Melen McBride, PhD, RN, FGSA

1. Melen McBride, PhD, RN, FGSA • Dr. McBride is involved in multidisciplinary geriatric and ethnogeriatric training, including programs offered through the internet. She collaborates with representatives of five HRSA funded Geriatric Education Centers and other groups to disseminate information about Geriatric Emergency Preparedness Recovery’s (GEPR). Her research activities focus on chronic care (diabetes, CVD, cancer), sensory rehabilitation, mental health, health promotion, and health literacy in older ethnic minorities.

2. Cultural Context of Emergency Preparedness for Vulnerable Groups: Culturally and Linguistically Diverse Communities of Older AdultsPresenter: Melen McBride, PhD, RN, FGSA

3. ObjectivesUpon completion of the session, participant will be able • Identify vulnerable groups to include in emergency preparedness systems. • Identify functional areas to address for preparedness in these groups . • Explain importance of cultural factors in preparedness for racial/ethnic minority elders. • Describe tools to infuse ethnogeriatrics in emergency preparedness for racial/ethnic minority elders.

4. Terms Defined Emergency preparedness: capability of public health, health care and emergency management systems, communities and individuals “to prevent, protect against, quickly respond to and recover from” emergencies involves “a coordinated and continuous process of planning and implementation” Nelson, Lurie, et al., 2008).

5. Terms DefinedVulnerable/At-Risk Diverse Groups • Racially and ethnically or At-Risk diverse communities, culturally diverse communities, diverse communities, and racial/ethnic communities • A collective group of individuals associating with differing cultures, races, ethnicities, nationalities, languages, tribes and/or religions • Intended also to include immigrants and limited English proficient (LEP) populations Andrulis, Siddiqui, & Purtle, 2009

6. Population 65 yrs+ and Hispanic Origin 2003 Estimates and 2050 Projections

8. Preparing Racially And Ethnically Diverse Communities For Public Health Emergencies • Literature review (PubMed), reports by government agencies, academic institutions, and private-sector organizations, including community-based programs. • Web sites (public and private) that offer at least generic information on emergency preparedness. Andrulis, Siddiqui & Gantner, 2007, Health Affairs http://content.healthaffairs.org/content/26/5/1269.full.html

9. Results: Web Sites (N=301) • 149 (49.5 %) no mention of racial/ethnic minorities • 114 (37.9 %) acknowledge importance of preparedness for these populations • 38 (12.6 %) provide information, materials, or publications focused wholly or largely on preparing diverse communities.

10. Results: Themes & Initiatives • Risk Communication • Training and Education • Resource Guides for Planners and Responders • Measurement and Evaluation • Policy and program Initiatives

11. Rand’s Categories of Special Needs Groups • Disabled Populations, Elderly, & Others with Functional Limitations • Race, Ethnicity, and Limited English Proficiency (LEP) • Rural Populations • Children • Ringel, Chandra, Williams, Felton, Adamson, Weden & Huang, 2009 • http://www.rand.org/pubs/technical_reports/TR681.html

12. Rand’s Functional Areas for Special Needs Groups • Maintaining independence • Communication • Transportation • Supervision • Medical care Ringel, Chandra, Williams, Felton, Adamson, Weden & Huang, 2009

13. Re-Classification of Populations • When Fema & CDC’s definitions of people with special needs are used – people with mixed or no English proficiency, older people, minority groups, children, people with serious mental illness, people without vehicles, people with specific dietary needs and pregnant women – this adds up to 50% of the population. Kailes, J. 2008, Southern California Wildfires After Action Report • http://www.access2readiness.org/atf/cf/%7BC14CBB0E-FAC4-403F-96ED-286A512B4DDA%7D/CaliforniaWildfires-final%2009-23-08.pdf

14. Results of Community-Based Interviews Ethnic/Minority Elders & Service Providers • Provide for language interpreters • Have a central place to go to in their community • Clarify payment for emergency services • Educate staff and volunteers especially emergency shelter workers about special needs • Consult ethnic minority elders to develop preparedness plan • Establish effective modes of communication during a crisis • Educate family how to provide guidance in a disaster • Develop a good readiness plan; when crisis occurs, not much can be done McBride, 2004

15. Racial/Ethnic Minority EldersLimited English Proficiency, Limited Health/Functional Literacy • Visually impaired • Hearing impaired • Cognitively impaired • Physically limited and/or disabled • Chronic mental illness • Dependent upon medical care, equipment, and/or medications

16. Ethnogeriatric Tools for GEPR Care • Culture bridge & C.A.R.D. – partnerships • Culturagram • Cohort Analysis • E.T.H.N.I.C. E.L.D.E.R.S. • L.E.A.R.N. • S.P.E.A.K.

17. Community Outreach & Partnerships • Culture Guide/Bridge • A trusted family member or community leader who can offer cultural insights into an elder’s and family’s health beliefs and practices.

18. Collaborating Agencies on Respondingto Disasters (CARD):California-based organization • Works with neighborhood and community organizations to build their capacity to respond to the needs of their racial/ethnic populations in emergencies; • Supports development/implementation of individually tailored emergency plans; • Provide user-friendly easily understood training on federal, state, and local response structures; and • Provide tabletop and practical exercises that incorporate issues around culture and language. http://cardcanhelp.org/

19. Culturagram - Assessment Tool l Brownell, P. & Congress, E. 1997; Congress, 2004

20. Cohort Analysis as a Tool in Ethnogeriatrics • Cohort Experiences – socio-political, economic, historical, environmental events shared by a generation or a group, e.g., immigration, Depression internment, boarding school, maybe reflected or influence values, health beliefs, illness behaviors, self-image, degree of trust /expectations of providers or institutions. • Cohort Analysis – assessment that provides insight on the impact of ethnicity on the health and mental health of elders. • Educational tool to increase cultural awareness of health professionals; helps organize history taking and recording health data in clinical settings. Yeo, G., McBride, M., Hikoyeda, H., Edwards, M., Soo-Young, Y., & Hendrix, L., 1998

21. Disaster Preparedness Focus Group: Vietnamese on Seeking Help • “I’m kind of afraid to stay in touch with the police.” • “I heard that police officers, they only come to your house for a bad problem, right?” • “Whenever a police shows up at your house, there will be a problem. That’s why I’m afraid. Just like the police officers in Vietnam.” Matthew, A.B. & Kelly, K., 2008 

22. E.T.H.N.I.C. E.L.D.E.R.S. • E valuate risk to ethnic elders • T ranslatetechnical information to simple, indigenous terms • H elp elders communicate special needs • N egotiate/navigate pathways to trust-relationship • I ntervenewith culturally appropriate plans • C ollaboratewith family, community, and ethnic media McBride, 2004

23. E.T.H.N.I.C. E.L.D.E.R.S. • E xplainhow to access local/neighborhood resources • L abelsurvival kits with English and other languages • D ifferentiatebetween stress-induced anxiety and language difficulties • E ducate elders, family, and community leaders • R especttraditional healing practices and rituals • S upportwith non-verbal behaviors McBride, 2004

24. Communication: L.E.A.R.N. L listenwith sympathy and understanding to patient/family’s perspectives E explain your perception of the issue A acknowledge and discuss differences and similarities R recommend an approach N negotiate an agreement Adapted from Berlin & Fowkes, 1983 24

25. S.P.E.A.K.: Mnemonic for Addressing Preparedness Literacy Issues S peech– How will the responder’s speech be received by the ethnic elder and/or caregiver? P erception – How will the elder and/or caregiver perceive verbal and written content during the communications with the responder? E ducation– What is the education level of the elder and/or caregiver? A ccess- How will the elder and/or caregiver access resources before, during, and after an event? K nowledge – How will assessment of preparedness literacy be carried out and what tools will be used? Adapted from Kobylarz, Pomidro, & Heath, 2006

26. Creating a Preparedness Culture • When asked how emergency information should be communicated to their communities, all four focus groups pointed to the radio as the first source… • “I think on the newsletters sent out by the City Hall, they should have advertisement every time. It should be in (multiple) languages to remind us: Are you prepared? Reminding us we should prepare for a disaster. Not just one piece of paper to stick, no matter how pretty it may be.” Chinese focus group participant Matthew, A.B. & Kelly, K., 2008

27. Creating a Preparedness Culture • “Vietnamese people have different ways of doing things. Other people prefer different things. You know, in a certain order, they would prefer it the other way around, so that’s why the cultural differences would come into being.” Vietnamese focus group participant • “We have to be shown and told what to do because we may have our own idea what to do, but it may not be right.” Latino focus group participant Matthew, A.B. & Kelly, K., 2008

28. Creating a Preparedness Culture • “The idea of sharing best practices is the best route to go. But since this concept [targeting and planning for these groups] is so new…nothing has come down the pipe that says we’ve been successful with targeting Vietnamese…or Hispanic populations. If one of those does come down the pipe, then we’ll absolutely partner with them…” County service provider Matthew, A.B. & Kelly, K., 2008

29. 14 Standards for Culturally & Linguistically Appropriate Services (CLAS) https://www.thinkculturalhealth.hhs.gov/ • Organized into three overall themes — Culturally Competent Care (1-3), Language Access Services (4-7), and Organizational Supports (8-14). https://www.thinkculturalhealth.hhs.gov/Documents/CLAS_Standards.pdf • Translated the CLAS Themes into four courses, no cost https://www.thinkculturalhealth.hhs.gov/ccdpcr/

30. Question and Answer Responders Arleen Johnson arleen@email.uky.edu Elizabeth M Shiels Betty.shiels@louisville.edu Melen McBride mcbride@stanford.edu RESOURCES – Next Slides Thank You for Participating.

31. References • Andrulis, D., Siddiqui, N., & Gantner, J. (2007) Preparing Racially And Ethnically Diverse Communities For Public Health Emergencies. Health Affairs, 26:5, 1269-1279. http://content.healthaffairs.org/content/26/5/1269.full.html • Andrulis, D., Siddiqui, N., Purtle. J. (2009). California’s Emergency Preparedness Efforts for Culturally Diverse Communities: Status, Challenges, and Directions for the Future. Center for Health Equality, Drexel University School of Public Health, Philadelphia, PA.www.diversitypreparedness.org • Berlin, E. & Fowkes, W. (1983). A teaching framework for cross-cultural health care Application in family practice. Cross Cultural Medicine. The Western Journal of Medicine, 136, 934-938 • Congress, E. (1994). The use of culturagrams to assess and empower culturally diverse families. Families in Society, 75, 531-540.

32. References • Kobylarz, F.A., Pomidor, A. & Heath, J.M. (2006). SPEAK: A mnemonic tool for addressing Health literacy concerns in general clinical encounters. Geriatrics. 61, 20-27 • Matthew, A.B. & Kelly, K., 2008, Disaster Preparedness Communities: Lessons Learned from Recent Catactrophic Events and Their Relevance to Latino and Asian communities in Southern California. A Tomás Rivera Policy Institute and Asian Pacific American Legal Center Report, Los Angeles, CA. • McBride, M., (2004) Sensory Loss and Emergency Preparedness Strategies for Elders with Diabetes. In G. Yeo, . (Ed.) Mental Health Aspects of Diabetes in elders from Diverse Populations, Stanford Geriatric Education Center. Stanford University, Palo Alto, CA. • Nelson, C., Lurie, N., Wasserman, J. Zakowski, S., & Leuschner, K.J. (2008). Working Paper: Conceptualizing and Defining Public Health Emergency Preparedness. RAND.

33. References • Ringel, Jeanne S., Anita Chandra, Malcolm V. Williams, Karen A. Ricci, Alexandria Felton, David M. Adamson, Margaret M. Weden and Meilinda Huang. (2009) Enhancing Public Health Emergency Preparedness for Special Needs Populations: A Toolkit for State and Local Planning and Response. Santa Monica, CA: RAND Corporation. http://www.rand.org/pubs/technical_reports/TR681.html • Yeo, G. McBride, M., Hikoyeda, H., Edwards, M., Soo-Young, Y., & Hendrix, L., 1998 Cohort Analysis as a Tool in Ethnogeriatrics: Historical Profiles of Elders from Eight Ethnic Populations in the U.S., Working Paper Series #12, 2nd Ed. Palo Alto, Stanford Geriatric Education Center, Stanford University.

34. Resources • Resource Guide for Public Health Preparedness - a gateway to freely available online resources related to public health preparedness; guidelines, factsheets, websites, research reports, articles, and other tools aimed at the public health community. All resources are cataloged and may be searched by keyword or browsed by topic. http://phpreparedness.nlm.nih.gov/ • CA Emergency Management System Website http://www.oes.ca.gov/WebPage/oeswebsite.nsf/HomePage?OpenForm click - Office for Access and Functional Needs Has resources specific to people with access and functional needs; about 52 languages translations http://www.nusura.com/media/projects/Cal_EMA_Toolkit/overview.html

35. Resources • OMH, USDHHS (February 2008) Cultural Competency in Disaster Response: A Review of Current Concepts, Policies and Practices. Contract # HHSN2639999000291, Task Order # C-2555 Task 4.1: First Responders - Environmental Scan • NYC Department of Health & Mental Hygiene (2009) Elderly Populations in Disasters: Hospital Guidelines for Geriatric Preparedness, a toolkit developed (www.nyc.gov/health) (DOHMH) to help hospitals prepare for treating and managing elderly patients during disasters.http://www.nyc.gov/html/doh/downloads/pdf/bhpp/hepp-geriatrictoolkit-nov2009.pdf

36. Resources for Individuals with Hearing and Vision loss • www.accessibleemergencyinfo.com - videos with ASL interpreters advising how to prepare for 18 Topics. The videos have an audible voice over and text appearing along side the interpreter. Along with the videos is the Emergency Preparedness Guide formatted in Braille, large print, and regular font for download. All of the information isfree for public use, any organization may link to the website and use the information to inform the public.

37. Resources for Individuals with Hearing and Vision loss • http://www.nws.noaa.gov/nwr/special_need.htm Emergency warnings for people who are deaf or hard of hearing. General information on how NOAA Weather Radio (NWR) can be used as an emergency warning tool for people who are deaf or hard of hearing. FAQs regarding use of NWR (National Weather Radio) by people who are deaf or hard of hearing

38. Resources • http://www.phe.gov/emergency/ Created by USDHHS Office of the Assistant Secretary for Preparedness and Response (ASPR). Has information on: current status of federal actions in preparing for and responding to public health emergencies and medical disasters; medical response, emergency support functions and medical services along with public health actions by federal government during domestic and international emergencies