OMH's Physician's Practical Guide to Culturally Competent Care: A ...

OMH's Physician's Practical Guideto Culturally Competent Care:A Tool to Reduce Health DisparitiesC. Godfrey JacobsProject Director, SRA InternationalGuadalupe Pacheco, MSWProject Officer, Office of Minority Health, HHSApril 8, 2010

Presentation Overview What is cultural competency? Why is cultural competency important? Office of Minority Health (OMH) at the U.S.Department of Health and Human Services OMH programs to address health disparities: TheThink Cultural Health suite Findings from a Two-Year Evaluation of thePhysician’s Practical Guide to Culturally CompetentCare Enhancements to A Physician’s Practical Guide toCulturally Competent Care

What is Cultural Competency? Cultural competency is effectively providing servicesto people of all cultures, races, ethnic backgroundsand religions in a manner that respects the worth ofthe individual and preserves their dignity. Aspects of culture include all of the following*:*Source: Graves 20013

Why is Cultural Competency Important?Facilitate the reduction of healthdisparitiesImprove patient careEnhance patient satisfactionDecrease malpractice risks andinsurance costsIncrease operational efficiencyIncrease compliance with Stateand Federal regulations4

U.S. Department of Health and Human ServicesOffice of Minority Health U.S. Department of Health and Human Services(HHS)• Established Healthy People 2010, a public health agendawith a focus on eliminating health disparities Office of Minority Health, HHS• Develops policies and programs to eliminate healthdisparities• Developed the National Standards for Culturally andLinguistically Appropriate Services (CLAS) in Health Care• Developed a suite of cultural competency continuingeducation programs and tools for health care providers5

National Standards for Culturally and LinguisticallyAppropriate Services (CLAS) in Health Care The CLAS Standards were developed by OMH inDecember 2000 as a means to improve access tohealth care for minorities, reduce disparities, andimprove quality of care. There are 14 CLAS Standards, which are divided intothree themes:• Culturally Competent Care• Language Access Services• Organizational Supports6

Cultural Competency Concepts Culturally Competent Care (Standards 1-3)• Disease vs. illness• Illness Beliefs• Communication Language Access Services (Standards 4-7)• Interpersonal communication best practices• Strategies to provide language access services• Interpretation vs. translation• Working with interpreters Organizational Supports (Standards 8-14)• Training staff in cultural competency• Collecting patient data• Community partnerships

OMH’s Cultural Competency E-Learning Programswww.ThinkCulturalHealth.orgA Physician’s Practical Guide toCulturally Competent CareCulturally Competent Nursing Care: ACornerstone of CaringCultural Competency Curriculum forDisaster Preparedness and CrisisResponseHealth Care Language ServicesImplementation Guide“Equip health professionals withawareness, knowledge, and skills totreat diverse patients”8

A Physician’s Practical Guide to Culturally Competent Care Launched in December 2004 Free e-learning course accredited for up to ninehours of continuing education Designed to equip providers with cultural andlinguistic competencies required to improve qualityof care Over 38,000 registered users• 49% of registered users are MDs• 56% of registered users are female• 65% of users are White, 15% are Asian, 8% are Black orAfrican American, 5% are Hispanic or Latino, 0.8% areAmerican Indian or Alaska Native, 0.6% are Native Hawaiianor Other Pacific Islander, and 4% are Other Over 176,000 credits awarded to participants9

A Physician’s Practical Guide:Two-Year Evaluation Data collected from 2,213 physicians who participatedin the curriculum from 2004 to 2006 Conducted to determine impact of program onphysicians’ knowledge, attitude, and skills in theprovision of culturally competent care Examined qualitative and quantitative data Used a repeated measures design to examineknowledge before and after curriculum participation Data sources included pre- and posttests, registrationquestionnaires, self-reflection surveys, andnationwide focus groups10

A Physician’s Practical Guide:Two-Year Evaluation Conclusions Physicians enter CCCMs with a reasonableunderstanding of cultural competency, but stillshow increased posttest scores and knowledgegain Curriculum participation renders a positive impacton practice behavior• Increased sensitivity to cultural differences• Took more time with patients• Asked more patient-centered questions Course resulted in improved perceptions of medicalinterpreters Curriculum participation results in enhanced selfawarenessof cultural competency concepts11

Course Evaluation FeedbackTo what extent did this course meet your expectations fordefining the benefits of incorporating cultural competence inmedical practice?1%1%34%13%51%Met completelyAlmost completely metPartially metBarely metDid not meet12

Course Evaluation FeedbackDo you feel the learning activities presented in this courseare effective?4%YesNo96%13

Course Evaluation FeedbackWould you recommend this course to a colleague?4%YesNo96%14

Participant Feedback“I liked the case based approach which helped to bring it alive.”“This program was excellent. I learned more than I have everlearned from any other CME program. It will definitely affect theway I interview patients.”“This is extremely valuable - every health care provider shouldparticipate.”“Loved the clinical examples that really enhanced the learning.”“Excellent information that I will be able to use in my practice.”“The fact that this can be completed from home is a huge plus.”

A Physician’s Practical Guide:Prevention-Focused Enhancements Prevention-focused enhancements for2010:• Ensuring that prevention tools are featured inresource lists• Updating sidebar facts and information toreflect best practices in the area of preventionand preventative care• Development of prevention-focused video casestudies, including one centered on childhoodobesity16

A Physician’s Practical Guide:Prevention-Focused Video Case StudyTo Address: Obesity rates are higher in Hispanic, Black, andAmerican Indian children than in White children These disparities contribute to health disparitiesthroughout the lifespan in diseases such asdiabetes and hypertensionCase Study: A nurse notices a spike in childhood obesity ratesin her community and develops an after schoolprogram that addresses wellness in a culturallycompetent manner The program discusses fitness and nutritionthrough the lens of the child’s culture and livedexperienceSource: Archives of Pediatrics &Adolescent Medicine 200917

OMH’s Think Cultural Health SuiteA One-Stop Cultural Competency Clearinghousewww.ThinkCulturalHealth.org A Physician’s Practical Guide to Culturally CompetentCare Culturally Competent Nursing Care Cultural Competency Curriculum for DisasterPreparedness and Crisis Response Health Care Language Services Implementation Guide And more!18

For More Information, Contact:C. Godfrey JacobsProject DirectorSRA InternationalGodfrey_Jacobs@sra.comGuadalupe Pacheco, MSWProject OfficerOffice of Minority Health, HHSGuadalupe.Pacheco@hhs.gov19

Healthcare InterpreterCertification Initiatives andStandards in the United StatesMahamud Ahmed, M.S.E. Lee Rosenthal. Ph.D., M.P.H.SPOHE, Atlanta, GAApril 8, 201020

AcknowledgementsSponsorship of study:• Department of Health and HumanServices, Minnesota• This study was completed as part of workunder a Pathway Fellowship of the state ofMinnesota; it was directed by MichelleBasham• 2007/200821

BACKGROUND22

The Need for Professional InterpreterServices:• The Institute of Medicine (2002) identifiedlanguage barriers as an important factoraffecting access to healthcare services• Professional interpreters providing translationservices help LEP patients fully participate inmaking decision about their healthcare23

• Quality of healthcare interpreters is essentialfor providing effective healthcare services• The use of trained healthcare interpreters canimprove access to quality care throughaccurate diagnosis, treatment, and follow-up(Brach, Fraser,& Paez, 2005)24

• Professional interpreters improve patientprovidercommunication and positively impactthe overall quality of healthcare services forLEP patients• Professional interpreters help to reducemedical errors• Interpreters can play essential roles in reducingheath and healthcare disparities25

• Quality improvement of healthcare interpretersthrough training, testing, and certification, areinadequate and limited to only a few states26

Study Purpose•To assess efforts in Minnesota pertaining tohealthcare interpreters•To explore interpreter quality initiatives inother U.S. states•To make recommendations to improve thequality healthcare interpreters in Minnesota27

Methodology:• Online survey and telephone interviews• Meetings with MN experts on interpretation services40 out of 50 states responded:• 16 states (40%) responded via e-mail• 24 states (60%) responded via phoneRespondents were from:• State health and human services• Not-for-profit human services organization28

Ten states not responding to three attempts:Alaska, California, Colorado, Kansas,Michigan, Missouri, New Jersey, New York,North Carolina, and TennesseeFor some of these states information wasobtained from the literature29

Minnesota Act on Interpreter Access:The bilingual act of 1995, Minnesota Statutes15.441, subd.1“Every state agency that is directly involved in furnishing information or renderingservices to the public and that serves a substantial number of non-Englishspeaking people shall employ enough bilingual person in public contact position,or enough interpreters to assist those in these positions, to ensure provision ofinformation and services in the language spoken by substantial number of non-English speaking people”Minnesota Law’s 2008 Chapter 363 article 17, § 2a) The commission of health shall establish a voluntary statewide roster, and developa plan for a registry and certification process for interpreters who provide highquality, spoken language health care interpreter services.”30

EMERGING STATE MODELSMINNESOTA•Voluntary roster in place since 2008•Planning to coordinate with nationalcertification efforts31

WASHINGTON• The only state that has a comprehensiveinterpreter certification program• The certification program grew out of lawsuitsand civil rights complaints and is administeredby the state’s Department of Social and HealthServices• Certification is for 8 languages:Cambodian, Chinese-Cantonese, Chinese-Mandarin, Korean, Laotian, Russian, Spanish,and Vietnamese32

Washington continued:• Medical interpreters must take both writtenand oral exams• The written test has five components: code ofethics, medical terminology, clinical medicalprocedure, English writing skills, and targetlanguage writing skills• The oral test includes sight translation ofwritten documents and consecutiveinterpretation of spoken language33

IOWA• Legislation enacted in 2004 charged the IowaDivision of Latino Affairs to create standardsthat qualify Spanish-English LanguageInterpreters• Interpreters must take coursework at the DesMoines Area community college including a12 credit general interpreter course and anadditional 8 credits of specialization in eithercourt, health, or social interpreting34

OKLAHOMA• Certification of medical interpreters in Oklahomawas started in 2005 by the Officeof Minority Health, Oklahoma State Department ofHealth pertaining to the Spanish language• Oklahoma Certified Health Interpreters werecreated in response to the standards put forward inthe National Standards on Culturally andLinguistically Appropriate Services (CLAS)• Certification is awarded when an interpretercompletes 24 hr training and pass the exam35

Other initiativesOREGON and INDIANA:• The states of Oregon and Indiana are working tostandardize healthcare interpretation in their states• Oregon has laws and administrative rules but at thetime of the study these were not yet implemented.WASHINGTON, D.C.:• Washington D.C. enacted “The Language AccessAct” in 2004• The Act requires that government programs providelanguage services36

CALIFORNIA• The state has an administrative hearing andmedical interpreter certification program forlimited situations• Specifically, the medical interpreter programprovides services at medical exams todetermine compensation or monetary award ina civil case37

ConclusionsAlthough some states have initiatives toaddress the quality of healthcare interpreters,the majority of states have little or no suchinitiative addressing the quality of healthcareinterpreters. Standards adopted at the state ornational level could lead to improved care andhealth outcomes contributing to greater healthequity for LEP patients.38

Nationally there are two competingefforts to establish national certificationfor medical interpreters1. The National Board of Certification for Medical Interpreterswas founded in March, 2009. Its purpose is to serve as anational certifying entity for medical interpreters2. Certification Commission for Healthcare Interpreters(CCHI) was incorporated in July, 2009. This organizationintends to serve as an independent interpreter certificationentity (MDH, 2010)It is expected that it will be two to three years before actualcertification in medical interpreting is available nationally(MDH, 2010).39