Georgia Health Policy Center Cultural Competency for Rural Health Systems Teleseminar February 18, 2

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Georgia Health Policy CenterCultural Competency
for Rural Health SystemsTeleseminarFebruary 18,
2009
Rosemary McKenzie Minority Liaison/Program
Services Manager National Rural Health
Association rmckenzie_at_NRHArural.org
816-756-3140, ext. 15
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An Introduction to the National Rural Health
Association
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History

• Founded in 1978 as the National Rural Primary
  Care Association.
• Celebrated 25th Anniversary in 2002.
• Offices in Kansas City, Missouri and Washington,
  DC.

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Who Are We?

• The voice for rural health care.
• A non-partisan, non-profit membership driven
  organization with over 18,000 members.
• A source of information for policymakers and NRHA
  members.
• A trusted resource for rural stakeholders.

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The NRHA Mission

• The National Rural Health Associations mission
  is to provide leadership on rural health issues.

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Mission Achieved Through

• Advocacy
• Communications
• Education
• Research

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The NRHA Offers

• Advocacy and Policy Development
• Legislative development, strategy tracking
• Action Alerts
• Information Alerts
• Congressional testimony
• Appropriations tracking
• Comments on regulations
• Policy briefs and papers

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The NRHA Offers

• Communications and Information Access
• Bimonthly E-News
• Quarterly magazine Rural Roads
• Journal of Rural Health
• Other publications
• Policy experts
• Organization linkages

Website www.RuralHealthWeb.org
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The NRHA Offers

• Educational Opportunities
• Policy Institute Late January 2009, Washington
  DC
• Rural Medical Educators May 2009, Miami Beach,
  FL
• 32nd Annual Conference May 2009, Miami Beach, FL
• Quality Clinical Conference July 2009, Park
  City, UT
• Skill-Building Workshop July 2009, Park City, UT
  
• RHC/CAH Conference October 2009, Portland, OR
• Minority Multicultural Health Conference Dec
  2009, Memphis, TN

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The NRHA Offers

• Leadership Opportunities
• Rural Health Fellows Program
• Constituency Groups, Issue Groups
• Develop papers for review by Rural Health
  Congress
• Provide issue expertise to NRHA staff

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The NRHA Offers

• Networking Opportunities
• Sharing of information, best practices,
  experiences
• Innovative ideas
• Research
• Build contacts among peers

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Whats New at NRHA?

• New in 2008
• NRHA Student Scholarships Available
• NRHA Website update
• Expanded offerings of Continuing Education
  Credits
• NRHA Border Health Initiative Expert Panel
  Meeting
• NRHA Social Networking Site
• New in 2007
• Association grew to over 18,000 members
• NRHA Services Corporation
• New Rural Health Fellows Program

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NRHA Quality Initiative

• In 2005, NRHA began a five-year initiative to
  improve the quality and safety of health care in
  rural America based on the Institute of
  Medicines recommendations.
• NRHA/ORHP released a manual on best practices in
  2007.
• NRHA collaborates with the University of Nebraska
  in 2008 to pilot AHRQs culture of quality survey
  in rural hospitals.

Rural Can Lead on Quality!
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Organizational Structure

• Board of Trustees
• Rural Health Congress
• Government Affairs Committee
• Constituency Groups

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The Policy Board and the Government Affairs
Committee

• Rural Health Congress
• The Rural Health Congress is the policy-making
  body of the National Rural Health Association.
  Includes representatives from the constituency
  groups, State Association Council, State Office
  Council, and the Associations officers. The
  Rural Health Congress determines the
  association's positions on public policy.
• Government Affairs Committee
• The NRHA's Government Affairs Committee works
  with the NRHA's Government Affairs staff to
  develop the association's legislative agenda. The
  committee develops and implements strategies to
  ensure that the association's public policies and
  government affairs activities are fully addressed
  and communicated.

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Overview of Multiracial/Multicultural Populations
Nationally

• As you all know, the population of the United
  States has become increasingly diverseracially
  and ethnicallyduring the past several decades.
  Approximately 65 million of United States
  residents live in rural settings. Rural ethnic
  minorities, include African American,
  Asian/Pacific Islander, American Indian/Alaska
  Native, Hispanic/Latino, Africans, Eastern
  Europeans and other comprise about 8 million
  people in rural areas. So, what are the
  implications presented by the growing diversity
  of rural America?

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• To bridge the widening gap between clients of
  varied cultural backgrounds, health professionals
  must become responsive to the needs of the
  growing multicultural population and begin to
  develop different and appropriate care
  strategies. The delivery of high-quality health
  care and the comfort level of communities require
  a deep understanding of the socio-cultural
  background of people, their families and the
  environments in which they live.

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• Culturally competent health services and
  community interactions facilitate encounters with
  a favorable outcome, enhance the potential for a
  more rewarding interpersonal experience and
  increase the satisfaction for the individual
  receiving health care or living in the community.

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Critical factors in beginning to understand
cultural competency include an understanding of
the

• Beliefs, values, traditions and practices of a
  culture
• Culturally defined, health related needs of
  individuals and families and communities
• Culturally-based belief systems of the etiology
  of illness and disease and those related to
  health and healing and
• Attitudes toward seeking help from health
  providers.

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• Systematic efforts must be implemented by policy
  makers, planners of service, and communities in
  order to effect system change, enhance the
  quality of services and improve the health care
  access and outcomes for racially, ethnically and
  culturally diverse groups.
•  
• .

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• The effectiveness of service providers in
  reaching and
• working with multicultural populations rests
  heavily
• Upon the sensitivity, respect and understanding
  paid
• to ethnic diversity. In order for an
  organization or
• community to continue to thrive, its culture
• (assumptions, values and practices) must remain
• compatible with the environment in which it
  operates

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Issues, Needs and Concerns of Rural
Multiracial/Multicultural Populations

• Lack of health insurance/inability to pay
• Transportation/child care 
• Communication - verbal and non-verbal
• Education
• Hours/schedules of clinics
• Social structure
• Language needs translators are a necessary
  step, as well as translation of written materials
  

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• Lack of knowledge of available services 
• Fear or mistrust of government services
• Lack of understanding of the health care system 
• Personal encounters 
• History of discrimination
• Cultural beliefs

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The Importance of Cultural and Linguistic
Sensitivity

• Cultures are different but different does not
  mean inferior. What is culture? It is the
  customary beliefs, social norms, and material
  traits of a racial, religious or social group.
•  

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• Health care organizations and programs are
  struggling with the challenges and opportunities
  to respond effectively to the needs of
  individuals and families from racially,
  ethnically, culturally and linguistically diverse
  groups. The incorporation of cultural competent
  approaches remains a challenge for many states
  and communities. Numerous reasons justify the
  need for cultural competence in health care at
  the patient-provider level, as well as the
  community

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These reasons include, but are not limited to the
following

• The perception of illness and disease and their
  causes varies by culture
• Diverse belief systems exist related to health,
  healing and wellness
• Culture influences help seeking behaviors and
  attitudes toward health care providers
• Individual preferences affect traditional and
  non-traditional approaches to health care
• Patients must overcome personal experiences of
  biases within the health care systems and
• Health care providers from culturally and
  linguistically diverse groups are
  under-represented in the current service delivery
  system.

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• In order to understand a cultural group, it is
  imperative to define and clarify who they are
  based on where they come from.
•  
• The growing population of Hispanics in the United
  States constitutes one of the most dramatic
  demographic shifts in American history. The
  number of Hispanics has increased four times as
  fast as the rest of the population, and they are
  expected to surpass African Americans as the
  largest minority group.
•  
• Financial implications - Many Hispanic immigrants
  come from less industrialization nations and have
  few of the skills they need in order to adjust
  easily to working in the U.S. Technical progress
  has eliminated many of the jobs earlier
  immigrants could obtain to achieve some degree of
  economic security, such as unskilled factory
  labor.

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• Hispanic families hold a strong kinship view of
  family, often including non-blood-related family
  members (such as African Americans---maybe all
  minorities) ----- which is extended beyond family
  ties to include community members.
• For Hispanic/Latino cultures, family tradition is
  an important aspect of life. Family unity is
  seen as very important, as is respect for and
  loyalty to family. Cooperation rather than
  competition among family members is stressed.
  Interpersonal relationships are maintained and
  nurtured with large network of family and friends.

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Things to do by both providers and the community

• CHALLENGES
• Acknowledge the members of the community that are
  different from you
• Make them a part of the community
• Hear their voices and concerns and act upon them
  
• Get to know them, learn their culture, their ways
  
• Understand their habits and fears
• Learn what they do as a family
• Initiate a cultural competency committee or task
  force

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• Establish policies and procedures for Limited
  English proficiency consumers
• Have available qualified interpreters
• Translate written materials (by a professional)
• Do a self assessment
• Do an organizational assessment
• Go to cultural competency training

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• OPPORTUNITIES
• Conduct self and organizational assessments
• Be aware of differences
• Be aware of similarities
• Be open
• Be honest
• Ask questions
• Plan to spend a little more time with your
  communities
• Establish Limited English Proficiency policies
  and procedures

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Following are publications and resources
developed by the NRHA to address cultural
competency

• Rural Minority Health Resource Book this
  resource book is for health professionals and
  others working with and serving rural racial and
  ethnic minority communities. This book is a
  compilation of important statistical, factual and
  anecdotal information regarding rural minority
  health issues such as access, transportation,
  barriers to care, cultural competency, health
  status indicators, and disparities concerns.

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• Cultural Competency Awareness and Training
  Materials to ensure the availability and
  accessibility of culturally competent health care
  services to rural racial and ethnic minorities,
  this two part manual is awareness
  raising/training materials about cultural
  competency in health care. These materials are
  to be used in a health care setting with staff,
  providers, board members and other volunteers to
  explain what cultural competent care is, why it's
  important and how to provide this care.

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• Contextual Health Profile for Rural Racial and
  Ethnic Minority Populations this
  computer/internet-based tool is to guide the
  health planner toward culturally competent health
  programming. The Profile is a comprehensive
  description of the health status of a specific
  community, and includes community health status
  information that is typically included in a
  community health needs assessment. In addition,
  it captures cultural and environmental
  information about a specific community to help
  the health planner reach a more informed decision
  or set of decisions regarding appropriate health
  interventions.

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• Information Warehouse Rural Minority and
  Multicultural Health Website this warehouse was
  developed to ensure that health data and
  information are appropriately applied for the
  benefit of rural racial and ethnic minority
  communities. The warehouse provides an access
  point to useable data and information to assist
  program planning and implementation, policy
  development and research to community-based
  organizations, policy makers, researchers,
  program planners and others.

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• A Comparative Study of the Status of Minority
  Populations in Americas Poorest Counties A
  Pilot Project This project developed a pilot
  profile of five counties, using county specific
  data for each of the five USDA rural high poverty
  groups Black, Hispanic, American Indian/Alaska
  Native, Southern Highlands and Other) that
  includes poverty, race/ethnicity, and health
  outcome measures.

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• Lay Health Workers in Rural Community Health
  Centers The purpose of this publication is
  three-fold 1) to describe how lay health workers
  are currently being used by rural community
  health centers 2) to introduce the lay health
  worker concept to health center administrators
  that are unfamiliar with the approach and 3) to
  provide a preliminary guide to health center
  administrators who are interested in
  incorporating lay health workers into their
  organization.
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• These publications and resources are helpful
  tools in enlightening communities, organizations
  and individuals to the need for cross-cultural
  understanding. You can call the NRHA Kansas City
  office [phone]) to order these
  publications/resources.

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Summary

• In closing, the NRHA is addressing rural health
  services for communities of color from all
  aspects, and we are working with other partners
  to ensure that the development of these health
  services are appropriate and accessible.
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Questions? / Thank you!

• Rosemary McKenzie
• Minority Liaison/Program Services Manager
• National Rural Health Association
• rmckenzie_at_NRHArural.org 816-756-3140, ext. 15