1. E-Health Technologies to Address Underserved Populations: A Training Program Silvia Martinez, Ed. D., Howard University Kevin Lyons, Ph. D., Thomas Jefferson University Margaret Vescovich, MS, Holy Redeemer Home Care and Hospice Services ASHA Convention

2. eHEalth Summer Institute Allied Health Center for Excellence in eHealth Promotion Programs for Underserved Populations (Allied Health CEEPs-UP) Allied Health Center for Excellence in eHealth Promotion Programs for Underserved Populations (Allied Health CEEPs-UP)

3. Center For Excellence IN eHEALTH PROMOTION: ALLIED HEALTH CEEPs UP Period of time: 2003-2006 Period of time: 2003-2006 Disciplines involved: Disciplines involved: Occupational Therapy Physical Therapy Speech Language Hearing

4. Allied Health CEEPs – UP Goal To develop a center for excellence in eHealth promotion To develop a center for excellence in eHealth promotion Partners Partners –Center for Collaborative Research –Journey Home –American Speech-Language Hearing Association –Occupational Therapy –Physical Therapy

5. Allied Health CEEPs – UP Objectives Conduct a yearly summer institute designed to teach allied health professionals how to develop eHealth programs tailored specifically to underserved populations Conduct a yearly summer institute designed to teach allied health professionals how to develop eHealth programs tailored specifically to underserved populations Train 60 allied health professionals how to develop eHealth websites Train 60 allied health professionals how to develop eHealth websites

6. Allied Health CEEPs – UP Teams of three individuals working in either urban, rural or Native American underserved communities Teams of three individuals working in either urban, rural or Native American underserved communities Combination of faculty and clinicians Combination of faculty and clinicians Preference to interdisciplinary teams Preference to interdisciplinary teams

7. Summer Institute: Overview Week long, hands-on experience designed to provide the knowledge and skill to develop a web-based eHealth Promotion Program Week long, hands-on experience designed to provide the knowledge and skill to develop a web-based eHealth Promotion Program Designed for interdisciplinary teams of clinicians and faculty Designed for interdisciplinary teams of clinicians and faculty Teams bring plan for a program and refine and revise the plan during the week so that they will have the first phase of the website designed to address a significant health problem in an underserved community and a plan for its implementation Teams bring plan for a program and refine and revise the plan during the week so that they will have the first phase of the website designed to address a significant health problem in an underserved community and a plan for its implementation

8. Summer Institute: Components Tailoring health information to a community Tailoring health information to a community Establishing an infrastructure in an underserved community Establishing an infrastructure in an underserved community Addressing issues of computer and health literacy Addressing issues of computer and health literacy Developing a website using a template and a website program Developing a website using a template and a website program

9. Summer Institute: Components Evaluating other health related internet websites as appropriate links. Evaluating other health related internet websites as appropriate links. Conducting needs assessments Conducting needs assessments Developing a plan to evaluate the effectiveness of the eHealth Program Developing a plan to evaluate the effectiveness of the eHealth Program Understand the barriers to implementation Understand the barriers to implementation

10. Projects Creighton University-Omaha, NB Creighton University-Omaha, NB –Omaha and Winnebago Ho-Chunk Indian Tribes –Interface with Tribal Community Health Education Office and Diabetes Program –Train community members to bring health information to the community –Training in computer and internet usage to increase access to allied health resources

11. Projects Springfield Technical Community College, Springfield, MA Springfield Technical Community College, Springfield, MA –Develop Healthline, a user friendly health information website for underserved residents; Black, non Hispanic (21%) Black, non Hispanic (21%) Hispanic (27%) Hispanic (27%) Asian (4%) Asian (4%) Caucasian (48%) Caucasian (48%)

12. Projects Holy Redeemer Home Care, Philadelphia, PA Holy Redeemer Home Care, Philadelphia, PA –Community outreach using the internet –Website for the care of the frail elderly Research on four syndromes Research on four syndromes Treatment protocols from Holy Redeemer Treatment protocols from Holy Redeemer True stories of those helped by the program True stories of those helped by the program

13. Conclusions If interested, go to the Center for Collaborative Research website, www.jefferson.edu/ccrgrants If interested, go to the Center for Collaborative Research website, www.jefferson.edu/ccrgrants

14. Talking Fotonovelas for Low-Literacy Hispanics and African Americans Silvia Martinez, Ed. D., CCC-S Howard University

15. Support American Speech-Language-Hearing Association (ASHA) Multicultural Grants Project

16. Collaborators Janice Trent, M. Ed. CCC-A – Howard University Speech and Hearing Clinic Janice Trent, M. Ed. CCC-A – Howard University Speech and Hearing Clinic Margarita Bautista-Vigas, M. A. CCC-S, Scottish Rite Center for Childhood Language Disorder Margarita Bautista-Vigas, M. A. CCC-S, Scottish Rite Center for Childhood Language Disorder

17. Assistants Tara Smith, CCC-S, Doctoral Student, Howard University Tara Smith, CCC-S, Doctoral Student, Howard University Martine Ellis, CCC-S, Doctoral Student, Howard University Martine Ellis, CCC-S, Doctoral Student, Howard University Johanna Losi, Master Student, Howard University Johanna Losi, Master Student, Howard University

18. The Issues One of the leading health indicators is Access to Health Care (Healthy People 2000-2010) One of the leading health indicators is Access to Health Care (Healthy People 2000-2010) For minorities, financial, structural and personal barriers prevent access to health. For minorities, financial, structural and personal barriers prevent access to health.

19. Barriers Structural- A structural barrier includes the lack of service providers to meet the needs of clients. Structural- A structural barrier includes the lack of service providers to meet the needs of clients. Personal - Includes language barriers and lack of knowledge about health procedures. Personal - Includes language barriers and lack of knowledge about health procedures.

20. Literacy Issues The Center for Health Care Strategies has estimated that minorities and immigrants (50% Hispanics and 40% Blacks) have disproportionate literacy problems, which increase their health risks. The Center for Health Care Strategies has estimated that minorities and immigrants (50% Hispanics and 40% Blacks) have disproportionate literacy problems, which increase their health risks. In Washington, D. C., adult education levels in the site communities are the second lowest with only 68.4% report having a High School education. In Washington, D. C., adult education levels in the site communities are the second lowest with only 68.4% report having a High School education.

21. Literacy Issues As reported by the National Library of Medicine (NLM), this study states that one- third of English-speaking patients at two public hospitals were unable to read basic health materials. As reported by the National Library of Medicine (NLM), this study states that one- third of English-speaking patients at two public hospitals were unable to read basic health materials. NLM also reports a Medicare finding that 34% of the English speaking and 54% of the Spanish speaking patients had inadequate or marginal health literacy NLM also reports a Medicare finding that 34% of the English speaking and 54% of the Spanish speaking patients had inadequate or marginal health literacy

22. Literacy Issues The Institute for Healthcare Advancement summarized from research that written health materials The Institute for Healthcare Advancement summarized from research that written health materials –usually appear at the 10th grade level or higher (above average abilities), –that they include too much information and no explanation of uncommon words, –and that treatments are accompanied by complex instructions

23. Broad Objectives Increase the knowledge of African Americans and Hispanic populations about speech and language pathology, and audiology issues and services. Increase the knowledge of African Americans and Hispanic populations about speech and language pathology, and audiology issues and services. Meet the needs of health providers by developing materials to complement and enhance their services. Meet the needs of health providers by developing materials to complement and enhance their services. Carry out research activities to probe the effectiveness of e-health web-based materials with low literacy and limited English proficient clients. Carry out research activities to probe the effectiveness of e-health web-based materials with low literacy and limited English proficient clients.

24. Specific Aims To describe health literacy growth in low- literacy clients after using web-based materials developed. To describe health literacy growth in low- literacy clients after using web-based materials developed. To describe health literacy retention in low- literacy clients after using web-based materials developed. To describe health literacy retention in low- literacy clients after using web-based materials developed.

25. Fotonovelas Fotonovelas are similar to comic books, contain photographs and simple dialogue bubbles, which address the needs of cultures with low literacy rates and oral traditions. Fotonovelas are similar to comic books, contain photographs and simple dialogue bubbles, which address the needs of cultures with low literacy rates and oral traditions. Internationally and historically have been effective as educational methods in the areas of education, health, and citizenship. They also have been used for entertainment. Internationally and historically have been effective as educational methods in the areas of education, health, and citizenship. They also have been used for entertainment.

26. An Example

27. How to Read a Book

28. Come on honey, lets read.

29. Isnt he too little to read? You can read to all children, even babies.

30. Oh, but I dont read too well. You dont need to know how to read.You can use the pictures.

31. Ill show you. Come here Michael and Davonte.

32. I can use the pictures to tell a story from my head.

33. Next Steps

34. Holy Redeemer Home Care -Founded in 1928 as a Catholic Health System -Missions Statement -Located in Greater Philadelphia Area -Services provided

35. JCAHO Disease Specific Certification in the care of the Frail Elderly Holy Redeemer Home Care is first in the nation to be granted this distinction as of September, 2003. Holy Redeemer Home Care is first in the nation to be granted this distinction as of September, 2003. Who are the Frail Elderly? Who are the Frail Elderly? Recertification process Recertification process

36. Why Tailor Specific Care To Specific Populations??? Commitment to care that is patient-centered. Commitment to care that is patient-centered. Get beyond generic home care. Get beyond generic home care. Quality of care should look different with Quality of care should look different with different disorders. different disorders. Model for chronic care Model for chronic care

37. Four Common Geriatric Syndromes Often seen in combination Often seen in combination Make living independently difficult, often requiring more restrictive placement Make living independently difficult, often requiring more restrictive placement Commonly affect the Frail Elderly: Commonly affect the Frail Elderly: 1. Depression 1. Depression 2. Dementia 2. Dementia 3. Falls Risk 3. Falls Risk 4. Urinary Incontinence 4. Urinary Incontinence

38. Four Common Geriatric Syndromes DEPRESSION DEPRESSION -affects about 6 million -affects about 6 million Americans over age 65 Americans over age 65 -frequently co-exists with other medical conditions -frequently co-exists with other medical conditions -only 10% of older Americans receive treatment -only 10% of older Americans receive treatment DEMENTIA DEMENTIA -affects about 45% of the population 85 and older -affects about 45% of the population 85 and older -chronic and progressive dysfunction -chronic and progressive dysfunction -whether temporary or chronic, dramatically impacts every part of life -whether temporary or chronic, dramatically impacts every part of life

39. Four Common Geriatric Syndromes FALLS RISK FALLS RISK -about 50% of those aged 80 and older are a falls risk each year -about 50% of those aged 80 and older are a falls risk each year -falls, and injury from falls, is a major reason for hospital and nursing home admissions. -falls, and injury from falls, is a major reason for hospital and nursing home admissions. URINARY INCONTINENCE URINARY INCONTINENCE -experienced by 50% or more of elderly persons living at home -experienced by 50% or more of elderly persons living at home -approximately 13 million Americans are incontinent (11 million are women) -approximately 13 million Americans are incontinent (11 million are women) -UI accounts for many NH admissions -UI accounts for many NH admissions

40. Holy Redeemers responsibility to Educate the Community Along with the distinction with certification in the care of the Frail Elderly comes the responsibility to educate the Community Along with the distinction with certification in the care of the Frail Elderly comes the responsibility to educate the Community This includes educating the public about the Frail Elderly, as well as specific problems relating to clients, their caregivers and families This includes educating the public about the Frail Elderly, as well as specific problems relating to clients, their caregivers and families Informing the public of LifeAssess-a program implemented by Holy Redeemer Home Care, specifically designed to care for the Frail Elderly Informing the public of LifeAssess-a program implemented by Holy Redeemer Home Care, specifically designed to care for the Frail Elderly

41. An Interdisciplinary Approach to Web- Site Development June of 2004- June of 2004- Fran Moore, PT, Kathy Staples, OT, and Maggie Vescovich, SLP, participated in week-long e-Health Summer Training Institute at Jefferson University in Philadelphia, PA. Fran Moore, PT, Kathy Staples, OT, and Maggie Vescovich, SLP, participated in week-long e-Health Summer Training Institute at Jefferson University in Philadelphia, PA. Jeffersons goal of e-health education for allied health professionals matched our desire to creatively educate the community as to the needs of the Frail Elderly. Jeffersons goal of e-health education for allied health professionals matched our desire to creatively educate the community as to the needs of the Frail Elderly.

42. LifeAssess.org –Collaboration –Design each syndrome to include a story, facts, self-survey and resources –Focus Group –Grant-Writing –Translations of website into Russian and Spanish –Provide field staff with laptop –Continuing Education re: Four Common Geriatric Syndromes

43. LifeAssess.org What is fastest growing group of computer users and information seekers on the World Wide Web? What is fastest growing group of computer users and information seekers on the World Wide Web? Who is more likely to talk to their physician about health information they found online-those in poor health, or those in good health? Who is more likely to talk to their physician about health information they found online-those in poor health, or those in good health?

44. CONCLUSIONS LifeAssess.org connects clients, caregivers and families to needed health resources and information through eHealth LifeAssess.org connects clients, caregivers and families to needed health resources and information through eHealth LifeAssess.org empowers healthcare consumers to be active participants in managing their disease LifeAssess.org empowers healthcare consumers to be active participants in managing their disease LifeAssess.org will further our mission to help seniors stay safely and comfortably in their own homes for longer than they might otherwise have LifeAssess.org will further our mission to help seniors stay safely and comfortably in their own homes for longer than they might otherwise have