Evaluating a Cultural Competency Curriculum for Disaster Preparedness and Crisis Response

1. Evaluating a Cultural Competency Curriculum for Disaster Preparedness and Crisis Response Guadalupe Pacheco, MSW HHS Office of Minority Health Eileen Hanrahan HHS Office for Civil Rights

2. Overview • Disasters and Federal Civil Rights Laws • Disasters and Cultural Competency • Cultural Competency Curriculum for Disaster Preparedness and Crisis Response • Conclusion

3. Federal Civil Rights Laws Apply to Emergency Planning, Response and Recovery • Title VI of the Civil Rights Act of 1964 (Title VI) prohibits discrimination on the basis of race, color, or national origin by recipients of Federal financial assistance. • Section 504 of the Rehabilitation Act of 1973 prohibits discrimination on the basis of disability by recipients of Federal financial assistance. • Title II of the Americans with Disabilities Act of 1990 prohibits discrimination on the basis of disability by public entities, whether or not they receive Federal financial assistance.

4. Persons Protected under Title VI • Persons of every race, color, and national origin • Limited English proficient persons

5. Experience of People from Racially and Ethnically Diverse Cultures and LEP Persons in Emergencies • Historically, emergency preparedness activities have lacked sufficient focus on these individuals. • As a result, these populations often: • Did not receive important information about emergencies; • Failed to receive needed services, including medical assistance. • Experienced poorer outcomes, generally • Many Hurricane Katrina “lessons learned” reports noted the importance of including “special needs populations” in planning, response, and recovery efforts for those efforts to be successful.

6. Regulations and Guidance Issued under Title VI • General nondiscrimination obligation • Requirement to take reasonable steps to provide Limited English proficient (LEP) persons meaningful access to the program • Number or proportion of LEP individuals likely to be served • Frequency of contact • Nature or importance of the service • Resources available and costs

7. How Does Title VI Apply to an Emergency • Recipients must provide equal access to their emergency preparedness programs • Integration into planning activities • Communication programs • Equal access to services, including health care • Evaluations, drills and exercises • Recipients may need to provide interpreter services or translate documents

8. The Office for Civil Rights Enforces Title VI and Other Civil Rights Statutes and Initiatives Promoting Equal Access to Emergency Preparedness Programs • Persons from diverse racial and ethnic cultures are protected under civil rights laws that prohibit discrimination on other bases. • OCR investigates discrimination complaints, conducts compliance reviews and provides technical assistance. • OCR has two National Initiatives that support equal access for these populations. • State medical education curriculum on health disparities and cultural competence • Effective communication for LEP individuals and persons with disabilities in hospitals

9. Cultural Competency • Effectively providing services to people of all cultures, races, ethnic backgrounds and religions in a manner that respects the worth of the individual and preserves their dignity.

10. Cultural Competency in Disasters Cultural competency concepts in disaster and emergency scenarios: • Services • Communication • Organization

11. Cultural Competency in Disasters: Rationale The human element • Improve the experiences of diverse cultural communities • Help eliminate health disparities The bottom line • Improve health outcomes • Quality assurance • Increased effectiveness and efficiency of services

12. Cultural Competency Curriculum for Disaster Preparedness and Crisis Response • Part of Think Cultural Health, an HHS Office of Minority Health initiative • Free, online continuing education course launched July 2009 • Equips disaster personnel with the knowledge, awareness, and skills needed to provide emergency health care services to diverse populations

13. Needs Assessment Focus Groups Environmental Scan National Project Advisory Committee Consensus Building Concept Papers Revisions Final Draft Field Testing *5 sites *February 2009 Cultural Competency Curriculum for Disaster Preparedness and Crisis Response Development Process 1st Draft Pilot Testing *5 sites *July-August 2008 Revisions Accreditation & Launch July 2009

14. Video Case Study But What if I’m Deported?: Providing Culturally Competent Care and Language Access Services During Recovery

15. Curriculum Evaluation Programmatic evaluation to determine: • How the program is received • Impact of program on participants’ knowledge and attitudes regarding cultural competency Behavior change evaluation to determine: • Impact of cultural competency training on participants’ behavior

16. Evaluation Methodology Programmatic Methods • Qualitative Analysis: focus groups, evaluation questionnaires, potential follow-up interviews • Quantitative Analysis: registration questionnaires, evaluation questionnaires, follow-up surveys, pre- and posttest scores

17. Programmatic Evaluation: Results • Preliminary results indicate the program has been well received • Over 1,500 registrants and 5,300 credits awarded • Focus group comments include: “This has been both a great refresher course on previously acquired knowledge and a source of new information to consider and apply when planning for and working with the cultural needs of disaster victims.” • Follow-up survey preliminary results are strong • All respondents “strongly agree” that the program equipped them with awareness & knowledge to provide culturally appropriate services to the individuals they serve • Over 70% indicate having made changes to their interactions with diverse populations

18. Behavior Change Evaluation • Behavior Change Methods • Qualitative Analysis: in-depth interviews, evaluation questionnaires • Quantitative Analysis: registration questionnaires, evaluation questionnaires, behavior change questionnaires, cultural competency assessment • Recruitment and interviews start Fall 2010

19. Summary • Federal civil rights laws, such as Title VI and others enforced by the Office of Civil Rights, are applicable to disaster preparedness and crisis response. • Cultural and linguistic competency plays a large role in disaster preparedness and crisis response. • OMH’s disaster curriculum offers an adaptable framework for cultural competency training and improving care for culturally and linguistically diverse populations. • The Curriculum also can help emergency personnel comply with Federal civil rights laws.

21. For More Information: Eileen Hanrahan HHS Office for Civil Rights Eileen.Hanrahan@hhs.gov Guadalupe Pacheco, MSW HHS Office of Minority Health Guadalupe.Pacheco@hhs.gov