Promoting Cultural Competency Among Family Planning Providers: Lessons from the Field

1
Promoting Cultural Competency Among Family
Planning Providers Lessons from the Field

• Grace Mose, D.A. Karen Anderson, MPH, MEd
• The Education Fund of Family Planning Advocates
  of NYS

2
Objectives/Overview

• Background
• Context Rationale for Organizational Assessment
• Introduction to CLAS Standards
• Assessment Process
• From Results to Action Mini-grants
• Limitations, Lessons and Recommendations
• Challenges Next Steps

3
Who We Are

• Family Planning Advocates is a statewide
  membership
• organization that represents the Planned
  Parenthood
• affiliates and individual family planning centers
  in New
• York State
• Mission To advance public policies that fulfill
  the rights of
• individuals to comprehensive sexual and
  reproductive
• health services and education that are consistent
  with the
• principles of justice and fairness and respect
  diversity,
• personal dignity and privacy

4
Context Rationale for Organizational Assessment

• 21 (almost 4 million) New Yorkers are
  foreign-born
• 2.2 million New Yorkers speak English less than
  very well
• More than 5 million immigrants, speaking 150
  languages, live in the NYC metropolitan area
• An estimated 2 million immigrant women in NYS
  need access to reproductive health services

5
Strengthening Cultural Competency among Family
Planning Providers

• An ongoing project funded by the Ford Foundation
• Goal To develop a strategy to help family
  planning providers assess and enhance their
  ability to provide culturally and linguistically
  competent services to diverse populations

6
National Standards for Culturally and
Linguistically Appropriate Services in Healthcare
(CLAS)

• Goal
• To increase access for the racial, ethnic and
  linguistic populations that face most barriers
• Collective set of 14 mandates, guidelines and
  recommendations issued by OMH
• Framework for developing practical guide for
  implementing and monitoring institutional
  progress towards cultural competence

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Brief Overview of CLAS Standards

• Themes
• Culturally Competent Care (Standards 1-3)
• Language Access Services (Standards 4-7)
• Organizational Supports for Cultural Competence
  (Standards 8-14)

• Stringency
• Mandates
• (Standards 4-7)
• Guidelines
• (Standards 1-3 8-13)
• Recommendations (Standard 14)

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Assessment Process

• Identify 6 interested family planning centers
• Solicit input from national experts in cultural
  competency
• Conduct Organizational Cultural Competency
  Assessment and Institutional Checklists
• Conduct data analysis and develop written report
• Provide mini-grants to help clinics implement
  recommendations
• Provide ongoing technical assistance

9
Assessment Team

• Wilma Alvarado-Little, Medical Interpreter/Trainer
  and co-Chair of the Board, National Council on
  Interpreting in Health Care
• Tim Frasca, Data analyst
• Dinah Surh, Vice President, Ambulatory Care
  Services, The Brooklyn Hospital and member of the
  National Center for Cultural Competence
• Dr. Stergios Roussos, Consultant, Community
  Scientist, AKOUO
• Karen Anderson, Director of Public Policy, FPA
• Grace Mose, Program Associate, FPA
• Sang Hee Won Claudia Barbaric, FPA

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Assessment Sites

• Planned Parenthood Mohawk Hudson, Utica Center
• Over 11,000 (total pop. 60,000) refugees from
  30 different language groups
• Planned Parenthood New York City, Boro Hall
  Center, Brooklyn
• Brooklyn Foreign-born population 38 in 2000
  with more than 46 of the population speaking a
  language other than English at home
• Community Healthcare Network, CABS Health Center,
  Brooklyn
• Williamsburg/Bushwick area Approximately 27 of
  the population is foreign-born
• Planned Parenthood Hudson Peconic New Rochelle
  Center
• Approximately 32 of the population is foreign
  born and 37 of the population speaks a language
  other than English
• PP South Central (May) PP Mid-Hudson Valley
  (September)

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Assessment Tools

• Organizational Cultural Competency Survey
• Staff ratings on importance and satisfaction of
  published factors indicative of culturally and
  linguistically appropriate health care
• 10-minutes written survey conducted during FPAs
  Assessment Day
• Institutional Audit Checklists
• Six checklists
• Interviews with key staff to assess key areas of
  cultural competence

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Institutional Audit Checklists

• Present and Future Patient Demographics
• Present Staff Demographics
• Assessment by Leadership
• Current Actions to Enhance Cultural Competence
• Patient/Community Access to Culturally
  Appropriate Care
• Community Involvement and Support

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Sample from SurveyStergios Roussos, Using the
Federal CLAS Standards to Foster a More
Culturally Competent Healthcare Environment,
132nd APHA Annual Meeting

• Please rate
• How important is each item in your service to
  patients who may have difficulties during their
  healthcare visit due to culture and language
  differences, and
• How satisfied you are at this time with your
  knowledge or skill for each item.

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Example of Application of CLAS Standards to
Survey Items

• CLAS Standard 4. Health care organizations must
  offer and provide language assistance services,
  including bilingual staff and interpreter
  services at no cost to each patient/consumer with
  LEP at all points of contact, in a timely manner
  during all hours of operation.
• Survey Items
• I am able to identify the different languages
  used by our patients
• I can describe community resources that I can use
  to assist patients with language and cultural
  barriers to health care
• Trained interpreters are readily available for
  the different languages of the patients we serve

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Application of CLAS Standards Findings and
Recommendations

• CLAS Standard 4 Health care organizations must
  offer and provide language assistance services,
  including bilingual staff and interpreter
  services at no cost to each patient/consumer with
  LEP at all points of contact, in a timely manner
  during all hours of operation

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From Results to ActionMini Grants and Technical
Assistance

• Mini Grants
• 3,000/ clinic to address at least one of the
  organizational priorities derived from the
  assessment.
• Examples of Outcomes
• Staff training on how to provide culturally and
  linguistically appropriate services
• Medical interpreter training for bilingual staff
• Bilingual signage and consent forms
• Refinement of patient registration to capture
  relevant demographic and cultural data

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Limitations

• Staff misunderstanding of the survey
• Interviewed only key people in leadership
  positions
• Did not collect any information from immigrant
  populations themselves

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Lessons Recommendations

• Key to engage leadership
• Include entire staff in kick-off and results
• Explore ways to train onsite evaluators
• Include patient and community perspectives

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Ongoing Challenges

• Need to secure funding to implement mandates
• Need for ongoing technical assistance
• Lack of qualified trainers and training resources
• Need to link cultural competency to larger
  political issues including immigration and
  immigrants rights

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Next Steps

• Continued funding from Ford Foundation to expand
  assessments
• Develop and pilot method to solicit patient
  feedback about cultural competency
• Establishment of information/resource
  clearinghouse at FPA
• Language Access Conference in NYS

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Grace MoseResearch and Program AssociateFamily
Planning Advocates of NYS17 Elk StreetAlbany,
NY 12207www.fpaofnys.orggrace_at_fpaofnys.org
22
Recommendations from Pre-Conference Immigrant
women Participants

• There should be standards for translations and
  interpretation
• Patients should have choice of interpretation
  services.
• Translations should be Culturally sensitive,
  Presented at
  different levels of literacy, and should be age
  appropriate.

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Recommendations Conti.

• Cultural and linguistic sensitivity must start at
  school level.
• Increase recruitment of female interpreters from
  more diverse communities.
• Funding is an recurring issue.
• Taking advantage of technology available such as
  interpretation equipment.

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• Adopt a policy for one stop comprehensive health
  services.
• Suggestion to do outreach for immigrant
  volunteers.

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Suggestion on the role of FPA

• FPA can be a corner stone and a unifying force
  for most immigrant organization and women across
  the state.
• FPA can do more grassroots with providers of
  various services and issues.
• FPA can educate and provide advocacy training and
  leadership skills.
• FPA can work with local communities with the
  goals to address issues specific to those
  communities.

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FPAs Role conti.

• FPA can be a center for resources (clearing
  house)
• FPA can push forward the policy agenda.