Culturally Engaged Health Care in Buffalo, NY

1. Culturally Engaged Health Care in Buffalo, NY Kim Rook, Outreach Coordinator, MPH Coordinator Pavani Ram, Director, Office of Global Health Initiatives, Associate Professor Jessica Scates, Coordinator, Office of Global Health Initiatives Paul Wietig, Vice President, Interprofessional Education University at Buffalo School of Public Health and Health Professions June 19, 2014

3. Arrivals by State for the Reporting Period of 1-October-2013 through 30-April-2014Data Texas 3888 California 3237 New York 2256 Data extracted from the Worldwide Refugee Admissions Processing System (WRAPS)

4. Refugees resettled in New York State Total: 3829 *Federal Fiscal Year 2013 New York State Bureau of Refugee and Immigrant Assistance

5. Sites of Refugee Resettlement in NY Erie County welcomes 36% of refugees in New York State! *Federal Fiscal Year 2013 New York State Bureau of Refugee and Immigrant Assistance

6. Background and Objectives • Refugee health in Buffalo • UB/Community engagement • Refugee Health Summit

7. State department of health University Medicaid County department of health Resettlement agency Funding organizations Refugee Insurers Medical specialists Refugee leaders Primary care providers State bureau of refugee and immigrant assistance Community organizations

8. Health Needs & Gaps Health needs to address Lead poisoning Trauma and torture STIs/STDs Tuberculosis Diabetes Cancer Mental illness – depression Suicide Other chronic conditions

9. Planning Committee Members Education Buffalo Public Schools Refugee Community Support Burmese Community Support Center H.E.A.L. International Resettlement Agencies Catholic Charities of Buffalo Jewish Family Service of Buffalo & Erie County Journey’s End Refugee Services, Inc. International Institute of Buffalo Primary Care Provision and Health Assessments Community Health Center of Buffalo Jericho Road Community Health Center Neighborhood Health Center Health Department New York State Department of Health University at Buffalo Global Health Initiative GSA Office of Global Health Initiatives Office of Interprofessional Education Office of Public Health Practice School of Dental Medicine School of Management School of Medicine & Biomedical Sciences School of Nursing School of Pharmacy and Pharmaceutical Sciences School of Public Health & Health Professions School of Social Work

10. Refugee Health Summit • Goal: • Examine barriers and explore solutions to culturally engaged health care provision for refugees in Buffalo • Objectives: • Describe existing barriers of culturally engaged health care provision for stakeholder groups in WNY • Learn about successful models to providing engaged health care for refugees in Buffalo and beyond • Identify potential linkages and spark collaborations to adapt and implement solutions to expand culturally engaged health care for refugees in Buffalo

11. Summit Program 12:30-1:00 Introduction 1:00-2:00 Panel 2:00-3:00 Share Fair 3:00-4:00 Informational talks 4:00-4:30 Next steps 4:45-5:00 Dinner 5:30-6:30 Breakout groups 6:30-7:15 Large group reporting and discussion 7:15-7:30 Closing

12. Panelists Refugees Resettlement agencies Providers State BishnuAdhikari Employment Specialist, Journey’s End Refugee Services, Inc. Denise Phillips Beehag Director of Refugee and Employment Services, International Institute of Buffalo Cheryl Brown Refugee Health Program, Public Health Representative II, New York State Department of Health, Western Region OmaChapagain Bhutanese Nepali Community Member Dianne M. Loomis Associate Clinical Professor, School of Nursing, Department of Family Medicine, University at Buffalo Chan MyaeThu Client Services Coordinator, Burmese Community Support Center

13. Culture Language Trust Religion Gender Definitions of good and poor health Health as a priority Preventive health vs. curative Interpretation Accessing personal health information Accessing preventive care Accessing knowledge about prevention Translating medical terms Non-verbal language Mental health History of trauma The doctor and other ‘authority’ figures Power within the family Many other issues as well…

14. Barriers to Healthcare • Access to medical care (primary care) • Cultural unfamiliarity among providers • Grouping refugees into one generalizable group • Health insurance • Language • Mental health and screening

15. Informational Talks Dr. Myron Glick Dr. Kim Griswold Jim Sutton, RPA-C

16. Models for Community Engagement & Care • Rochester Model • RSMI – Remote Simultaneous Medical Interpreting • Empowered oversight committee • Coordinated providers and care • Jericho Road Community Health Care Model • Hire a diverse staff, encourage diversity • Invest in community relationships • Built walk-ins into the system

17. Models for Community Engagement & Care • Mental Health Provision • Train bi-lingual / bi-cultural mental health care providers • Adjust screening methods • Increase mental health value among refugees • Ethnic community support groups • Burmese Community Support Center • Others: Bhutanese Iraqi

18. Breakouts to Address Barriers • Coordination of stakeholders • Mentorship of providers • Mobilizing human capital / leadership among refugee community • Interpretation • Improving linkages of care, addressing gaps in care

19. Solutions to Barriers • Coordination of stakeholders • Day-to-day agency partnerships through agreements • Community-based steering committee or council • Annual summit to reassess • Culturally engaged healthcare assessment available online • Provider mentorship, education • Referral / map app and web based resources • Hiring of bilingual health providers and front office staff • Relocate specialists to primary care locations • Culturally engaged health care grand rounds

20. Solutions to Barriers • Refugee mentorship, education, leadership • Platform for ethnic community-based support organizations • Identify leaders in the community for continued education training • Interpreter services • RSMI (UN-like headsets) • Interpretation phone apps • Hire local community members and bi-lingual employees • Web-based portal with language resources • Educate providers in second languages

21. Solutions to Barriers • Improving linkages of care, addressing gaps • Health-e-Link health assessment • Mental health providers in community health centers • Mapping system addressing transportation issues • Referral / map app • Agency partnerships • Health education – preventive care

22. Takeaways • 110 registrants, 130 participants • 30 agencies and University Schools • Collaborations among agencies and refugee maximizes resources • Meaningful interagency relationships • Task forces and action plans created • UB will be leader in steering committee, exploration of interpretation models, among other areas

23. Takeaways • Improving Linkages of Care (10) • Mentorship of Providers (15) • Coordination of Stakeholders (7) • Mobilizing of Human Capital (4) • Interpretation (5)

24. Next Steps • Dissemination of Refugee Health Summit Report • Exploratory meeting with Refugee Advocates (June) • Task force development • Health for Refugee Populations Course

25. Next Steps • Solidify University at Buffalo’s role moving forward • School of Pharmacy continuing education • School of Social Work build capacity and linkages • School of Public Health provide field placement • IT involvement • Recruitment of talent from the refugee community • Best practice research and assessments

26. Acknowledgements:Office of Global Health Initiatives Dr. Pavani Ram Jessica ScatesDr. Arthur GoshinSchool of Public Health and Health ProfessionsUB Office of Interprofessional EducationDr. Paul WietigCommunity Agencies Thank You