Culturally Effective Pediatric Care: Recommendations for Education and Health Policy Ethan Alexander Jewett, MA November 20, 2006

Why culturally effective care?  A variety of terms: what’s the difference?  cultural competency  cultural sensitivity  culturally effective care  Culturally effective care focuses on the outcome of the interaction between the health care provider and the patient.

An expanded definition  Race  Ethnicity  Race  Ethnicity  Language  Religion  Sexual orientation  Gender  Disability  Socioeconomic status

Pros/Cons of Expanded Definition  Acknowledges that other attributes effect the delivery and quality of care beyond race and ethnicity  Recognizes that other cultural groups have health disparities  In line with policy of other organizations  Dilutes focus on race and ethnicity, on which little progress has been made to date  More groups sharing limited funds for diversity programs  Makes data collection on diversity difficult ProsCons

Recommendation 1  Develop curricula  Impact of provider’s cultural norms on delivery of care  Education tailored for each stage of educational spectrum  Curricula should include full range of cultural attributes

Recommendation 2  Institutional commitment necessary  Develop policies and plans to identify community needs and support community programs.  Disparities between cultural attributes and health status of providers and those of patients being served.

Recommendation 3  No unfunded government mandates  Burden should not fall disproportionately on payers and providers  Inadequate reimbursement  Financial viability of health systems threatened.

Recommendation 4  Establish federal and state incentive programs on culturally effective care  Must be an evaluative component to measure access and outcomes  Reward physicians for improving care  Establish incentive programs to encourage physician practice to the underserved

Recommendation 5  Medical students and residents should learn a second language  Reward medical students and residents for preparing themselves to care for underserved patients.

Recommendation 6  Pediatricians should be leaders in advocating for culturally effective care  Identify best interest of pediatric patients  Promote public policy in support of children

How do we get from theory to practice?  Most resources are conceptual: the feel-good “we need to do the right thing” approach.  Few resources on culturally effective care focus on the nuts-and-bolts of implementation.  There are educational issues, and then there are systems issues.  How do evaluate the success of interventions, and how do measure our improvement?

Possible Next Steps for COPE  Identify existing culturally effective care resources for residents and practicing pediatricians. Each has different needs.  Work with other organizations: NHMA, NMA, GLMA, AMA-RFS, APPD, etc.  Produce a resource guide for residents.  Push for advocacy training that focuses on CEPC  Develop an e-learning module for residents/pediatricians on CEPC.