Cultural Competency/Health Literacy (CC/HL): An … · Cultural Competency & Health Literacy ....

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Wilma Alvarado-Little, AlvaradoLittle Consulting, LLC September 29, 2016 Albany Medical Center PPS Delivery System Reform Incentive Payment (DSRIP) Cultural Competency/Health Literacy (CC/HL): An Introduction

Transcript of Cultural Competency/Health Literacy (CC/HL): An … · Cultural Competency & Health Literacy ....

Wilma Alvarado-Little, AlvaradoLittle Consulting, LLC

September 29, 2016

Albany Medical Center PPS Delivery System Reform

Incentive Payment (DSRIP)

Cultural Competency/Health Literacy (CC/HL): An Introduction

Agenda • Welcome & Introductions – Expectations for participation

• Overview of Cultural Competency, Language Access and Health Literacy

• Learn about where we are as an organization and how strategy will guide next steps towards well-being and healthy outcomes

• Next steps

• Questions

Can You Connect The Dots?

Can You Connect The Dots?

Cultural Competency and Health Literacy

We don’t see things as they are, We see things as we are.

Anais Nin

Objectives Learning objectives include: – Discuss health literacy and cultural and linguistic barriers to accessing healthcare – Develop an awareness of federal, state and local mandates – Provide resources regarding the provision of quality culturally and linguistically appropriate services (CLAS) to address barriers contributing to health disparities within our communities

CC/HL Champions

• Everyone’s active participation in CC/HL is critical for the success of DSRIP. – True system transformation will require cultural changes in our

patients, providers, and organizations

• CC/HL Champions: – Collaboration is essential – Be willing to share any CC/HL-related

best practices – Become a change agent for your organization – Bring information and initiatives back to your organization to

disseminate and implement

Cultural Competency and Health Literacy

• Patient-centered care is communication-based and

the frontline to addressing issues contributing to health disparities

• When we do not speak the language of the patient we must use an additional set of skills to continue to provide excellent, patient-centered care.

Cultural Competency “The ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.” Cultural Competence in Health Care: Is it important for people with chronic conditions? (2004). Retrieved from https://hpi.georgetown.edu/agingsociety/pubhtml/cultural/cultural.html.

Ethics

Grooming and

presence

Health and

Medicine

Language

Recreation

Values

Time

Significant event

Manners of

interacting

Workplace

Rural Urban

Adolescents

Elder community

Transportation

Domain 1: Organizational Components

Domain 2, 3 & 4: Project Components

Better care, less cost

Domain 2: System Transformation

A. Create Integrated Delivery Systems

1. Create IDS for PHM

2. Health Home At-Risk

3. Create Medical Village in Nursing Homes

A. Behavioral Health 6. Integration

of PC & BH services

7. BH community crisis stabilization services

B. Care Coordination &Transitional Care Programs 4. ED Care

Triage for At-Risk Population

Governance Financial Stability

Cultural Competency & Health Literacy

Workforce Strategy

Population Health

Management

Practitioner Engagement

Clinical Integration

Performance Reporting

IT Systems & Processes

Domain 3: Clinical Improvement

Domain 4: Population Wide Projects

B. Prevent Chronic Diseases 10. Promote tobacco use

cessation among low SES populations

11. Increase Access to Preventive Care and Management (Cancer)

B. Cardiovascular Health 8. E-B

strategies for managing Hypertension

D: Utilizing Patient Activation to Expand Access 5. Implement

Patient Activation Activities (PAM)

C. Asthma 9. Implement

E-BM guidelines

According to the AMCH PPS Partner Surveys…

of organizations responded that they use appropriate language services (e.g., trained medical interpreters) with patients who prefer a language other than English.

has a policy that minimizes the use of family members as interpreters.

conducts staff training on the use of interpreters.

uses sign language interpreters to provide interpretation services.

uses certified or trained medical interpreters to provide interpretation services.

However

A Word about Language Access

State New York State Code of Rules and Regulations Section 405.7 New York State health Insurance and Managed Care Laws and Regulations State of New York Executive Order No. 26 Statewide Language Access Policy

New York Lawyers for Public Interest Language Access Legal Cheat Sheet www.nylpi.org

What’s the difference? Bilingual vs. Interpreting vs. Translation •Bilingual- someone who professes to speak two

languages. •Interpreting- Oral communication •Translation- Written Communication

What’s the difference?

Interpreting vs. Translation

These require two different skill sets

and at times fall under different mandates.

Simultaneous Translation?

More from the AMCH PPS Partner Surveys…

of organizations has funds allocated for cultural competence activities/initiatives.

has active initiatives within their organizations for the promotion and retention of a culturally diverse workforce.

of organizations has a diverse governing body or policy-influencing group with representatives from populations and community served.

responded that their organization requires or facilitates individual provider assessments regarding cultural competence.

Where are we?

Have you ASKED?

Source: Campinha-Bacote et al., Transforming the face of Health Professions through Cultural and Linguistic Competence Education: The Role of the HRSA Centers of Excellence (p. 37). Prepared for, the U.S. Department of Health and Human Services, Health Resources and Services Administration

Health Literacy

According to the Institute of Medicine, health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Institute of Medicine. (2004).

Health literacy: A prescription to end confusion. Board on Neuroscience and Behavioral Health, Nielson-Bohlman, L., Panzer, A.M., Kindig, D.A., Editors, Institute of Medicine and the National Academies. The National Academies Press: Washington, D.C.

Guidelines

Effective communication? • Patient’s sister: “Why are his hands so swollen?” • ICU RN: “Well, it’s a physiological explanation.” • ICU RN (looking me and then at the family) “That’s

the only explanation I have. ” • ICU RN (to patient’s sister) “Um, well, did you

understand that?” • Patient’s sister: “No. I don’t know what that

means.”

Policies The Affordable Care Act One key to the effectiveness and success of the exchanges will be the ability of consumers to understand and navigate the process of choosing a plan and becoming insured. The ACA acknowledges this and incorporates requirements to ensure that cultural and linguistic competence be part of the exchange process in order to help as many people as possible, including those of limited English proficiency.

Andrulis, D. et al (2013) The Affordable Care Act & Racial and Ethnic Health Equity Series (2013) http://www.texashealthinstitute.org/uploads/1/3/5/3/13535548/thikp_exchange_report_final_03.06.2013.pdf

Mandates Federal Title VI of the Civil Rights Act of 1964 - Prohibition against

exclusion from participation in, denial of benefits of, and discrimination under federally assisted programs on ground of race, color, or national origin. www.justice.gov

American with Disabilities Act - Federal disability discrimination laws mandate equal access to and an equal opportunity to participate in and benefit from health care services, and effective communication with individuals who are deaf or hard of hearing. http://www.nad.org/issues/health-care/providers/questions-and-answers

Partnerships “To effectively communicate we must realize that we are all different in the way we perceive the world and use this as a guide to our communication with others.” Tony Robbins

Remember this is a journey and we can change the climate!

Next Steps

Please email Mingie Kang [email protected]

if you have any question or concern.

Resources The Patient Protection and Affordable Care Act https://www.govtrack.us/congress/bills/111/hr3590/text Section 1557 of the Patient Protection and Affordable Care Act http://www.hhs.gov/civil-rights/for-individuals/section-1557/ American with Disabilities Act https://nad.org/issues/health-care/providers/questions-and-answers US Department of Health and Human Services Office for Civil Rights Title VI http://www.hhs.gov/ocr/civilrights/resources/specialtopics/tanf/crrequirementstvi.html

Resources Institute of Medicine Ten Attributes of Health Literate Health Care Organizations http://www.iom.edu/Global/Perspectives/2012/HealthLitAttributes.aspx National Academies of Sciences, Engineering and Medicine http://www.nationalacademies.org/hmd/Activities/PublicHealth/HealthLiteracy.aspx US Department of Health and Human Services Office of Minority Health National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (The National CLAS Standards): https://www.thinkculturalhealth.hhs.gov/clas/standards Think Cultural Health! https://www.thinkculturalhealth.hhs.gov/ Institute for Healthcare Advancement https://www.iha4health.org/

Resources NCIHC Code of Ethics and Standards of Practice http://www.ncihc.org/ethics-and-standards-of-practice American translators Association https://www.atanet.org/publications/getting_it_right.php National Board of Certification for Medical Interpreters http://www.certifiedmedicalinterpreters.org/ Certification Commission for Healthcare Interpreters http://www.cchicertification.org/ Registry of Interpreters for the Deaf, Inc. (RID) http://rid.org/

What questions do you have?

Wilma Alvarado-Little, MA MSW AlvaradoLittle Consulting, LLC

Albany, NY 12208 Office: 773.301.6438

Fax: 518.207.1913 [email protected]

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