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Promoting Cultural Competency Among Family Planning Providers: Lessons from the Field

This article discusses the importance of promoting cultural competency among family planning providers and shares lessons learned from a field study. It highlights the use of the CLAS standards and the assessment process, as well as the implementation of mini-grants to improve service delivery. The article concludes with limitations, lessons, and recommendations for future steps.

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Promoting Cultural Competency Among Family Planning Providers: Lessons from the Field

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  1. Promoting Cultural Competency Among Family Planning Providers:Lessons from the Field Grace Mose, D.A. & Karen Anderson, MPH, MEd The Education Fund of Family Planning Advocates of NYS

  2. Objectives/Overview • Background • Context & Rationale for Organizational Assessment • Introduction to CLAS Standards • Assessment Process • From Results to Action: Mini-grants • Limitations, Lessons and Recommendations • Challenges & Next Steps

  3. Who We Are Family Planning Advocates is a statewide membership organization that represents the Planned Parenthood affiliates and individual family planning centers in New York State Mission: To advance public policies that fulfill the rights of individuals to comprehensive sexual and reproductive health services and education that are consistent with the principles of justice and fairness and respect diversity, personal dignity and privacy

  4. Context & Rationale for Organizational Assessment • 21% (almost 4 million) New Yorkers are foreign-born • 2.2 million New Yorkers speak English “less than very well” • More than 5 million immigrants, speaking 150+ languages, live in the NYC metropolitan area • An estimated 2 million immigrant women in NYS need access to reproductive health services

  5. Strengthening Cultural Competency among Family Planning Providers • An ongoing project funded by the Ford Foundation • Goal: To develop a strategy to help family planning providers assess and enhance their ability to provide culturally and linguistically competent services to diverse populations

  6. National Standards for Culturally and Linguistically Appropriate Services in Healthcare (CLAS) • Goal • To increase access for the racial, ethnic and linguistic populations that face most barriers • Collective set of 14 mandates, guidelines and recommendations issued by OMH • Framework for developing practical guide for implementing and monitoring institutional progress towards cultural competence

  7. Themes Culturally Competent Care (Standards 1-3) Language Access Services (Standards 4-7) Organizational Supports for Cultural Competence (Standards 8-14) Stringency Mandates (Standards 4-7) Guidelines (Standards 1-3 & 8-13) Recommendations (Standard 14) Brief Overview of CLAS Standards

  8. Assessment Process • Identify 6 interested family planning centers • Solicit input from national experts in cultural competency • Conduct Organizational Cultural Competency Assessment and Institutional Checklists • Conduct data analysis and develop written report • Provide mini-grants to help clinics implement recommendations • Provide ongoing technical assistance

  9. Assessment Team • Wilma Alvarado-Little, Medical Interpreter/Trainer and co-Chair of the Board, National Council on Interpreting in Health Care • Tim Frasca, Data analyst • Dinah Surh, Vice President, Ambulatory Care Services, The Brooklyn Hospital and member of the National Center for Cultural Competence • Dr. Stergios Roussos, Consultant, Community Scientist, AKOUO • Karen Anderson, Director of Public Policy, FPA • Grace Mose, Program Associate, FPA • Sang Hee Won & Claudia Barbaric, FPA

  10. Assessment Sites • Planned Parenthood Mohawk Hudson, Utica Center • Over 11,000 (total pop. ~ 60,000) refugees from 30 different language groups • Planned Parenthood New York City, Boro Hall Center, Brooklyn • Brooklyn: Foreign-born population ~ 38% in 2000 with more than 46% of the population speaking a language other than English at home • Community Healthcare Network, CABS Health Center, Brooklyn • Williamsburg/Bushwick area: Approximately 27% of the population is foreign-born • Planned Parenthood Hudson Peconic New Rochelle Center • Approximately 32% of the population is foreign born and 37% of the population speaks a language other than English PP South Central (May); PP Mid-Hudson Valley (September)

  11. Assessment Tools Organizational Cultural Competency Survey • Staff ratings on importance and satisfaction of published factors indicative of culturally and linguistically appropriate health care • 10-minutes written survey conducted during FPA’s Assessment Day Institutional Audit Checklists • Six checklists • Interviews with key staff to assess key areas of cultural competence

  12. Institutional Audit Checklists • Present and Future Patient Demographics • Present Staff Demographics • Assessment by Leadership • Current Actions to Enhance Cultural Competence • Patient/Community Access to Culturally Appropriate Care • Community Involvement and Support

  13. Sample from Survey**Stergios Roussos, Using the Federal CLAS Standards to Foster a More Culturally Competent Healthcare Environment, 132nd APHA Annual Meeting Please rate: • How important is each item in your service to patients who may have difficulties during their healthcare visit due to culture and language differences, and • How satisfied you are at this time with your knowledge or skill for each item.

  14. Example of Application of CLAS Standards to Survey Items CLAS Standard 4. Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services at no cost to each patient/consumer with LEP at all points of contact, in a timely manner during all hours of operation. Survey Items I am able to identify the different languages used by our patients I can describe community resources that I can use to assist patients with language and cultural barriers to health care Trained interpreters are readily available for the different languages of the patients we serve

  15. Application of CLAS Standards: Findings and Recommendations CLAS Standard 4: Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services at no cost to each patient/consumer with LEP at all points of contact, in a timely manner during all hours of operation

  16. From Results to Action:Mini Grants and Technical Assistance Mini Grants • $3,000/ clinic to address at least one of the organizational priorities derived from the assessment. Examples of Outcomes • Staff training on how to provide culturally and linguistically appropriate services • Medical interpreter training for bilingual staff • Bilingual signage and consent forms • Refinement of patient registration to capture relevant demographic and cultural data

  17. Limitations • Staff misunderstanding of the survey • Interviewed only key people in leadership positions • Did not collect any information from immigrant populations themselves

  18. Lessons & Recommendations • Key to engage leadership • Include entire staff in kick-off and results • Explore ways to train onsite evaluators • Include patient and community perspectives

  19. Ongoing Challenges • Need to secure funding to implement mandates • Need for ongoing technical assistance • Lack of qualified trainers and training resources • Need to link cultural competency to larger political issues including immigration and immigrants’ rights

  20. Next Steps • Continued funding from Ford Foundation to expand assessments • Develop and pilot method to solicit patient feedback about cultural competency • Establishment of information/resource clearinghouse at FPA • Language Access Conference in NYS

  21. Grace MoseResearch and Program AssociateFamily Planning Advocates of NYS17 Elk StreetAlbany, NY 12207www.fpaofnys.orggrace@fpaofnys.org

  22. Recommendations from Pre-Conference Immigrant women Participants • There should be standards for translations and interpretation • Patients should have choice of interpretation services. • Translations should be: Culturally sensitive, Presented at different levels of literacy, and should be age appropriate.

  23. Recommendations Conti. • Cultural and linguistic sensitivity must start at school level. • Increase recruitment of female interpreters from more diverse communities. • Funding is an recurring issue. • Taking advantage of technology available such as interpretation equipment.

  24. Adopt a policy for one stop comprehensive health services. • Suggestion to do outreach for immigrant volunteers.

  25. Suggestion on the role of FPA • FPA can be a corner stone and a unifying force for most immigrant organization and women across the state. • FPA can do more grassroots with providers of various services and issues. • FPA can educate and provide advocacy training and leadership skills. • FPA can work with local communities with the goals to address issues specific to those communities.

  26. FPA’s Role conti. • FPA can be a center for resources (clearing house) • FPA can push forward the policy agenda.

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