1. California Project to Improve Health of Refugees
Sponsor:
CA Department of Pubic Health
Refugee Health Section
Presenters:
Patricia Erwin, MPH
Sandra Meucci, PhD

2. Presentation Outline I. Our Challenge
II. Role of State Public Health Dept
IIA. Role of Local Public Health Dept
III. Implementing Infrastructure Change
IV. Evaluation Model

3. I. Our Challenge
How can state and local health departments assist refugees in to become and stay healthy; through prevention, early detection and management of chronic conditions?

4. Top 15 Refugee Groups in California from 2006 – 2009 ( 16,994 refugees of total 18,357)
Iran
9221
Iraq
3964
Myanmar (Burma)
785
Vietnam
602
China
587
Ukraine
368
Bhutan
314
Russia
216
Armenia
198
Somalia
194
Moldova
144
Ethiopia
122
Nepal
100
Afghanistan 98
Kenya 81

5. Top Three Health Conditions of CA Refugees 2006 - 2009
Dental Carries (Mean = 1,388)
Essential Primary Hypertension (Mean = 991)
Obesity (Mean = 958)

6. 5 Year Project Goal:
Promote overall well being, change behaviors for healthy living, and improve self management of cardiovascular risk factors related to chronic health condition for refugees throughout California

7. II. Role of California Dept of Public Health
Provide the Direction and Leadership by:
A. Performing Chronic Disease Risk Assessment of newly arriving refugees
B. Identifying and subcontracting with local health departments dealing with different refugee groups in different regions of CA.

8. CA Dept of Public Health
C. Providing ongoing technical assistance in two areas: program implementation and evaluation
D. Providing Training: Develop a “train the trainer” model for community health workers and develop training for health care providers on chronic care management with refugees from the refugee communities being served

9. IIA. Role of Local Public Health Departments
Implement Infrastructure Changes to improve follow-up with refugees with risk factors for chronic disease (to inform patient of chronic health condition s/he is at risk of, to make referral to primary care, to have information flow to primary care physician, to see that person has kept appointment)

10. Local Public Health Departments
Foster partnerships between clinical assessment and services and community based agencies, mutual assistance agencies, voluntary organizations (to deliver culturally relevant health education and follow-up services)

11. Local Health Departments
Recruit, train and deploy community health workers to liaison between health delivery system and refugee group

12. III. Designing and implementing infrastructure changes
to improve follow-up of identified chronic and other harmful health conditions of newly arrived refugees

13. Important Consideration
How well acquainted are the clinic staff with the culture/customs/language of refugee group and of the chronic care model?

14. Ways to Improve Cultural Competency of Clinic Services
Training of health care providers on the chronic care model specific to the refugee populations in their clinics may be needed.
Use of Community Health Worker (either within clinical setting or within local voluntary agencies or Mutual Assistance Associations) to serve as community liaisons; sustain preventive health education and awareness in the community.

15. Important Consideration
How well connected is the local health department (or entity performing initial health assessment of newly arrived refugee) to the primary care physicians who treat the refugees post-health assessment?

16. Health Department/Primary Care
Some public health departments are situated within clinics that have primary care physicians who will see refugees on an ongoing basis after the initial health assessment and others are have no relationship with the primary care physicians in the community who will treat the refugees.

17. Improve Coordination
These different levels of connection between health department and ongoing primary care have implications for the amount of coordination that needs to occur after referral and for ongoing follow-up.
Communication between health assessment staff and primary care providers support enhanced follow-up efforts.

18. IV. Evaluation methods and tools
We want to measure changes within different health care environments and among many different refugee groups
Objectives (SMART) are developed collaboratively
EXAMPLE: By June 30, 2010, 100% of refugees identified with chronic conditions or other harmful conditions (to be defined by the grantee) will be referred to a primary care physician, and 70% of the refugees referred to a PCP will be followed up utilizing a follow-up appointment system to confirm that the refugee kept the first appointment

19. Evaluation Measures
Standardized measurement of changes in knowledge and behavior (eating, exercise, coping with stress, using the medical system) according to trans-theoretical model. This allows for cross-comparisons of programs and changes over time within each program.
Evaluation survey is translated into all appropriate languages – still a fee refugees are not literate in any language

20. Evaluation - Reporting
Individual differences are taken into account
An individual case study approach is done for each grantee which allows for unique configuration of health delivery system to be described and explored.