AHN Immigrant Health Readiness Assessment Kheir Mugwaneza, Immigrant Health Program Manager, Center for Inclusion Health Annette Fetchko, Service Line Director, Center for Inclusion Health 2017 TOWN HALL

Overview Immigrant Health Program: SWOT Analysis: Next Steps Background Description Goals SWOT Analysis: Defining the issue Analysis Method Findings & Recommendations Next Steps

Immigrant Health Program How It All Started: Listening to the immigrant stakeholders Taking Action by: Creating the Immigrant Health Program Assessing AHN Tools & Resources Involving Stakeholders in the Process Doula/CHW Project

Immigrant Health Program Goals: Establish infrastructure across Allegheny Health Network Service areas to increase access to healthcare and provide better services to immigrants and refugees Collaborate and engage the immigrant community and organizations that assist immigrants and refugees. Increase knowledge about different immigrant and refugee populations across the network through improved employee onboarding protocols and continuing education trainings on language access and cultural competency Collaborate with AHN Human Resources and Highmark D&I to establish an Immigrant/refugee career referral process

SWOT Analysis Defining the issue: Method: -Language/Cultural barriers significantly impact safe and effective health care provision and accessibility Method: -Cross-Departmental attendees: Nursing, Training/Education, Social Work, Case Managers, Physicians, Patient Relation, Volunteer Management, Food Services, Emergency Department,… -Analysis: Open Discussion/Follow-Up questions

SWOT Analysis Strengths Weaknesses Opportunities Threats Stratus Video Interpretation Back-up services: Phone/translation/In-person Interpreters Recognition to improve services Immigrant patients “champions” Phone/video interpretation does not work well with all patients Insufficient resources to effectively work with diverse populations Limited understanding of barriers associated with immigrant population Limited immigrant related topics in training plans Opportunities Threats Review and use of Social Determinants of Health screening tool Connecting with experts in cultural diversity training and provide training to staff Establish Linguistically/Culturally appropriate communication tools for non-English speaker patients Overall trend of increased Immigrant population in Western PA Perception/Stigma towards immigrants/refugees No/limited insurance coverage and limited financial capabilities affect accessibility to care Limited related training and education Limited data and knowledge about local immigrant population Relying exclusively on Video Remote Interpreting system SWOT Analysis

SWOT Analysis Themes: Language Access Language ID Tools Staff Diversity Social Services Cultural Humility Data Tracking Systems & Operations

Findings & Recommendations Language Access: -Relying on Video/Phone Interpretation -Limited use of professional interpreters -Use of family/friends as interpreters Contract more vendors with local interpreters for In-Person interpretation Ensure interpretation at no cost and in timely manner, at all key points of contact, including scheduling appointments

Findings & Recommendations Language Identification Tools: Limited use of language identification cards Limited use of written notices in language of preference Display of language identification cards in key locations Provide verbal or written notices informing LEP patients of their right to receive interpretation services at no cost Provide translated key forms and consents from EPIC

Findings & Recommendations Diverse Staff: -Recruit staff with diverse background and culture -Limited resources/programs to educate staff on diversity Establish strategies to recruit, retain, elevate diverse staff Work closely with workforce agencies that assist minorities to find jobs

Findings & Recommendations Navigating Patients to Social Services: Difficulties navigating non-insured and under-insured patients Difficulties referring patients to appropriate social services Establish a comprehensive list of service providers in each facility area Update AHN Charity Care guidelines by removing the citizenship requirement

Findings & Recommendations Cultural Humility Training Limited regular cultural humility trainings Limited robust onboarding training for new hires Require Cultural Humility training for all staff: onboarding and continued education training curriculum Require other immigrant health related topics as part of continued education training curriculum Establish periodic “Immigrant Health Education” sessions

Findings & Recommendations Data Tracking Limited data of interpretation service usage Limited data of the immigrant population patients Establish a system at each facility/unit to track the use of interpretation/translation services Integrate data into network management system and operations

Findings & Recommendations Systems & Operations Need for coordinated use of resources by facilities/units Standardize interpretation contracting process(In-Progress) Establish a centralized contact for all interpretation service related matters Establish a full-time interpreter/coordinator at each hospital according to each site most requested language Management accountability/oversight mechanisms to provide culturally and linguistically appropriate services Communicate progress made to all stakeholders Establish a Language Access Plan

Integrated Advisory Board Develop the Implementation Plan Next Steps Integrated Advisory Board Starting with our November meeting Develop the Implementation Plan Cross-Departmental Collaboration Social Services Stakeholders Develop a Community Health Worker Model

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