Advancing Health Equity: Building Capacity through Innovative Training Models


Good afternoon, everyone. Thanks for joining
us. My name is Ben Duncan and I’ll just do a quick background on me. I’m the Chief Diversity
and Equity Officer and the Director of the Office of Diversity and Equity for Multnomah
County, which is where Portland, Oregon is. I’m also a founding board member of OPAL Environmental
Justice Oregon, who organizes low income and people of color to build power for environmental
justice and civil rights in the community; co chair of the Region X Health Equity Council.
And I’d like to welcome you to today’s webinar from Region X Health Equity Council along
with my co-chair, JamieLou Delavan. Today’s webinar will highlight novel approaches
focused on building capacity to address health inequity. We’ll hear about the DELTA, which
stands for Developing Equity Leadership through Training and Action program, which is a comprehensive
health equity, an inclusion leadership program that strategically provides training, coaching,
and consultation to key health community and policy leaders in Oregon. We’ll also hear
about the Idaho Community Health Advisor program, which applies to culturally specific and trauma
informed approach to increase access to health systems by training refugee community members
and health navigators. Now I’ll briefly do some housekeeping points.
If you have a question during the webinar, you’re welcome to post it to the chat box
that you’ll see at the lower left-hand corner of your screen at any time during the webinar.
These questions will be answered during the Q & A at the end of the presentations. At
the conclusion of the webinar, you’ll be directed to an evaluation survey and we’d ask you to
please take a few minutes to complete the survey as we appreciate any feedback you have
to help inform future ASTHO webinars. We’re also going to include two polling questions
as we go through, and we encourage your active participation from all of you. And we will do – if I can figure out the slides
– we’ll do the first polling question now. It reads: What resources would be most beneficial
for you from a Regional Health Equity Council? And this is a live poll, so as you do it,
it’ll start collecting responses. Webinars and information sharing, successful policy
examples, data and research, partnerships, and conferences and convenings. We’ll give
you a minute or two to fill it out live. [Silence from 0:02:56 to 0:03:57] Let’s take about
one more minute to get the final results. [Silence from 0:04:02 to 0:04:37] Okay, last
chance before we switch out. So we’re going to show the results and you’ll
see “partnerships” jumping out. So for the Regional Health Equity Council and I appreciate
all of you who have participated in this. This is really, for us, meant to guide and
get a sense of regionally what folks are looking for in terms of the role of what a regional
council can play in this region. So obviously, all of these represent some level of importance
for you. I’m seeing the “partnerships” and “information sharing” being the top two. It
gives us some direction. In a minute, I’ll be passing it over, after we do our speaker
biographies; and JamieLou Delavan, my co chair, will talk a little bit about the National
Partnership for Action and the Regional Council. So thank you for your participation. So I’d
like to, before we dive into the presentation, give a little background on the Region X Health
Equity Council. I just want to quickly read the esteemed panelists and presenters that
we have today. The first speaker we’ll hear from is Charniece Tisdale. Charniece moved
to Portland in October of 2012 to work at the Oregon Health Authority in the Office
of Equity and Inclusion as the Centers for Disease Control and Prevention, Prevention
Specialist. In her role, she coordinates the Developing
Equity Leadership through Training and Action, also known as DELTA leadership development
program, and helps provide technical assistance to health-related organizations throughout
Oregon. Her previous experiences have included planning, implementing, and evaluating public
health research, programs, and community-based initiatives in various settings, including
nonprofits, hospitals, and universities. She is a graduate of the University of Michigan
School of Public Health. Our second presenter will be Sandra Clark
who joined Health Share of Oregon’s team in 2012 as Project Director for Community Health
Strategies. Health Share of Oregon is the state’s largest coordinated care organization
serving over 230,000 people in the Portland metro area who qualify for Medicaid, an Oregon
Health Plan. She facilitates Health Share’s cultural competence work crew and health equity
initiatives and project manages the Coordinated Care Organizations Community Health Improvement
Plan. She earned her Masters of Public Health from Oregon State University in 2010 and was
a 2013 participant in Oregon Health Authority’s Developing Equity Leadership through Training
and Action program. We’ll also hear from Tracy Harrod. Tracy and
her family lived and worked in rural Kenya for seven years. Since moving to Boise in
2008, Tracy has enjoyed the opportunities to serve Idaho’s diverse refugee populations
in many different ways. She presently serves at the Saint Alphonsus Center for Global Health
and Healing, where she coordinates the Community Health Advisor program. This program assists
individuals and families being resettled in the United States to overcome linguistic,
cultural, and trauma-based barriers in order to access equitable health care. She also
serves as an intercultural consultant and provides training across a wide variety of
disciplines to help strengthen health and community services to diverse populations.
As a Swahili interpreter, she specializes in interpreting for survivors of torture,
war trauma, gender-based violence, and domestic abuse. I’d like to now pass it over to my co moderator,
JamieLou Delavan. And just quickly, JamieLou is a State Minority Health Coordinator at
the Idaho Department of Health and Welfare where she serves as cultural liaison and cultural
competency guide for health promotion and chronic disease programs. In 2009 Jamie initiated
a project with International Rescue Committee and Idaho Women’s Network where she co-authored
a refugee rights and responsibilities program covering American culture, law, education,
healthcare and social services. She is currently developing a wide renter program for immigrants
and people experiencing homelessness. JamieLou is also the co chair of the Health Equity
Council for Region X. And I’ll pass it on to her. Good afternoon, everybody. I just want to
quickly go through before our presentation because I know we’re all waiting for the presentation.
So I want to give you a tiny bit of background about the National Partnership for Action
and Health Disparities. Go ahead on the next slide. I don’t have to pull over my slides
when you hear me say “next” a little bit. The National Partnership for Action to End
Health Disparities is a national movement that’s facilitated by the Office of Minority
Health, and the purpose is to increase the effectiveness of programs happening across
the nation in different regions and to mobilize partners and leaders and stakeholders with
the goal of eliminating health disparities. And often we’re bringing together leaders
that may not have been collaborating in the past but are still all working on issues that
impact health and especially health disparities. This movement, this initiative, the NPA, is
broken out into ten regions. So there are ten regional movements called RHEC, or Regional
Health Equity Council. Thank you. And each council has come up with their own action
items, depending on the region, in mobilizing in that way and leveraging federal, regional,
state and local resources and all with the purpose of infusing NPA goals and strategies
and policies and practices. So each region is a little bit different. Obviously, our
nation is very different. And we aim to share information, such as through this webinar,
and successes in promising practices throughout the nation. Next slide. And there’s just a pictorial example
of where the ten regions are. So we are presenting from Region X: Washington, Oregon, Alaska,
and Idaho. Next slide. So the RHEC common priorities, the NPA’s priorities, are building
communication and capacity; developing membership, partnerships and champions; improving access
to quality care; identifying intervention points; and developing tailored strategies,
cultural and linguistic competency, education and training; and improving data collection,
usage and reliability; and disseminating that data. Next slide. The Region X, each region, obviously
has their own vision and mission. They’re very similar. Our vision is to see a nation
free of health and health care disparities. And our mission is to identify efforts and
resources in the region that target the elimination of health disparities, promoting health equity,
and educating and increasing awareness of social determinants of health within our region. Next slide. Our primary priority areas are
to increase plain language, health equity communication, and outreach efforts; enhance
our membership to continue to diversify it from fields in different backgrounds; and
enhance our diversity in the workforce. Next slide. When we were preparing for this webinar,
we were thinking about different examples of things that were happening in the region.
And we really wanted to look at two different – we decided to bring in two different approaches.
One is from more of a training around policy and program decisions, and the other impacts
more of a local level clinical services. So there are two very different approaches to
address health inequities and health disparities in the region. Next slide. So we come to our next poll: Are
training models an integral part of your organization strategy to address health disparities? Go
ahead and take a moment to answer yes; no; or I don’t know, you’re not sure. [Silence
from 0:14:16 to 0:14:48] Okay, and I think we’re just about ready. Do we have our results?
Okay. So with that, we’re going to segue into our first presentation. And our first presenter
is Charniece Tisdale. Thank you. Good afternoon, everyone. Again
my name is Charniece Tisdale and I am the program coordinator for the Developing Equity
Leadership through Training and Action, or DELTA program. Joining me on this call is
one of our wonderful pilot co participants, Sandra Clark, who will talk about her experiences
in the program later in this presentation and I just want to say that 15/45 it’s exciting
to see how many people are using training modules in regard to eliminating health disparities
based on that poll. All right. So now I want to get into the goals
of this presentation. Here’s what we’re hoping to achieve for today. I want to provide an
overview of the Oregon Health Authority Office of Equity and Inclusion, also known as OEI.
I want to share OEI’s innovative practices for developing health equity leadership through
the DELTA program and also discuss experiences of the DELTA program from a participant’s
perspective. So first, let me talk a little bit about OEI. OEI’s business statement is
all people communities and cultures co creating and enjoying a healthy Oregon. Our mission is to engage and align diverse
community voices and the Oregon Health Authority to ensure the elimination of avoidable health
gaps and promote optimal health in Oregon. There are three units within OEI. They’re
equity, diversity, and administrative. As you can see on the slide, we engage in various
activities, including policy development, community engagement, strategic communications,
recruitment, and retention as well as data improvement. The DELTA program is housed in
the equity unit under community engagement. So what does DELTA stand for, and how does
it a play a role in advancing health equity? Developing Equity Leadership through Training
and Action is a health equity and inclusion leadership program intended to convene a coterie
of leaders, who in turn, directly impact issues, structures and policies around health equity.
The original concept of the program came about after noticing a gap and need for training,
technical assistance and practical implementation of health equity, diversity, and inclusion
strategies from public health, healthcare, community based and other related organizations,
institutions across Oregon. To date, there have been two cohorts of the
DELTA program. The first cohort was piloted in 2013 and funded by Kaiser Permanente community
benefits grants. Upon conclusion of the pilot program, OEI received funding from the Centers
for Medicare and Medicaid Innovation, otherwise known as CMMI grant, for three additional
cohorts. We are in the process of wrapping up the second DELTA cohort in September and
we will begin our third cohort in January 2015. The program is compromised of full day
classroom-based training, supplemental pools, materials and resources, project management,
and coaching and technical assistance. Our first cohort was comprised of 18 participants
who met once a month for six months. They received technical assistance and were involved
in a large scale evaluation. Our second cohort, which is our current cohort, has 23 participants,
and they meet once a month for nine months. They also do technical assistance and were
involved in evaluations, but in addition, they have a project component so they can
actually practically apply the things that they are learning. Past DELTA topics have
included health literacy, language access, leadership for health equity, race, ethnicity,
and language data and health equity metrics, diversity in recruitment, hiring and retention. Our training consisted of local and national
subject matter experts. We have had dynamic trainers come as far as from the National
Health Law Program In Washington D.C. to Kaiser Permanente in Oakland, California and right
down the street at the Multnomah County Health Department in Portland. When selecting participants
for the DELTA program, we seek diversity in a racial and ethnic background, gender identities,
sexual orientation, organizational type, and job positions in order to achieve a well-rounded
and inclusive experience. In regards to a professional makeup, a large
percentage of the DELTA participants identified themselves as program managers. However, there
are a variety of titles including a senior director of clinical services, director of
child and nutrition program, maternal and child health policy specialists. We have a
chief health strategy officer, manager of diversity and civic leadership, health equity
officer, language access supervisor, associate professor, and more. Many of our participants
are from community based organizations and nonprofits. However, several are also from
Coordinated Care Organizations, health systems and local, county, and the state health department. Since health disparities are intricately linked
to social determinants of health, we have also included members from the Department
of Education, Behavioral Health Organization, Housing and Foundation. Most cohort members
work in the Portland area, but we have made a concerted effort to diversify geographically.
For example, this year’s cohort has 13 Portland-based participants and 10 members from cities outside
of Portland, such as Ashland, in Eugene, Oregon. As far as our recruitment strategy, we like
to host informational sessions. This year we’ll be traveling to rural areas throughout
the state to conduct target outreach. It’s important to know that this program is
not designed exclusively for health equity experts. This program is intended to enhance
the knowledge and skills of anyone interested in advancing equity work on a systemic and
institutional level. So I just wanted to show a few images of what a typical DELTA training
looks like. And so as you can see in the presentation, we have lots of group discussions as well
as games, brainstorming, people taking notes, and yeah, we have speakers. That’s the part
of the training. It’s a variety of techniques for adult learning. So now I’d like to take a step back and talk
about the overarching goals of DELTA, in other words, what we hope this program achieves.
The goal is that, by the end of the program, DELTA cohort members will become equity change
agents through partnership engagement, enhanced knowledge and skills, project implementation
and strategic planning. More specifically, we hope that the cohorts will act as drivers
and enablers of an equity and inclusion agenda within Oregon’s public health and healthcare
system as well as facilitate the development and institutionalization of health equity
and inclusion strategies in their own healthcare and public health setting. Now I would like
to turn it over to Sandra Clark, who was a member of our pilot cohort and now currently,
a member of our alumni network. She will talk about her learning experience in the program
as well as how it translated into the work that she does currently for Health Share Coordinated
Care Organization. Thanks, Charniece. Well, I just wanted to
start out by saying that it’s just such a great opportunity to have a few moments to
reflect with everyone participating in this seminar on the impact that the DELTA program
has had on me and, by extension, on my work at Health Share of Oregon. When I joined the
DELTA program in 2013, I think I really kind of fit into that description Charniece just
went over: someone who didn’t have very much specific training in health equity and analyzing
health disparities beyond kind of the bedrock foundational work I did in my public health
program and being exposed to the health equity and empowerment lens through Multnomah County
Health Department in a previous position. And I didn’t have a high comfort level with
kind of embracing the role of health equity and eliminating health disparities in my own
job at Health Share where we are tasked with providing care and services and improving
outcomes among over 230,000 people on Medicaid here in the Portland metro area. And our membership is more than 50 percent
people of color and we have over 100,000 members who require health services in a language
other than English. Yet for various reasons, in a lot of the foundational plans for Medicaid
in the Oregon Health Plan, eliminating health equity, eliminating health disparities and
promoting health equity usually comes as an add on to the Triple Aim. And in my position,
I really needed support to take things to the next level and bring that up and that’s
where my experience in DELTA really impacted me. And so when I was thinking about my learning
experiences, I really sort of break them down into some very tangible and specific valuable
outcomes and others that are less tangible. And just like the first polling question we
had, we saw that most people value partnerships from a Regional Health Equity Council. Probably the biggest value was developing
this network among the cohort of individuals that I was able to work with and bond with
and get to know as we went through this six month journey together. And that network has
been really powerful for me in the long term. I think one of the really valuable approaches
that the Office of Equity and Inclusion here took with developing the DELTA program was
creating a safe space in the training program to where we were all there based on our roles
in our organization. We were there acknowledging that we have a role with the state or with
the health system or with a particular program goal. But what our trainers really worked
to do was emphasize our skills building as individuals. And from the very first session, they emphasized
how this work is the work of a career and we will move into different positions over
our lifetimes, but that as Oregonians, that we’re coming together to form a long term
network and cohort of individuals committed to developing our leadership and committed
to doing this work together over time because as we know this movement to promote health
equity and truly eliminate health disparities is a long term project that’s not something
that you check off. And I think sometimes we’re working for organizations where we have
pressures, either because of grants or timelines that kind of prevent us from thinking with
that long term goal, especially in the context of our own individual lives and our roles
in the community; and also, as a white ally, gaining that identity was really important. And then in terms of – what happened over
the next six months was that we were exposed to really amazing trainers and provided tools,
including learning about different approaches to framing health equity and understanding
what healthcare disparities are and understanding how you can talk about health disparities
and then link them to actual healthcare disparities which turns out to be really important in
my work, working for a Medicaid plan where our responsibilities tend to be on the health
outcomes, and sometimes it’s a little hard to locate the organization’s role in eliminating
broader inequities that we link to larger social determinants of health. The Enhanced CLAS Standards (Culturally and
Linguistically Appropriate Services Standards) were newly released in 2012 and the DELTA
program invited Ignatius Bau from Washington D.C., who had a role in developing those enhanced
standards. And he came to us in the capacity of a consultant, which was kind of great because
he wasn’t there necessarily representing the Office of Minority Health but as an individual.
And so he was able to highlight the improvements to the CLAS Standards but also discuss how
there’s still room to grow and there are things that we need to do and as individuals and
as change agents that we can use the CLAS Standards but take them the next step further,
kind of recognizing that things change incrementally. And on a less tangible side, it’s not a typo
that I repeated developing a network. In the last session Ben Duncan, our moderator, here
for the webinar today, was one of our trainers, and he presented on Multnomah County’s Health
Equity and Empowerment Lens. And towards the end of his presentation, he said something
that has stuck with me and really had an impact on me, which was to say that as individuals
doing this work, we should think of ourselves as an organization of nonprofit which always
has a board of directors and that the role of the board of directors is to help steer
the organization to ensure stability, ensure its long term health. And he encouraged all
of us, as we moved forward, to think about who would we have on the board of directors
as change agents promoting health equity and eliminating health disparities. And I have been, actually written down my
list, and some of them might not know it, but I have a board of directors. And so that
was a more a kind of less tangible thing in terms of thinking about my network of people
that I’m working with, but also reaching up and out to people that I want to be like and
emulate and learn from. And again, it also promoted a lot of internal exploration, emphasizing
how this isn’t just about your job, but who are you in your community. And this is how
I would just describe that it’s had a long term effect. And I think part of this derives
from the format of the training, which I think shouldn’t be overlooked which was to give
us a full day once a month and then come back month after month. And it gives more of an
opportunity for the learning to sink in and for us to reflect. And to tell you the truth,
I strongly feel that the impacts of DELTA on me have really been more about what’s happened
in the year after I took DELTA, like it’s really had this long-term kind of sinking
in. And just a couple of minutes on how I’ve applied
the skills, we at Health Share are a collaborative of many different organizations – managed
care, hospital systems – and we face the challenge of organizing a systems level approach to
establishing measures for improvements. And I helped form an organizational assessment
that consisted of five sections that I based on the new CLAS Standards that we conducted
over the last year. And the way that we did that was through convening a Cultural Competence
Workgroup, which I facilitate. And one of the effects of DELTA was that I kind of found
my voice and found my role in helping create a similar safe space for the leadership people
representing their organizations, leaders coming together through this workgroup to
not do things that made identifying gaps seem like we’re auditing or trying to be critical,
but that we’re identifying gaps so that we can see where the real opportunities for making
tangible changes are. And we, also at the CCO, have a requirement
to conduct a quality improvement plan focused on disparities. And I was exposed to a lot
of national resources, including the National Quality Forum’s work on identifying disparity
sensitive measures, and that probably helped me overcome what may have been hours of extra
work or going down the wrong path. And so we were just really given a lot of resources
that helped me apply them directly. And now the Oregon Health Authority Transformation
Center, which supports our CCO and the other 16 Coordinated Care Organizations throughout
Oregon, we’re establishing a health equity learning collaborative that Charniece is also
providing technical assistance to help all of us in the CCO focus in on the opportunity
for promoting health equity. And finally, one of the best outcomes for
my point of view is, how since finding my voice and having the support from the state
with this DELTA program, we have included cultural competence and health equity as a
foundational strategy at Health Share, in addition to our strategies around the Triple
Aim. And our CEO and our leadership executive team have really embraced health equity and
disparities, and I think one of the reasons why that has happened is just because of the
leadership of the Oregon Health Authority including this DELTA program and the support
that we’ve received over time. So thank you. Okay. So I believe we’re going to get some
questions at the end of the program, but here is my contact information. And now I would
like to hand it over to Tracy Harrod. Thank you. Good afternoon. And thanks, everyone,
for listening in. I’m Tracy Harrod. I work as a coordinator of the Community Health Advisor
program and also as an intercultural consultant at the Saint Alphonsus Center for Global Health
and Healing in Boise, Idaho. And I’m going to be sharing with you this afternoon sort
of a specific example of a community based service model which also serves as a training
model for our entire community, really. This is a relatively new program. We’ve just been
actually been officially operating for a little over a year. So I’m just going to tell you a little bit
about the foundational principles around which the program is being developed and how the
program is seeking to train the community in equities through modeling and also just
since we’re a relatively new program, some of the things that we’re noticing and learning
so far. The community health advisors are the key in the center of this program. And
they are multicultural, multilingual individuals who are trained to assist individuals and
families who are resettling in the United States as refugees to navigate the healthcare
system. So community health advisors, or CHA, are seeking to decrease health inequities
by increasing access to culturally responsive, linguistic appropriate and trauma informed
healthcare. They do this by serving as cultural mediators and care coordinators. The community health advisors are members
of the patient’s own culture and language group. We think that they are uniquely qualified
to be trained to reduce barriers to health care by helping to navigate the healthcare
system. So they’re seeking to reduce health inequities by increasing access to trauma
informed, culturally responsive and linguistically appropriate care. They’re providing training
to both providers and patients by serving as cultural mediators. So this is a pictorial
example of the models that we use both in training community health advisors and, also,
as we have opportunities to train healthcare providers in our community about partnering
with community health advisors in order to reduce healthcare inequity. We call this the
equity triad and this is just something that we’ve developed because we feel like the three
points that are represented here are really sort of the foundational principles that we
need to focus on because these are the three areas that we need to adapt services in, in
order to provide equitable care. So that the three areas are trauma informed
practice and that is one of our foundational principles because for so many members of
the diverse population who are immigrating to the United States, whether that’s a refugee
status or other forms of immigration, trauma is pervasive for these populations. And so
in order to be ready for this pair, we’ve got to be adapting our services to be trauma
informed; also, culturally responsive because obviously, we’re dealing with diverse populations
and diverse cultures; and then, linguistically appropriate. So these are the three things
that we focus on. The reason that we believe CHA, the community health advisors, are uniquely
able to increase access to trauma informed practice is because, first of all, they usually
understand the patient’s trauma history better than we could, better than any of us in the
provider service or care position could because this is a member of the patient’s own community,
possibly has a similar trauma history themselves or at least are very aware of the historical
trauma that’s involved with their population group. Also, community health advisors are able to
recognize trauma and stress reactions that might be causing trust issues that are making
it difficult to provide quality care and good health outcome. A lot of times what we perceive
in a patient might appear to be something like resistance or what we typically call
noncompliance in health care. It’s actually a trauma or a stress response, and the CHA
is able to recognize that a lot of times and, therefore, reduce the inequities that sometimes
happens as a result of that. CHA assists the provider to restore dignity and respect to
a trauma survivor through the appropriate use of greetings and title. And this is an
example of one of the ways that you’ll see the three circles that represent our three
foundational principles there, how they’re sort of interlinked. And the reason that we’ve designed this model
this way is to show that these things really – the three of them cannot be separated. They’re
all constantly interacting with one another. So for example, the cultural issues, such
as not being able to provide a respectful greeting to someone who, through their cultural
lens, would make them feel safe and be able to establish trust with the provider. If there’s
a lack of dignity and respect in the room, then that could actually cause a trauma response.
And so that’s an example of how these things interact with each other and that’s something
that really a CHA is uniquely able to help us with. CHA can also establish safety and trust for
a survivor by monitoring environmental factors and explaining what will happen next. So for
example, in a room that’s a very small room, maybe the door is closed, maybe there are
no windows, maybe the provider is seated between the patient and the door. There can be an
environmental factor that can be a trauma trigger for a survivor. And those types of
things are things that a CHA can recognize and help them navigate so that we can provide
better health outcomes. Also, explains what will happen next. A lot of times this is very
important for trauma survivors to be able to be able to feel some power and control
by knowing what’s happening in a medical system that’s very different from anything they’ve
ever experienced before. And also, a CHA can advocate for a trauma
survivor’s need to have a choice and voice in every medical encounter. The trauma survivors,
during their traumatic experience, power and control is stripped away from them. And so
in order to establish a trust relationship with a provider, they have to be able to feel
like they are able to have a voice and able to be in control of being a partner in their
own healthcare. And a lot of times those things are mistrust because we don’t understand the
cultural lens through which they’re viewed, and the CHA can really assist us in that. The CHAs also assist us in increasing access
to culturally responsive practice. This obviously is a great need of ours because the only person
who’s an expert in their own culture is that person themselves. And particularly, as our
patient populations are getting more and more diverse, it’s going to be impossible for us
to know what our appropriate cultural response is in every encounter. So we’re going to really
need to be depending, I think, more and more on people who are insiders in culture and
language groups to guide us in these things. So CHA serves as a cultural bridge who is
trained to understand the cultural lens of both provider and the patient. With the patient’s
permission, the CHA can explain cultural answers to provide better health outcomes. A lot of
times there are things that are being misunderstood; maybe the patient doesn’t feel comfortable
to speak out about them. And those are things that can greatly affect health outcomes and
sometimes we’re not even aware of it if someone doesn’t point it out. The CHA can also help address cultural stigma
that surrounds concern conditions, illnesses and treatment methods within the patient’s
cultural viewpoint. Again, these are things that a lot of times aren’t even voiced to
a provider. So sometimes a patient will have difficulty following through treatment or
making medications due to the cultural stigma that they’re experiencing and it’s not being
addressed, sometimes because no one knows about it. But a CHA would be someone who would
know about it and be able to address it. And also CHA provides home visits and other
culturally appropriate avenues for building trust between the patient and the healthcare
system. We’re finding this to be really important that a patient a lot of times, especially
if they’re a relatively new arrival in the United States, their health advisor might
be a person that they really feel comfortable with and trust that’s related to the healthcare
system. So we try to really encourage that trust and then the CHA is able to transfer
that trust to the provider and to the healthcare system building a bridge that sometimes we
wouldn’t otherwise be able to bridge and enabling us to reduce health inequity. And then the third area we’re – sorry; let
me go back to the proper slide there. The third area is in the linguistically appropriate
practice. A lot of times we assume that if we just have an interpreter present that we
are providing linguistically appropriate care. And a lot of communities are actually more
complicated than that. And a CHA is someone who can be aware of all the intricacies of
providing linguistically appropriate practice so that we are reducing barriers rather than
increasing barriers. A CHA can make sure that a patient understands their treatment plan,
medication and other instructions because they obviously are a person from within the
patient’s own language group. They understand and advocate for the details
of a patient’s linguistic needs such as dialect specification, gender issues with an interpreter,
ethnicity issues with an interpreter. Some of those specific issues that come up with
interpreters, we’re usually not aware of, but that might actually prevent a trust relationship
from being built and, of course, if there’s no trust in the encounter, health outcomes
are not going to be good. They can also – a CHA can also assist with interpretation, translating
for pharmacies. Usually, the pharmacy is a place where there isn’t a lot of interpretation
translation provided, which you can imagine, of course, is a big factor sometimes in health
inequities, so if neither the CHA can translate medication instructions into the patient’s
language or use picture-based instructions for folks who are preliterate. And the CHA can assist with phone communication
with providers, such as making or rescheduling appointments because it’s one thing to have
interpreters at a medical encounter, but what about those phone calls to make an appointment,
reschedule appointments? The phone calls that come from the provider’s office about an appointment,
there’s obviously a language issue there. So CHAs can also help with those language
issues that can fall between the cracks. So these are the three important foundations
that we try to focus on because we believe these are the three areas where services need
to be adapted the most in order for us to provide equitable care if we’re paying attention
to trauma informed practice and culturally responsive practice and linguistically appropriate
practice. And we’re noticing that we’re having great
response from patients who have a community health advisor and we’re able to make a lot
more progress in making sure that these three areas of service are being adapted with the
assistance of a community health advisor who is able to be that cultural bridge. CHAs also
reduce disparities by seeking creative solutions to transportation and financial barriers.
A lot of times people are not accessing healthcare just because of transportation barriers, of
not knowing how to seek creative solutions for that and, of course, obviously financial
barriers, knowing what resources are available. CHA also assist with care coordination in
those ways. Coordinating care between multiple providers. A lot of times people are not receiving
quality care because they’re needing a lot of specialty appointments, and it’s very difficult
and overwhelming for them to be managing those specialty appointments or even making the
appointments, finding transportation for them. That’s where health inequities sometimes come
in and CHA can assist with that. Also, connecting patients with resources for addressing social
needs because it’s very difficult sometimes for a patient, especially trauma survivors,
to focus on caring for their own healthcare needs. When there’s a great social need that’s
right in front, right on top, and that’s the thing they’re focusing on. CHA can connect patients to resources such
as social work, people who can assist with housing needs, they can help with health and
welfare and filling out forms, applying for assistance, those kind of things; so that
patients can better focus on their healthcare needs. And also CHAs can and do participate
in community based training for care and service providers. So they’re able to get feedback
at various clinics, mental health clinics, community clinics. Primary care providers
– they’re able to give community specific or culture specific feedback to providers
that enable the providers to give more culturally responsive and trauma informed care and information
to their patients. So I’ll just leave you with a little bit of
information about the very short history of our program development so far. We began November
2012 with funding provided by the Schwartz Center for Compassionate Healthcare in collaboration
with the Idaho Department of Health and Welfare Refugee program. We piloted for a few months
in 2013 with just one community health advisor working with a small group of elderly patients.
And then we officially launched in May of 2013. We now have 9 community health advisors
working in 16 different language groups between them. We currently have six primary care clinics
that send patient referral to us. So patients are referred to us by primary care providers.
We have about 76 current participants, patients who are participating in our program. And in the first year of operations, we had
575 CHA-assisted appointments. And we have a long way to go in collecting data since
we’re a new program, but here’s one that we’ve noticed so far. One of our clinics that probably
provides the most referrals into our program – the average no show rate of that entire
clinic, all population group, is 22 percent. For CHA program participants at that clinic,
the no show rate, including primary care specialty and mental health appointments, is 4.96. So
we’re seeing that, at least, we’re helping patients to access better by getting them
to their appointments. So thank you very much for your time today and here’s some contact
information from me if you have questions. Great. Thank you to all of our presenters,
very informative, and certainly inspiring. I’m imagining a standing ovation, but we’ll
have to use our imagination. The operator, as we go into the Q & A part of this webinar,
if you can just give some brief instructions on how to call in with questions because there’s
also going to be an audio option as well. Certainly. Ladies and gentlemen, if you would
like to register a question, please press star, followed by the “1” on your telephone
keypad. Once your question has been answered and you would like to withdraw your registration,
please press the pound key. One moment for your first question. We actually had a couple of questions in the
chat that are really quick. So first, for the DELTA program, if you can clarify what
the age demographics are. And I think the question was related to whether there’s an
option for youth participation in leadership development. So if you can just quickly answer
that. Okay, thank you, Ben. So in regards to the
age demographics, we don’t have any of the numbers, but most of our cohort members are
working professionals. So I presume 21 and up. We do not engage high school or undergraduate
students in the process just because we’re really focused more on making change in a
reorganizational setting, not to say that that can’t be something that’s done in the
future, but right now, we’re really focused on testimonies, strategic planning, and outcome
at the organizational level. And so that’s why we haven’t really engaged with younger
participants. Thank you. Thank you. And I saw that question came from
Anya May. She said that maybe the youth leadership program can be something that gets developed
out of Office of Minority Health. For the second question, it’s maybe a quick clarification
around two things. One, is there a difference between a community health worker versus a
community health advisor? Is there an actual difference in kind of work, in a difference,
or is it a language choice? But also, are they paid? Yeah, thank you. Both important questions.
Yeah, community health advisor is very similar to community health worker and in fact, our
model is based similarly to a community health worker model. I think the important thing
that’s specific to this program is the CHAs are drawn from within the patient’s own population
group. So in many community health worker models, that wouldn’t necessarily be true.
But yeah, basically this is a culture and language specific community health worker
type program. So I hope that clarifies that a little bit. And yes, they are paid and they’re
not – I noticed someone else had a question about Medicaid here. So the services at this
point are not covered by Medicaid. We have – that’s paid through our funding which comes
through Idaho Department of Health and Welfare. So they are paid as contractors by the hour. Great. Thank you. We were going to go back
and forth, but it looks like JamieLou is telling me that she can’t see the questions. This
is probably for both of you and realizing it’s probably a deep question but trying to
have a quick response. What has been your biggest challenges in implementation of these
two programs? Or maybe starting with DELTA and then go into immigrant refugee work. So the biggest challenges with implementation,
I would say, especially for our pilot cohort and our pilot program, there wasn’t necessarily
a guide for us. We kind of just explored everywhere we were going along. We convened the DELTA
advisory committee, which definitely helped with the guidance of developing curriculum
and needs assessment and evaluation plans. But I think starting from the ground up, just
trying to figure out what this program is going to be and how it’s going to be implemented
was the biggest challenge as well as meeting the needs. We have a very diverse cohort. We do have a very diverse cohort currently
and just trying to meet the needs of everyone, particularly how you can address a topic within,
like a Coordinated Care Organization versus a very small community based organization.
So really trying to blend topics and experience to come up with a really holistic curriculum,
but sometimes that doesn’t work out. But that’s what we try to do to accomplish that barrier.
I think that’s the biggest one. And Tracy. Yeah, long question, but I’ll give a short
answer. I think one of the main challenges for us is that we haven’t – we’re not aware
of a lot of models that are similar to this one. So there’s been a lot of program development
where we’re researching and finding everything we can from similar models. But really kind
of needing to do a lot of the development ourselves and coming up with our own training
model for training health advisors. And also, obviously, very multicultural group of people.
So that’s been both the challenge, I would say, and also, the excitement of this program. It looks like we have a question and I don’t
know who it’s directed to by Mei Chi Yang, it looks like: What’s the best way to share
the curriculum or guide? And I don’t know if there’s a – this is probably for DELTA,
but I don’t know if there’s a similar response to that for you, Tracy. So what’s the best
way to share, Charniece? By personally contacting me or visiting our
website. If you just google Oregon Health Authority Office of Equity and Inclusion and
then search DELTA within that, you can find our website and it should have our curriculum
and our bios and all that information, but if you want more detailed information about
the actual planning process, then you can contact me directly. Tracy, I don’t know if there’s a guide for
what you’re doing, but for folks that are attending, the slides will be available afterwards
that have the contact information for our presenters. Is there any phone questions to
the operator? No questions at this time. And I see Tanya Harris. Traditionally and
predominantly, community health workers are from the community they’re a part of and trained
to work within their community. So Tracy, I don’t know if you have a distinction. I
think the statement you made was that these are folks that are kind of coming out of that
community or within that community. So I don’t know if you have a response or thought around
maybe a deeper clarification around the difference that you were trying to articulate. Yes. Thank you for the opportunity to clarify
that and for making that point because obviously, again, this is a type of community health
worker program. It’s not officially a community health worker program, but it’s a very similar
model. And I think the important point for us in this model is that since the program
is designed specifically for populations of people that are recently here as refugees,
what we’re trying to do specifically is bring folks into the program as community health
advisors that arrive in this country as refugee themselves so that they’re able to really
share in that experience and, particularly, the trauma experience of people from within
their communities. But yes, very similar to that, in that community health workers are
coming from the community that they’re a part of. Okay. Thank you. So it looks like we’re right
about the time. I’m going to move us – I don’t see any other questions coming in. There’s
an evaluation that will be coming at the conclusion of the webinar and we really would ask that
you take a few minutes to complete the survey. It really does impact for ASTHO and also for
RHEC, as we think about doing more of this type of information sharing in the future.
So if I don’t see any other questions pop up, I think you’ll be redirected to the survey.
But I just wanted to give one last moment of appreciation for all of our presenters
for the wonderful questions and clarifying questions that folks put out and for everyone
for attending in this very important critical work that we all are invested so deeply in.
So thank you for participating. I’d also like to thank the Office of Minority
Health for helping to sponsor this along with ASTHO and to let you all know that there will
be a recording of today’s webinar available on the ASTHO website within the next few days.
So I think that website will probably come up on the screen shortly. Thank you and enjoy
the rest of your day.

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