Healthy Kansans 2010: Discussion

Cultural Competency Action Group Meeting 1 Discussion Board

October 24, 2005
Welcome to Cultural Competency Action Group!

[NOTE: Comments listed here are based on notes taken during the meeting and may not accurately capture or summarize comments made by participants. Corrections and clarifications are welcomed and should be emailed to Connie Satzler, csatzler@kansas.net.]

Members Present: Cathy Anderson (phone), April Davies, Heather Fuller (phone), Sandy Griffith, Suzanne Hawley (phone), Anita Hodge, Jamey Kendall, Allison Koonce, Dan Leong, Paula Marmet, Karry Moore, Angelia Paschal (phone), Penney Schwab (phone), Brandon Skidmore, Cyndi Treaster, Cindy Winters

* Paula gave overview of HealthyKansans 2010 process to date.

* Connie reviewed information in packet

* Anita gave overview of medical interpreter and cultural competency training. 125 bilingual participants completed medical interpreter course. Offer trainings in all 6 regions in the state. This is the 5th year of training. Trainers are from Jewish Vocational Service. This is the 3rd year of training for cultural competency training. 124 participants completed last year. Do not have to be bilingual.

KDHE, through Office of Local and Rural Health, is currently sponsoring training in district offices for all KDHE staff. Training provided by Jewish Vocational Service. ITV 2 different times.

Around 200 KDHE staff completed this training.

Purpose: to train medical and social providers. We have reached over 400 participants. In reaching... have broadened beyond medical and social services - fire and police, meat packing, Area Agencies on Aging, Girl Scouts, Boy Scouts, AIDS education and many more - reaching diverse set of providers.

Want to get information out in hands of people who actually need the training. Has been very successful. Need to market, get information out. Hope to see that services are rendered in timely manner and unnecessary tests are not completed just because we don't understand the culture of the patients. Haven't arrived yet, but we are making progress.

April: Thank you! On Missouri side, it costs $300 and a month full of Saturdays.

Anita: Medical interpreter training is 40 hours. Training is free.

Cathy: Training is through Seattle, Cross-Cultural Health Care Programs (is this the correct name, Cathy?). Our trainers take a week-long training.

Anita: Have to start at home. Made available to all KDHE employees. We need to say we've trained our own staff first.

Paula: How will people who have attended training use? Can you give an overview of goals?

Cathy:
1. Demographics: Tailor this section to the different parts of state (e.g., Southwest KS)
2. Cultural Practices, usually related to health care
3. Title VI, federal law, foundation for our work, requires equal access to health care and social services
4. How to work with interpreters.
Making sure people know basic features of cultural competency so they are effective on job.

Cyndi: As someone who attended both medical interpreter and cultural competency training, medical interpreter is just dynamite. Great opportunity. Cultural competency training was pretty general, wonderful thing to begin with for groups that haven't had a lot of concepts. But think when we are talking about developing resource center or speakers, important to break down into different cultural groups. Much more specific about traditional medicine, all the dynamics of the culture, how to approach working with them. Great for a start, but I think we need more specific resources to offer.

Anita: So develop an advanced course?

Cyndi: Several advanced courses related to different cultural groups.

Cathy: Think this is a very good solution to some of issues coming up. We have created modules that look at different ethnic groups, go through cultural practices and cultural norms. Could actually develop this much more comprehensively, more relevant case studies.

We do try to understand the different groups that are coming into an area of the state and focus training on those groups. e.g., when in Dodge City and Garden City, talked about German Mennonites, but could deepen this.

Anita: KDHE - did diversity in the workforce. Basically, having tolerance. Saw that we needed this within the agency as a whole. Felt like KDHE training in our building was very beneficial. What feedback did you get?

Cathy: Would like to share the power point presentation. Power dynamics, race, social class, classism - all of these could certainly be deepened. Did KDHE in 8 hours. Others are 2 days. In general, spend 6 hours on different ethnicities in state, and then spend other time looking at Cultural Competency as a concept in itself...quite a bit here.

Paula: CC training is open to anyone? How do we pay for?

Anita: Yes, open. HRSA BT grant because have to address diversity, people who are non-English speaking. One year through Sunflower, but mostly has been through BT funding.

Paula: Private or public sector?

Cathy: Mostly public

Brandon: What's involved in reaching others?

Anita: Word of mouth. School districts, etc. - has been broad.

Brandon: Are they supplementing a cultural competency plan, or are they agencies that don't have a plan in place?

Cathy: Varies. Have a grant to Sunflower foundation to go into organizations. Assessments, update or refine their English Proficiency policies, help start plan for cultural competency. Could be a number of things - signage, use different media source, etc.

Paula: Question related to evaluation...is there a way for a business owner or organization leader to be able to see if they are more culturally competent as an organization?

Cathy: This is an area of need, haven't gotten to this point yet. Assessment is a second project. Within 2-day training, don't do follow-up. We make ourselves available to organizations, but follow-up process or evaluation is not formalized at this time.

Cathy: Have trained almost every interpreter in Kansas, we do have a developing database. Might be a future resource. Anita has that database in her office.

If anyone is interested in cultural assessments, please feel free to reach me.

Connie: Overview of what universities are doing.

Anita: Catholic Charities - Ryan Smith, working with nursing students on refugee resettlement. Has been wonderful. On second round of nursing students, helping with needs assessment on refugees. They have been great. Getting great experience first hand.
Suzanne: KU MPH program. Suzanne and Angelia have developed cultural competency web-based course. MPH program is primary training for this degree for Kansas. WSU program is no longer accepting applicants. New program at K-State just emerged, have some emphasis with Vet Med.

Their cultural competency course, 16-week, online format teaches topics, including those mentioned by Cathy. Intense, theoretical models, specific ethnic groups. Students look at research, self-assessment, term paper. Has been very well-received. One of most popular classes. Evaluations have been encouraging. Because online can teach both KC and Wichita students. Any student from KU can register for class.

Will start third year of teaching class in January 06.

Have students try to find resources locally. One student did internship at Jewish Vocational Service.

Most of our students are already in practice at public health system.

Angelia is chair of admissions program. Have tried to find ways to become more sophisticated to recruit and retain diverse students. Have also expanded definition of diversity. Also look in terms of rural areas. Now require essay question to help committee better consider diversity in how they select students.

Class looks at concept as well as theories on organizational and individual level.

Students are a diverse group, although most tend to be already in public health
profession. Reach a large number of people through.

Students are self-assessed their abilities on all 68 core competencies. One of those is cultural competency.

Suzanne and Angelia also do pre- and post- assessment on cultural competency in their class. Statistically significant increase in cultural competency.

Found that students rate themselves the highest in CC of all of the domains. So, didn't know it would be significant. Thought maybe the more students learned, the more they might realize they don't know...but how people assess themselves in a pretest is important.

Does school health index address cultural competency?

Heather: Within the core competencies, they do look at professional development, but don't think they look at CC...

Cyndi: Think it's important to have assessment that agencies can use. Don't think necessarily one tool will fit all. Like the idea of a resource center. Each agency will be so different. Some - economics may be as or more critical than racial/ethnic group. Another - language might be the key issue. To know where to begin, need to have a good assessment.

How do you begin to develop an intervention until you know where you are?

Cathy: One useful tool we found is the Child Welfare League of America agency self-assessment instrument. Sections that require governing organizations of institution... Self-assessment is possible for organization to use tool and use as launching pad.

Suzanne: Also in MPH course, do some assessments, think it would be really helpful to pull all self-assessments that are available, then group to decipher, come up with top assessments.

Cyndi: Think it's important to identify tools and which tool is best to use where.

Anita: Not only do we need to develop tools, but we need to get certain sections of the state to realize there is a need. Some sections of the state don't realize that they have any diversity whatsoever.

Paula: Would HR offices be group to advocate?

Cyndi: Administration, accreditation, grant writing, think there's some recognition out there, but not sure if we've given them.

Anita: Think until they're forced to give it (that information)

Suzanne: Through census data or whatever to look at - within each county and region - the disparities that overlap what we're talking about then identify resources that overlap demographics for each region. What is critical? Intersect with what Jewish Vocational Services is doing. GIS map - what we've done, where/how we've trained, where the needs are.

Cyndi: Sometimes have pockets of people we aren't even aware of (example of Pacific Islander group in Southwest KS).

Brandon: Referring to Jean's comments, realizing culture is not just race and ethnicity. Rather than seeing as looking at groups of people. (e.g., poor, homeless, etc.) Maybe we need to change how we are marketing.

Cyndi: I like that because often people see CC only as foreign born. This might deepen people's understanding.

Suzanne: Could this group provide a common language, some mechanism to communicating common definition of diversity.

Cathy: Cultural layers, cultural lenses. So many layers; can be much deeper than race...personality, gender, time they were born, where they live, etc. We are all multi-striped!

Paula: What about need for evaluation?

Suzanne: Think data would be key, starting with data collection...not sure who is required to provide what kind of information.

Cyndi: Think we need to go to communities. Ask them. How are we doing? Are we accessible? Do we understand how you perceive your health? Obviously, when we see improvement in health, that's wonderful. But related to cultural competency, also a satisfaction component.

Ghazala: Baseline assessment. Evaluate what they are doing (piece of assessment), what else can be done?

Paula: What are you measuring, in a baseline?

Suzanne: Part of that depends on population for that group, health disparities. Could document - do they have training provided, does organization do anything within organizational structure that promotes diversity, recruitment and retention

Cyndi: How reflective are employees of the group that they serve? May not be a Hispanic doctor, e.g., but are there Latinos in the agency, lay health promoters, people at entry-level jobs?

Penney: Think you can also look at actual outcomes of measurable things. What are your outcomes on certain population groups on Hemoglobin A1c.

Cyndi: It's pretty easy to get info for Latinos, but what about your other groups? Are you taking services out to populations?

Paula: Also resource center, clearinghouse, training

Ghazala: Defining communication process, common language around cultural competency, developing communication process - whoever is involved in different programs, everyone is defining CC-related issues the same way.

Paula: Will send out update before next meeting. Please comment. Steering Committee is ready for action. Looking at short-term and long-term collaboration opportunities.

Cyndi: Resource center should be multi-departmental

Nov. 30th as 2nd meeting date?? Check your calendars.