Cultural Competence Through Awareness,Understanding and Experience:

1. Cultural Competence Through Awareness,Understanding and Experience: Experiential Learning Aboard The Family Van Nancy E. Oriol, MD President & Founder Toni K. Williams Director of Service

2. What is The Family Van? • The Family Van is a mobile preventive health and social service program designed to increase access to health care and healthy life behaviors for men, women and children living in Boston’s economically disadvantaged neighborhoods.

4. Our Mission • To educate, counsel, screen and assist community members to take the necessary action to strengthen and protect their bodies, minds, families and communities.

6. Our Clients • The Family Van serves urban Boston. Its target populations are those who are underserved and living in poverty with less than adequate social supports. • Over 98% are people of color. • For 33% English is a second language.

8. Our Clients • We serve all ages • 13% are children and youth • 61% are adults • 26% are elderly Note: children and youth: ages 0-23; adults: ages 24-64; elders: age 65 and older

9. Our Collaborators We have built a broad network of partners. Over 100 Community Based Organizations and State and city sponsored programs including: • The Massachusetts Department of Public Health • Community Health Centers • Medical and other health professions schools including teaching hospitals • Massachusetts General Hospital • Beth Israel Deaconess Medical Center

11. Service Provision We provide cost effective medical screenings and health education including: • Pregnancy and HIV/AIDS testing • Hypertension and cholesterol testing • Diabetes, Glaucoma screening and much much more • We do not duplicate services but rather facilitate the clients’ navigation and use of these resources in order to ensure efficient and coordinated care

13. Education and Referrals • Nutrition education • Disease prevention education • Cancer self-screening education • Counseling and Support • Health and social service referrals • Referral to Mass CHIP children’s health insurance and other state sponsored insurance programs • Care coordination and advocacy

15. The Family Van Services • Free • Confidential • Culturally Reinforcing

16. Cultural Competence in Health Care Delivery • The Office of Minority Heath defines Cultural Competence as the set of behaviors, attitudes, and policies that allows people and groups to work effectively in cross-cultural situations. Source: US Department of Health and Human Services Offices of Minority Health (2001). National Standards for Culturally and Linguistically Appropriate Services in Health Care: Final Report, March 2001, Washington, D.C.

17. What is Culture? Culture: The system of shared beliefs, values, and behaviors that members of a society use to cope with and make sense of their world and these customs are passed from generation to generation.

18. Office of Minority Heath, Class Standards onCulturally Competent Care, Standards 1-3 Standard 1: Health care organizations should ensure that care is understandable, and provided in a respectful manner compatible with their cultural health beliefs, practices and preferred language. Standard 2: Health care organizations should implement strategies to recruit, retain, and promote a diverse staff that are representative of the demographic characteristics of the service area. Standard 3: Health care organizations should ensure that all staff should receive ongoing education and training in culturally and linguistically appropriate service delivery.

19. Why Cultural Competence ? • The perception of illness and disease, healing and wellness, varies by culture. • Culture and personal experiences of bias influence help-seeking behaviors. • Care providers from these diverse cultures are underrepresented in our current system. Source: Rationale for Cultural Competence in Primary Health Care, Developed by E. Cohen and T. Goode, National Center for Cultural Competence, Winter 1999

20. Teaching Cultural Competence on the Family Van Each year 40-60 students join us curbside from many disciplines: • Medicine and Nursing • Public Health and Public Policy • Nutrition sciences • Social work and more

21. Family Van Experiential Learning Goals & Activities • Students are lead in guided study • The Family Van service team and faculty present didactic sessions on health disparities. • Students learn about local resources • Students visit community-based agencies that serve as the primary resources for van clients. • Exposure to target communities • Students tour the selected neighborhoods with the specific task of learning, from the residents, their health concerns

22. Curbside!

23. Family Van Experiential Learning • The Goal of Direct Service is: To learn to respond effectively to the health care needs of anyone who boards the van. Every encounter is a cross-cultural encounter!

24. We employ a multi-cultural, multi-disciplinary team. We listen loudly to our clients and allow them to tell the entire story. We allow the client to control the encounter. LEARN – Guidelines for Health Practitioners Listen with sympathy and understanding to the patient’s perception of the problem E. Explain your perceptions of the problem Acknowledge and discuss the similarities and differences. R. Recommend treatment N. Negotiate agreement Source: Berlin EA. & Fowkes WC, Jr. “ A Teaching Framework for Cross Cultural Health Care” Western Journal of Medicine 1983, 12: 139, 93-98 The Family Van Model:how it facilitates cultural exchange

25. Liaison Committee onMedical Education LCME Educational Directives 2002 ED-21 Faculty and students must demonstrate an understanding of how people of diverse cultures perceive and respond to health, illness, symptoms and treatments. ED-22 Students must learn to recognize and address biases in themselves, others, and the health care institutions

26. Why does The Family Van model optimize cultural awareness? • We are designed by the people we serve • This non-traditional approach has the flexibility to respond organically to changing needs. • Our service team is familiar with our clients’ viewpoints, resources and their understanding, or lack thereof, of how best to utilize “helping” systems. • We share control of the health care interaction with our client, promoting self-advocacy.

27. Future Enhancements • We have already developed formal educational programs for allied health professionals and medical residents. • We are being built into the experiential arm of HMS’ Cultural Competence Curriculum • We are developing a formal clinical clerkship for medical students • And, as always, our students are taking it even further.

28. Student Sight Savers-Glaucoma Screening & Education • Glaucoma is the leading cause of irreversible blindness among African Americans. • African Americans have 4-5X higher rates than Whites. • African Americans develop the disease earlier. • 1 million or > unaware that they have the disease.