Holy Cross Hospital: A Minority Outreach Network with an Adaptable Community Infrastructure

Wendy W. Friar, RN, MSVice President, Community Health

October 21, 2010

Minority Outreach and Technical Assistance

(MOTA)

Maryland Commission onIndian Affairs

Cigarette Restitution Fund Program (CFRP)

1998 - The State of Maryland became a signatory party to the Master Tobacco Settlement reached in litigation filed by multiple states against the tobacco industry to recover Medicaid costs associated with smoking.

As a signatory party to the Tobacco Settlement, Maryland received funds to enable it to make extraordinary strides in education, health and agriculture, to transform Maryland into an anti-cancer State.

The plan was to assemble leading minds, practitioners and concerned community activists for the most effective distribution of Tobacco Settlement monies targeted for programs to end smoking and conquer cancer in Maryland.

Cigarette Restitution Fund Program (CFRP) continued

The Maryland Department of Health and Mental Hygiene has administrative oversight on the distribution of health related funds

The Maryland CFRP’s primary goals are to:- Reduce smoking- Reduce the incidence of cancer- Reduce minority health disparities

associated with cancer and tobacco product use  

Cigarette Restitution Fund Program (CFRP) continued

With funds from the CRFP, the overall strategy to meet these goals, is the development of a network of community-based, minority-serving organizations that will:

Increase awareness about cancer prevention and tobacco-use cessation.

Ensure that ethnic/racial minorities benefit from the tobacco settlement fund programs. 

Overview - Minority Outreach &Technical Assistance (MOTA)

2000 - Maryland established the Minority Outreach & Technical Assistance Program (MOTA) to ensure the involvement of minorities in the CRFP throughout the State.

With CRFP funds, MOTA provides 24 jurisdictions with funding to:- Partner with the local health department around cancer and

tobacco product control- Attend local CRFP cancer and tobacco coalition meetings- Collaborate with multiple minority groups - Reach out to faith-based groups- Empower local minority communities to act decisively and

effectively around: Prevention & early detection health and wellness

Minority Outreach &Technical Assistance (MOTA) con’t

Targeted minority outreach efforts may be through community leadership and networks: MOTA encourages the establishment of community-based collaborations that target racial and ethnic minority groups (e.g., community and faith-based organization’s, minority health initiatives, coalitions, and hospitals):

Collaborations provide the opportunity to recognize and respect diversity to ensure cultural competency and linguistic sensitivity.

MOTA Empowerment Strategies

Community-based collaborations: Enhance the educators’ knowledge of health

disparities that affect minority communities through community and organizational capacity building.

Engage and empower community members through T/A training: To encourage health screenings, early detection, and healthy behaviors and lifestyles among minorities.

Refer community members to the local health department for health screenings and treatment.

MOTA Empowerment Strategies (continued)

Community development is a process that connects people, ideas and resources in a culturally appropriate way to improve the health of the community. Engage and empower local minority communities to

act decisively and effectively Capacity building creates relationships and an exchange of

knowledge across cultures to bring people together and strengthen communities around the elimination of health disparities.

MOTA grantees are collectively diverse entities that offer leadership, time, knowledge, creativity, compassion, and hard work to community partnerships for collaboration around health to eliminate health disparities.

Two (2) Key Components – The Building of an Infrastructure

1. Organizational Capacity Building Technical assistance (T/A) training (health promotion):

- Early detection and screening- Education and empowerment- Referral services- Shared knowledge

Community Activism:- Leadership training that impacts cancer, tobacco abuse

and chronic and emergent health conditions, and healthcare decision making

2. Community Capacity Building Community education and empowerment Self-advocacy for sustainability

Minority Communities Empowerment Project (MCEP)

2005 – Holy Cross Hospital became the only hospital-based partner and lead entity for the Minority Communities Empowerment Project (MCEP): A multi-organization collaborative to reduce health disparities in cancer morbidity and mortality and chronic and emergent health conditions. MCEP targets racial and ethnic communities.

Montgomery County Demographics: Total: 950,680Non-Hispanic White: 519,847Minority Population: 430,833 45.3%African American: 165,899Asian/Pacific Islander: 135,175American Indian: 4,823Hispanic:140,657 Source: Maryland Vital Statistics Annual Report 2008

Minority Communities Empowerment Project (MCEP) continued

Target populations may have low English proficiency; are low-income, uninsured, under-insured, medially underserved; racial and ethnic communities in Montgomery County. Communities with low-resources.

Racial and ethnic groups targeted for outreach are: – African Americans – Blacks of the Caribbean and Africa– Asian Americans – Latino Americans – Native Americans

Minority Communities Empowerment Project: Partnerships

Participating fiscal year 2011 partners: Holy Cross Hospital – lead entity (July 2004) Asian American Health Initiative (2004) African American Heath Program (2004) Community Ministries of Rockville (2004) Maryland Commission on Indian Affairs (2007)

Historically: CASA de Maryland (2004 – 2010) Latino Health Initiative (2004) African Women’s Cancer Awareness Association (2009)

Minority Communities Empowerment Project: Collaboration

1. Contributes – Researches and gathers information, shares information

2. Takes Responsibility – Duties as assigned, shares equally

3. Value Other’s Viewpoints – Listens to and cooperates with teammates, helps team reach a fair decision

From: http://edweb.sdsu.edu/triton/tidepoolunit/Rubics/coorubic.html

Minority Communities Empowerment Project (MCEP) continued

Raises awareness about the importance of early cancer detection and prevention, tobacco-related illness, chronic disease self-management and emergent conditions.

Links community members with local medical screening opportunities.

Three (3) points of access: 1. Financial 2. Cultural 3. Geographical

Implantation through the Sustainable Minority Outreach Technical Assistance (SMOTA) model.

Sustainable Minority Outreach & Technical Assistance (SMOTA)

SMOTA model: http://www.crf.state.md.us/html/mota.cfm

Minority Communities Empowerment Project (MCEP) continued

Multiple venues provide culturally competent and linguistically sensitive outreach and education:

Community centers Faith-based institutions Day Laborer sites Barbershops Beauty salons Metro stations Ethnic grocery stores Health fairs Individual meetings and community gatherings

Ethnic Health Promoters

Holy Cross is committed to reducing health disparities.

2001 - Established an ethnic health promoter program. Ethnic health promoters:

Reach out to racial and ethnic minority populations who have reduced access to health care

Medically vulnerable and underserved populations with:- Limited English proficiency- Financial constraints- Geographical constraints- Varying cultural practices - Lack of knowledge of the U.S. healthcare system

Ethnic Health Promoters (continued)

Ethnic Health Promoters (multi-ethnic health educators): 80 collectively

Live in the communities where they provide outreach Speak foreign languages Establish trust Raise awareness about early disease detection Link to care, treatment and immunization Provide education Offer support during screening, diagnosis and

treatment

Strategies for Success

The MCEP is a multi-organizational collaborative that works harmoniously and collectively based upon:

Equitable delegation of roles and responsibilities. Respectful value other’s knowledge and opinions. Shared knowledge -- best and promising practices based

on the literature, evidence-based practice, experience, observation and learning's from the community.

Promotion on the grassroots level. Joint responsibility for the success of an activity

(outcomes) .

Challenge: Hard to Reach Populations

Limited English proficient (LEP) individuals. The LEP individuals are often socially isolated,

making them a hard to reach population. May experience communication barriers in

everyday activities. Barriers can threaten individual health, safety and

access to public services. The County’s foreign-born population has nearly

doubled from 140,000 in1990 to more than 270,000 in 2007.

Challenge: Hard to Reach Populations (continued)

2005 - 90% of Latino households spoke a language other than English, 30% spoke little to no English.

2006 - Montgomery County’s LEP population was higher than the national and state average.

2008 - Asian Americans in Montgomery County had the highest linguistic isolation with a rate of 40% when compared to other minorities.

Culturally competent and linguistically sensitive ethnic health promoters are able to reduce the barriers to communication.

Outcomes for Fiscal Year 2010

Health education encounters (FY 2010): African Health Program - 2,193 Asian American Health Initiative - 880 CASA de Maryland - 1,319 Community Ministries of Rockville - 5,507 Holy Cross Hospital - 7,530

MCEP Total: 17,429

Outcomes for Fiscal Year 2010 (continued)

Referrals for cancer screenings: African Health Program - 8 Asian American Health Initiative - 45 CASA de Maryland - 226 Community Ministries of Rockville - 496 Holy Cross Hospital provided – 12

MCEP Total: 787

Program Replication

2009 & 2010 – MOTA was asked to draw upon its network’s statewide infrastructure to reach minority communities not adequately reached through mainstream prevention efforts.

Holy Cross Hospital (HCH) provided a demonstration of an adaptable community infrastructure to address chronic disease and emergent health conditions:

- To promote and encourage self-management of chronic diseases

- To disseminate H1N1 prevention messages and vaccinations Replication of HCH’s cancer prevention activities (MCEP),

created the necessary infrastructure to provide effective H1N1 outreach in the targeted minority communities. 

Target groups were ethnic and racial minorities facing cultural, linguistic and geographical barriers to H1N1 prevention information and vaccination in Montgomery County.

Populations at-risk for H1N1 included: Pregnant women Children under four years of age Non-elderly adults with chronic disease School aged students

Program Replication for Emergent Health Conditions (con’t)

Program Replication

The MCEP model is amenable to multiple chronic and emergent and disease prevention activities:

Cancer (e.g., colorectal, prostate, cervical, oral)

Tobacco product cessation Breast cancer (Komen for Cure) H1N1 Expanding to chronic disease-self management

During fiscal year 2010 the infrastructure of the MCEP model was adapted to a culturally competent H1N1 information and immunization program.

Key elements:

1. Culturally competent outreach

2. Education through empowerment

3. Immunization navigation with links to the health department and hospitals

4. Collaborative with the Montgomery County Department of Health and Human Services.

Replication of Emergent Health Conditions

Culturally competent and linguistically sensitive outreach and education was provided at multiple venues:

One-to-one encounters, health fair participation and group presentations were provided in a variety of community venues including:

Faith-based organizationsBeauty salons Grocery store Public Schools Child day care sitesDay laborer sites Community centers Skilled care facilities (for staff)

Program Replication for Emergent Health Conditions (con’t)

November 2009 – July 2010: Participated in 544 outreach

events/educational sessions Provided H1N1 health education to

approximately 19,700 low-income and uninsured community members

Approximately 3,500 community members were referred to free H1N1 vaccination clinics in Montgomery County.

Program Replication for Emergent Health Conditions (con’t)

January 2010 - Holy Cross Hospital hosted a “quiet” flu clinic in collaboration with the Dennis Avenue Health Center, Disease Control Center (MCHHS)

The outreach workers and HCH staff provided information to approximately 300 community members.

H1N1 vaccinations were administered to 275 community members.

A special area was set-up to be inviting and “friendly” for children.

The target population was Holy Cross Hospital staff, volunteers, physicians and family members.

Program Replication for Emergent Health Conditions (con’t)

We can achieve sustainable positive outcomes when all segments of the community work together -- to make the vision of healthy communities in Maryland a reality. (anonymous adapted)

Thank You