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Promoting Cultural Competency Among Family Planning Providers: Lessons from the Field Grace Mose, D.A. & Karen Anderson, MPH, MEd The Education Fund of.

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Presentation on theme: "Promoting Cultural Competency Among Family Planning Providers: Lessons from the Field Grace Mose, D.A. & Karen Anderson, MPH, MEd The Education Fund of."— Presentation transcript:

1 Promoting Cultural Competency Among Family Planning Providers: Lessons from the Field Grace Mose, D.A. & Karen Anderson, MPH, MEd The Education Fund of Family Planning Advocates of NYS

2 Obj ectives/Overview Background Background Context & Rationale for Organizational Assessment Context & Rationale for Organizational Assessment Introduction to CLAS Standards Introduction to CLAS Standards Assessment Process Assessment Process From Results to Action: Mini-grants From Results to Action: Mini-grants Limitations, Lessons and Recommendations Limitations, Lessons and Recommendations Challenges & Next Steps Challenges & Next Steps

3 Who We Are Family Planning Advocates is a statewide membership organization that represents the Planned Parenthood affiliates and individual family planning centers in New York State Mission: To advance public policies that fulfill the rights of individuals to comprehensive sexual and reproductive health services and education that are consistent with the principles of justice and fairness and respect diversity, personal dignity and privacy

4 Context & Rationale for Organizational Assessment 21% (almost 4 million) New Yorkers are foreign-born 21% (almost 4 million) New Yorkers are foreign-born 2.2 million New Yorkers speak English “less than very well” 2.2 million New Yorkers speak English “less than very well” More than 5 million immigrants, speaking 150+ languages, live in the NYC metropolitan area More than 5 million immigrants, speaking 150+ languages, live in the NYC metropolitan area An estimated 2 million immigrant women in NYS need access to reproductive health services An estimated 2 million immigrant women in NYS need access to reproductive health services

5 Strengthening Cultural Competency among Family Planning Providers An ongoing project funded by the Ford Foundation An ongoing project funded by the Ford Foundation Goal: To develop a strategy to help family planning providers assess and enhance their ability to provide culturally and linguistically competent services to diverse populations Goal: To develop a strategy to help family planning providers assess and enhance their ability to provide culturally and linguistically competent services to diverse populations

6 National Standards for Culturally and Linguistically Appropriate Services in Healthcare (CLAS) Goal Goal To increase access for the racial, ethnic and linguistic populations that face most barriers To increase access for the racial, ethnic and linguistic populations that face most barriers Collective set of 14 mandates, guidelines and recommendations issued by OMH Collective set of 14 mandates, guidelines and recommendations issued by OMH Framework for developing practical guide for implementing and monitoring institutional progress towards cultural competence Framework for developing practical guide for implementing and monitoring institutional progress towards cultural competence

7 Brief Overview of CLAS Standards Themes Culturally Competent Care (Standards 1-3) Culturally Competent Care (Standards 1-3) Language Access Services (Standards 4-7) Language Access Services (Standards 4-7) Organizational Supports for Cultural Competence (Standards 8-14) Organizational Supports for Cultural Competence (Standards 8-14) Stringency Mandates (Standards 4-7) Guidelines (Standards 1-3 & 8- 13) Recommendations (Standard 14)

8 Assessment Process Identify 6 interested family planning centers Identify 6 interested family planning centers Solicit input from national experts in cultural competency Solicit input from national experts in cultural competency Conduct Organizational Cultural Competency Assessment and Institutional Checklists Conduct Organizational Cultural Competency Assessment and Institutional Checklists Conduct data analysis and develop written report Conduct data analysis and develop written report Provide mini-grants to help clinics implement recommendations Provide mini-grants to help clinics implement recommendations Provide ongoing technical assistance Provide ongoing technical assistance

9 Assessment Team Wilma Alvarado-Little, Medical Interpreter/Trainer and co-Chair of the Board, National Council on Interpreting in Health Care Wilma Alvarado-Little, Medical Interpreter/Trainer and co-Chair of the Board, National Council on Interpreting in Health Care Tim Frasca, Data analyst Tim Frasca, Data analyst Dinah Surh, Vice President, Ambulatory Care Services, The Brooklyn Hospital and member of the National Center for Cultural Competence Dinah Surh, Vice President, Ambulatory Care Services, The Brooklyn Hospital and member of the National Center for Cultural Competence Dr. Stergios Roussos, Consultant, Community Scientist, AKOUO Dr. Stergios Roussos, Consultant, Community Scientist, AKOUO Karen Anderson, Director of Public Policy, FPA Karen Anderson, Director of Public Policy, FPA Grace Mose, Program Associate, FPA Grace Mose, Program Associate, FPA Sang Hee Won & Claudia Barbaric, FPA Sang Hee Won & Claudia Barbaric, FPA

10 Assessment Sites Planned Parenthood Mohawk Hudson, Utica Center Planned Parenthood Mohawk Hudson, Utica Center Over 11,000 (total pop. ~ 60,000) refugees from 30 different language groups Over 11,000 (total pop. ~ 60,000) refugees from 30 different language groups Planned Parenthood New York City, Boro Hall Center, Brooklyn Planned Parenthood New York City, Boro Hall Center, Brooklyn Brooklyn: Foreign-born population ~ 38% in 2000 with more than 46% of the population speaking a language other than English at home Brooklyn: Foreign-born population ~ 38% in 2000 with more than 46% of the population speaking a language other than English at home Community Healthcare Network, CABS Health Center, Brooklyn Community Healthcare Network, CABS Health Center, Brooklyn Williamsburg/Bushwick area: Approximately 27% of the population is foreign-born Williamsburg/Bushwick area: Approximately 27% of the population is foreign-born Planned Parenthood Hudson Peconic New Rochelle Center Planned Parenthood Hudson Peconic New Rochelle Center Approximately 32% of the population is foreign born and 37% of the population speaks a language other than English Approximately 32% of the population is foreign born and 37% of the population speaks a language other than English PP South Central (May); PP Mid-Hudson Valley (September)

11 Assessment Tools Organizational Cultural Competency Survey Staff ratings on importance and satisfaction of published factors indicative of culturally and linguistically appropriate health care Staff ratings on importance and satisfaction of published factors indicative of culturally and linguistically appropriate health care 10-minutes written survey conducted during FPA’s Assessment Day 10-minutes written survey conducted during FPA’s Assessment Day Institutional Audit Checklists Six checklists Six checklists Interviews with key staff to assess key areas of cultural competence Interviews with key staff to assess key areas of cultural competence

12 Institutional Audit Checklists 1. Present and Future Patient Demographics 2. Present Staff Demographics 3. Assessment by Leadership 4. Current Actions to Enhance Cultural Competence 5. Patient/Community Access to Culturally Appropriate Care 6. Community Involvement and Support

13 Sample from Survey* *Stergios Roussos, Using the Federal CLAS Standards to Foster a More Culturally Competent Healthcare Environment, 132 nd APHA Annual Meeting Please rate: a) How important is each item in your service to patients who may have difficulties during their healthcare visit due to culture and language differences, and b) How satisfied you are at this time with your knowledge or skill for each item. 1=Low/negative 5=High/positive Please rate this item a) Importance for how I serve patients b) My satisfaction with my skill for this I know how to identify when a patient needs a medical interpreter. Comments: 1 2 3 4 5

14 Example of Application of CLAS Standards to Survey Items CLAS Standard 4. Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services at no cost to each patient/consumer with LEP at all points of contact, in a timely manner during all hours of operation. Survey Items I am able to identify the different languages used by our patients I can describe community resources that I can use to assist patients with language and cultural barriers to health care Trained interpreters are readily available for the different languages of the patients we serve

15 Application of CLAS Standards: Findings and Recommendations CLAS Standard 4: Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services at no cost to each patient/consumer with LEP at all points of contact, in a timely manner during all hours of operation Strengths a)30% of staff members speak Spanish which is the primary language of patient population b) Staff feels confident in their ability to identify when a patient needs medical interpreter. c) Staff knows how to protect a patient’s confidentiality when using a medical interpreter regardless of whether or not the patient personally knows the interpreter. d) Majority of their written materials are translated into Spanish. Areas for Improvement a)Trained interpreters are not available to assist LEP patients. b)Telephone answering services for non- English and non-Spanish speaking callers are unavailable. Recommendations a)Provide training in medical interpretation for bilingual staff members that serve as interpreters b)Provide staff trainings on proper use of trained medical interpreters to protect patient confidentiality and ensure effective communication. c)Assess needs to provide language assistance in languages other than Spanish and explore the possibility of using telephonic interpreting services d)Assess the demand and supply of language services at all points of contact to better plan the provision of language services e)Include interpreting tasks into job descriptions of bilingual to integrate linguistic competence into the organization.

16 From Results to Action: Mini Grants and Technical Assistance Mini Grants $3,000/ clinic to address at least one of the organizational priorities derived from the assessment. $3,000/ clinic to address at least one of the organizational priorities derived from the assessment. Examples of Outcomes Staff training on how to provide culturally and linguistically appropriate services Staff training on how to provide culturally and linguistically appropriate services Medical interpreter training for bilingual staff Medical interpreter training for bilingual staff Bilingual signage and consent forms Bilingual signage and consent forms Refinement of patient registration to capture relevant demographic and cultural data Refinement of patient registration to capture relevant demographic and cultural data

17 Limitations Staff misunderstanding of the survey Staff misunderstanding of the survey Interviewed only key people in leadership positions Interviewed only key people in leadership positions Did not collect any information from immigrant populations themselves Did not collect any information from immigrant populations themselves

18 Lessons & Recommendations Key to engage leadership Key to engage leadership Include entire staff in kick-off and results Include entire staff in kick-off and results Explore ways to train onsite evaluators Explore ways to train onsite evaluators Include patient and community perspectives Include patient and community perspectives

19 Ongoing Challenges Need to secure funding to implement mandates Need to secure funding to implement mandates Need for ongoing technical assistance Need for ongoing technical assistance Lack of qualified trainers and training resources Lack of qualified trainers and training resources Need to link cultural competency to larger political issues including immigration and immigrants’ rights Need to link cultural competency to larger political issues including immigration and immigrants’ rights

20 Next Steps Continued funding from Ford Foundation to expand assessments Continued funding from Ford Foundation to expand assessments Develop and pilot method to solicit patient feedback about cultural competency Develop and pilot method to solicit patient feedback about cultural competency Establishment of information/resource clearinghouse at FPA Establishment of information/resource clearinghouse at FPA Language Access Conference in NYS Language Access Conference in NYS

21 Grace Mose Research and Program Associate Family Planning Advocates of NYS 17 Elk Street Albany, NY 12207 www.fpaofnys.org grace@fpaofnys.org www.fpaofnys.org@fpaofnys.org www.fpaofnys.org@fpaofnys.org

22 Recommendations from Pre- Conference Immigrant women Participants There should be standards for translations and interpretation There should be standards for translations and interpretation Patients should have choice of interpretation services. Patients should have choice of interpretation services. Translations should be: Culturally sensitive, Presented at different levels of literacy, and should be age appropriate. Translations should be: Culturally sensitive, Presented at different levels of literacy, and should be age appropriate.

23 Recommendations Conti. Cultural and linguistic sensitivity must start at school level. Cultural and linguistic sensitivity must start at school level. Increase recruitment of female interpreters from more diverse communities. Increase recruitment of female interpreters from more diverse communities. Funding is an recurring issue. Funding is an recurring issue. Taking advantage of technology available such as interpretation equipment. Taking advantage of technology available such as interpretation equipment.

24 Adopt a policy for one stop comprehensive health services. Adopt a policy for one stop comprehensive health services. Suggestion to do outreach for immigrant volunteers. Suggestion to do outreach for immigrant volunteers.

25 Suggestion on the role of FPA FPA can be a corner stone and a unifying force for most immigrant organization and women across the state. FPA can be a corner stone and a unifying force for most immigrant organization and women across the state. FPA can do more grassroots with providers of various services and issues. FPA can do more grassroots with providers of various services and issues. FPA can educate and provide advocacy training and leadership skills. FPA can educate and provide advocacy training and leadership skills. FPA can work with local communities with the goals to address issues specific to those communities. FPA can work with local communities with the goals to address issues specific to those communities.

26 FPA’s Role conti. FPA can be a center for resources (clearing house) FPA can be a center for resources (clearing house) FPA can push forward the policy agenda. FPA can push forward the policy agenda.


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