Culturally Engaged Health Care in Buffalo, NY Kim Rook, Outreach Coordinator, MPH Coordinator Pavani Ram, Director, Office of Global Health Initiatives, Associate Professor Jessica Scates, Coordinator, Office of Global Health Initiatives Paul Wietig, Vice President, Interprofessional Education University at Buffalo School of Public Health and Health Professions June 19, 2014

Data extracted from the Worldwide Refugee Admissions Processing System (WRAPS) Arrivals by State for the Reporting Period of 1-October-2013 through 30-April-2014Data Texas 3888 California 3237 New York 2256

Refugees resettled in New York State *Federal Fiscal Year 2013 New York State Bureau of Refugee and Immigrant Assistance Total: 3829

Sites of Refugee Resettlement in NY *Federal Fiscal Year 2013 New York State Bureau of Refugee and Immigrant Assistance Erie County welcomes 36% of refugees in New York State!

Background and Objectives Refugee health in Buffalo UB/Community engagement Refugee Health Summit

Refugee County department of health State department of health Primary care providers Community organizations Insurers Funding organizations Medicaid State bureau of refugee and immigrant assistance Medical specialists Resettlement agency Refugee leaders University

Health Needs & Gaps Lead poisoning Trauma and torture STIs/STDs Tuberculosis Diabetes Cancer Mental illness – depression Suicide Other chronic conditions Health needs to address

Buffalo Public Schools Burmese Community Support Center Catholic Charities of Buffalo Community Health Center of Buffalo H.E.A.L. International International Institute of Buffalo Jericho Road Community Health Center Jewish Family Service of Buffalo & Erie County Journey’s End Refugee Services, Inc. Neighborhood Health Center New York State Department of Health Planning Committee Members University at Buffalo Global Health Initiative GSA Office of Global Health Initiatives Office of Interprofessional Education Office of Public Health Practice School of Dental Medicine School of Management School of Medicine & Biomedical Sciences School of Nursing School of Pharmacy and Pharmaceutical Sciences School of Public Health & Health Professions School of Social Work

Education Buffalo Public Schools Refugee Community Support Burmese Community Support Center H.E.A.L. International Resettlement Agencies Catholic Charities of Buffalo Jewish Family Service of Buffalo & Erie County Journey’s End Refugee Services, Inc. International Institute of Buffalo Primary Care Provision and Health Assessments Community Health Center of Buffalo Jericho Road Community Health Center Neighborhood Health Center Planning Committee Members Health Department New York State Department of Health University at Buffalo Global Health Initiative GSA Office of Global Health Initiatives Office of Interprofessional Education Office of Public Health Practice School of Dental Medicine School of Management School of Medicine & Biomedical Sciences School of Nursing School of Pharmacy and Pharmaceutical Sciences School of Public Health & Health Professions School of Social Work

Refugee Health Summit Goal: Examine barriers and explore solutions to culturally engaged health care provision for refugees in Buffalo Objectives: Describe existing barriers of culturally engaged health care provision for stakeholder groups in WNY Learn about successful models to providing engaged health care for refugees in Buffalo and beyond Identify potential linkages and spark collaborations to adapt and implement solutions to expand culturally engaged health care for refugees in Buffalo

Summit Program 12:30-1:00Introduction 1:00-2:00Panel 2:00-3:00Share Fair 3:00-4:00Informational talks 4:00-4:30Next steps 4:45-5:00Dinner 5:30-6:30Breakout groups 6:30-7:15Large group reporting and discussion 7:15-7:30Closing

Panelists Bishnu Adhikari Employment Specialist, Journey’s End Refugee Services, Inc. Denise Phillips Beehag Director of Refugee and Employment Services, International Institute of Buffalo Cheryl Brown Refugee Health Program, Public Health Representative II, New York State Department of Health, Western Region Oma Chapagain Bhutanese Nepali Community Member Dianne M. Loomis Associate Clinical Professor, School of Nursing, Department of Family Medicine, University at Buffalo Chan Myae Thu Client Services Coordinator, Burmese Community Support Center Refugees Resettlement agencies Providers State

CultureTrustLanguage Religion Gender Definitions of good and poor health Health as a priority Preventive health vs. curative Interpretation Accessing personal health information Accessing preventive care Accessing knowledge about prevention Translating medical terms Non-verbal language Mental health History of trauma The doctor and other ‘authority’ figures Power within the family Many other issues as well…

Access to medical care (primary care) Cultural unfamiliarity among providers Grouping refugees into one generalizable group Health insurance Language Mental health and screening Barriers to Healthcare

Dr. Myron Glick Dr. Kim Griswold Jim Sutton, RPA-C Informational Talks

Rochester Model ­RSMI – Remote Simultaneous Medical Interpreting ­Empowered oversight committee ­Coordinated providers and care ­Jericho Road Community Health Care Model ­Hire a diverse staff, encourage diversity ­Invest in community relationships ­Built walk-ins into the system Models for Community Engagement & Care

Mental Health Provision Train bi-lingual / bi-cultural mental health care providers Adjust screening methods Increase mental health value among refugees Ethnic community support groups ­Burmese Community Support Center ­Others: Bhutanese Iraqi Models for Community Engagement & Care

Coordination of stakeholders Mentorship of providers Mobilizing human capital / leadership among refugee community Interpretation Improving linkages of care, addressing gaps in care Breakouts to Address Barriers

Coordination of stakeholders  Day-to-day agency partnerships through agreements  Community-based steering committee or council  Annual summit to reassess  Culturally engaged healthcare assessment available online Provider mentorship, education  Referral / map app and web based resources  Hiring of bilingual health providers and front office staff  Relocate specialists to primary care locations  Culturally engaged health care grand rounds Solutions to Barriers

Refugee mentorship, education, leadership  Platform for ethnic community-based support organizations  Identify leaders in the community for continued education training Interpreter services  RSMI (UN-like headsets)  Interpretation phone apps  Hire local community members and bi-lingual employees  Web-based portal with language resources  Educate providers in second languages Solutions to Barriers

Improving linkages of care, addressing gaps  Health-e-Link health assessment  Mental health providers in community health centers  Mapping system addressing transportation issues  Referral / map app  Agency partnerships  Health education – preventive care Solutions to Barriers

110 registrants, 130 participants 30 agencies and University Schools Collaborations among agencies and refugee maximizes resources Meaningful interagency relationships Task forces and action plans created UB will be leader in steering committee, exploration of interpretation models, among other areas Takeaways

Improving Linkages of Care (10) Mentorship of Providers (15) Coordination of Stakeholders (7) Mobilizing of Human Capital (4) Interpretation (5) Takeaways

Dissemination of Refugee Health Summit Report Exploratory meeting with Refugee Advocates (June) Task force development Health for Refugee Populations Course Next Steps

Solidify University at Buffalo’s role moving forward School of Pharmacy continuing education School of Social Work build capacity and linkages School of Public Health provide field placement IT involvement Recruitment of talent from the refugee community Best practice research and assessments Next Steps

Acknowledgements: Office of Global Health Initiatives Dr. Pavani Ram Jessica Scates Dr. Arthur Goshin School of Public Health and Health Professions UB Office of Interprofessional Education Dr. Paul Wietig Community Agencies Thank You