcare services. The question remains, if
one can mobilize a community fast enough to respond to their needs before
the door of wellness closes…..…too little, too late.
Sharon Sherlock, RN, BSN, MSA, has worked 26 years as a clinician
and in various management positions throughout healthcare. Sharon’s
employment background extends from hospitals, to home care, to managed
care organizations, and currently into community health. As executive
director for Reach Out, Sharon has successfully grown a grassroots organization
into one of Dayton’s largest healthcare partnership programs with
local support from community groups, Universities, service clubs, health
department and charter schools. Sharon has assembled volunteer physicians,
nurses, pharmacist, translators as well as other health professionals
to deliver free health care services to the Underserved in Dayton, Ohio.
Reach Out was a 1994 recipient of Robert Wood Johnson’s physician
initiative project and has grown to be a sustainable volunteer program
serving a culturally diverse population serving all age groups. Ms. Sherlock
has been asked to speak in various venues regarding the needs of the Latino
population and health care for the uninsured and underserved populations.
She is completing a doctorate in health administration with Central Michigan
University.
Sharon Sherlock, RN, BSN, MSA
Reach Out of Montgomery County
1344 Woodman Drive,
Dayton, Ohio 45432
Improving
access and quality of primary health care for migrants: migrant health
educators bridging the gap between migrant patients and general practitioners:
Experiences in Amsterdam, the Netherlands
- 1. Description of the project.
- About 37 % of the Amsterdam population is of migrant origin. The
most important groups of migrants are coming from Morocco, Turkey, Surinam
and the Dutch Antilles, besides political refugees with a large variety
of ethnic backgrounds. In the late nineties it became clear that general
practitioners working in neighbourhoods of Amsterdam with a large proportion
of migrants experienced a very heavy workload due to language and cultural
differences with there patients. Therefore in 1998 we decided to introduce
the migrant health educators in the practices of family doctors with
a large proportion of migrant patients.
The migrant health educators are trained as intermediate between the
general practitioner and the patients. Not only as an interpreter, but
also at the level of health educator, bridging both the cultural and
language gaps between the patient and the general practitioner. The
migrant health educators give individual health information to patients,
attend the consultation of the patient and the general practitioner,
and organise information meetings for groups of patients. At present
12 migrant health educators are working in 22 different practices in
Amsterdam.
- 2. Successes of the project.
- Evaluation of the effect of the implementation of the migrant health
educators revealed that the quality of health care as experienced by
both the general practitioners and the patients improved significantly.
The GP’s experienced workload is decreased, the patients have more
knowledge about their illness and are more loyal to therapy. The mutual
understanding of the general practitioner and the patient is improved.
The most frequently discussed topics include the organisation of the
health care system in the Netherlands, psychosocial distress, anatomy
('understand your body'), upbringing and diabetes care.
- 3.Challenges of the project.
- At the start of the project it was for both general practitioners
and health educators insufficiently clear what they could expect and
demand from each other. The health educators were not all sufficiently
prepared to work in a complex environment such as the family doctor’s
practices. This meant that not in all practices the implementation of
the health educators became a success. Also, not all migrant patients
are willing to discuss there questions or problems with the health educators,
precisely because they are coming from the same community.
- 4. Lessons learned.
- For a successful implementation of a migrant health educator within
family doctor’s practices, the following conditions are crucial.
First, a considerable part of the patient population of the practice
should be of migrant origin. Second, the support for the implementation
should be strong among the general practitioners as well as their assistants.
Third, the general practitioner should actively refer patients to the
health educator. And fourth, a health educator should be trained adequately
for the job.
Marijke Ekkelboom (1955) was trained as a general nurse at the
university clinic of the Free University in Amsterdam. After several years
of working as a nurse in general hospitals in Amsterdam and abroad (Norway),
she was appointed as public health nurse in one of the mother and child
health care centres of Amsterdam (1982-1999). Within this position she
became especially skilled in primary health care delivery towards migrants.
She was a teacher of trainings for migrant health educators. Since 1999
she is working as coordinator of migrant health educators working with
general practitioners.
Resource Binder Information
See PowerPoint presentation.
Marijke Ekkelboom
Municipal Health Service Amsterdam
Department of Epidemiology & Health Promotion
P.O.Box 2200, 1000 CE Amsterdam, The Netherlands
Phone: ++31.20.555.5503
Fax: ++31.20.555.5160
mekkelboom@gggd.amsterdam.nl
www.gggd.amsterdam.nl
Innovative
Program: Healthy Aging Summits “Honoring Our Elders-Caring for Our
Diverse Communities”
In the 21st century, as the demographics of the senior population rapidly
change, studies indicate an increase in chronic disease, disability and
dependence observed in the ethnic elderly populations. Many of these health
conditions can be prevented through lifestyle management and education.
Prevention must become a priority of the health care delivery system.
A culturally sensitive and senior friendly approach for improved health
care must be established to support a change from a fragmented system
to a coordinated health care system that is proactive and promotes prevention
and self-care strategies.
The Healthy Aging Coalition of Northern California is a unique collaborative
whose mission is health promotion and disease prevention. The Coalition
accomplishes this mission by bringing together Sacramento’s major
healthcare providers, policy makers and over 200 community based organizations
that serve at risk older adults. The Healthy Aging Coalition membership
possesses the infrastructure and expertise to provide access to free health
services and community resources. The ethnic underserved elderly population
encounters many barriers in accessing the traditional model of health
care and education. Due to these cultural barriers, many older adults
do not receive necessary healthcare. The Healthy Aging Summits provide
a community-friendly venue for free health screening, as well as linkages
to a multitude of community resources. Since the first summit in 2001,
we have served over 12,000 members of the Latino, Southeast Asian, African
American and Caucasian older adult community. The Healthy Aging Summits
have extensive community support and viable infrastructure, providing
a very cost-effective means for many organizations to reach regional underserved
communities. A steering committee comprised of leaders and members from
specific ethnic groups assist in organizational development, marketing,
and promotion of their Summit. These committees are instrumental in defining
the program and addressing the dilemmas of how best to serve the medical,
social, and cultural needs of the community.
Successes of Program and Innovative Approaches: . In 2002, The
Healthy Aging Summits for diverse communities received a national award
from the American Society on Aging for innovation and quality in health
care program.
Since 2001, the Healthy Aging Summits have provided a venue which supports
collaboration over competition and enhanced communication among the health
systems, political officials and the community based non-profit organizations
that serve older adults and diverse communities. Approximately 80-120
non-profit community health organizations have been able to reach out
and provide screening and comprehensive information services to thousands
of at risk and older adults. These summits have provided hands-on training
for college/medical students and health care professionals in cultural
competency while providing direct services. These events have provided
some individuals with their only opportunity to receive free health screenings
and have access to essential community information and health education
in one place at one time. The Summits have promoted intergenerational,
caregiver and family involvement in the participant’s health. The
Summits contribute to the community members leaving with a better understanding
of how to access the health care system through the “Now What?”
component. Approximately 20-30 culture/linguistic specific organizations
per summit are committed to ensuring the project’s cultural relevance
to the identified ethnic community. Through their involvement, these organizations
learn valuable tools to sustain the program. Finally, these Summits provide
an ideal venue for research on “hard to reach” ethnic communities
as many of the attendees will enroll in research studies that are instrumental
to disease prevention and protecting future generations
Challenges (risks/benefits) of the program: The Healthy Aging
Summits project support is dependent on the solicitation of direct funding
exceeding $150,000 annually. Much of the coalition’s funding and
support also comes from in-kind contributions which include personnel,
resources, and related media (television, print, radio) promotion and
advertising. To date, the Coalition’s membership exceeds 70 organizations
(both profit and non-profit), and includes over a hundred volunteers from
these respective organizations and the community-at-large. With each summit,
it is difficult to predict attendance consequently marketing and promotional
material must be comprehensive and provide as much information as possible.
A challenge in using consortiums is that roles must be clearly defined
to ensure success and group harmony. A challenge in reaching both the
older adult community and ethnic communities is that the events are dependent
on expensive media support and extensive grass roots support. There must
be continued buy-in from the media and the community based organizations.
Traditionally attendees from ethnic communities have shown more interest
in free health screenings, and community resource fairs rather than health
education lectures. It is difficult to find non-profit, cultural specific
organizations that have the infrastructure, leadership and staff to manage
a large project such as the Healthy Aging Summits, making sustainability
problematic. The final challenge in serving these ethnic communities is
to continue to identify adequate resources for the cultural and linguistic
challenges associated with providing health services to non-English speakers.
Translators must be recruited and language specific materials must be
developed that is culturally sensitive and addresses the needs of the
specific ethnic community
Opportunities
for Replication of Model Program/ Lessons Learned/ Resources
The Healthy Aging Summits are now being viewed as a model blueprint for
other communities - ethnic, disabled, gender specific etc. Our model is
highly adaptable to these communities since we have now created a set
of “templates” that give other local health care providers and
community organizations tools designed to specifically target and reach
new populations. Since Sacramento, California has just been named the
most diverse city in the nation, our timing and associated opportunity
to expand this initiative is ideal.
Martha Geraty is a graduate of UC Berkeley and serves as the Director
of Community Outreach for the UC Davis Center for Healthy Aging. Martha
has formal training in Human Development/Geriatrics, and possesses over
15 years of program expertise developing grass roots, multi-cultural events.
She has successfully delivered over 600 education and training programs
and 50 large conferences, health fairs, summits and walks aimed at improving
the lives of older adults. In 1999, she created the successful “Coming
of Age Lecture Series ” which serves over 3000 individuals with 26
lectures each year. Martha is an appointed Commissioner for the Sacramento
Adult and Aging Commission. During her tenure, she has received honorable
awards and resolutions for her commitment to diversity and personal achievements.
Drawing from her expertise in community relations and aging, she has been
dedicated to outreach and education while nurturing ongoing relationships
with Sacramento’s older adult, professional and educational communities.
Martha Geraty, BA
Director Community Outreach Programs
Chair, Healthy Aging Summits for Diverse Communities 2002-2004
UC Davis Center for Healthy Aging
4625 2nd Avenue, Suite 2004
Sacramento, CA 95817
916-734-4768
fax: 916-734-4773
megeraty@ucdavis.edu
website: http://healthyagingsummit.ucdavis.edu
Co-Presenting with Martha Geraty will be Delia Roberts who has
served as the Event Co-Chair for the Healthy Aging Summits for Diverse
Communities. In this role, Delia has been responsible for overseeing the
finances, promotional material design, event program, entertainment and
developing a multicultural/ intergenerational art room which was a “major
feature” of the 2003 Summit held at the California State Fair Exposition
Center. In addition to her work with the UC Davis Center for Healthy Aging,
Delia is the owner of Very Momentous Occasions, a private event coordination
company.
Delia Roberts
Senior Community Health Program Coordinator
Event Co- Chair, Healthy Aging Summits 2003-2004
UC Davis Center for Healthy Aging
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