E-Learning Program to Improve Cultural Competency in Emergency Response

1. E-Learning Program to Improve Cultural Competency in Emergency Response 2011 USPHS Scientific & Training Symposium June 22, 2011 Guadalupe Pacheco, MSW HHS Office of Minority Health

2. Overview Cultural Competency Cultural Competency in Disasters The Cultural Competency Journey Prepare, Respond, Recover Cultural Competency Curriculum for Disaster Preparedness and Crisis Response

3. Objectives At the end of this session, attendees will be able to: Identify culturally and linguistically competent communication strategies for various stages of disaster preparedness and crisis response. Describe the rationale for cultural and linguistic competency training in terms of improving communication skills with clients. Describe cultural and linguistic competency as a means of providing effective health information to those with limited English proficiency and/or low literacy skills.

4. HHS Office of Minority Health Mission: To improve the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities

5. What is Cultural Competency? Cultural competency is 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.

6. CLAS Standards National Standards for Culturally and Linguistically Appropriate Services in Health Care: Provide the framework for all health organizations to best serve the nation’s diverse communities Culturally Competent Care Language Access Services Organizational Supports Enhancement Initiative

7. Cultural Competency in Disasters Evidence indicates that racially and ethnically diverse populations suffer disproportionately at every stage of a disaster.

8. The adaptation of preparedness, response and recovery efforts to fit cultural contexts improves disaster personnel’s ability provide appropriate and effective services in order to best meet a community’s needs. Cultural Competency in Disasters

9. Rationale: the human element Improve the experiences of diverse cultural communities Help eliminate health disparities Cultural Competency in Disasters

10. Rationale: the business bottom line Improve health outcomes Quality assurance Increased effectiveness and efficiency of services Cultural Competency in Disasters

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

12. Services: Ensure that clients receive effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language. Cultural Competency in Disasters “ I would see [disaster personnel] go into a situation…they felt that their presence alone and the fact they were there to provide a service should be reason enough for these people to be accepting of them and accepting of the care that they wanted to give. And although your heart might have been in the right place and this is your job…if you don’t understand or take the time out to try to understand their culture and what makes them tick, your services may, although be needed, may not be wanted. Source: Fire 20/20, 2007 ”

13. Communication: Provide language assistance services, including bilingual staff, interpreter services and translated documents. Cultural Competency in Disasters “ When we got there two women were screaming and crying. Neither spoke English. I didn’t even know who was the mother or if either one was the mother. We didn’t know how long the infant had been unresponsive, didn’t know if he had been sick. But worst of all, we had no way to comfort the women or explain to them what was happening. Since the baby died at home, in our town we had to wait for the police to arrive. It took them fifteen minutes—fifteen minutes of my feeling totally helpless. Source: Bronheim, 2003 ”

14. Organization: Focus on policies and procedures to help staff provide effective services to the community at every point of patient contact Cultural Competency in Disasters “ In 1994, severe rains in Alaska resulted in extensive flooding of the Koyukuk River. Three native villages experienced tremendous damage. With FEMA funding, the State of Alaska developed a disaster crisis counseling project that included professionals and paraprofessionals, Alaska Native and non-native staff, and tribal elders. Among the counselors were individuals with cultural sensitivity and respect for the wisdom of the elders. The project organized sewing circles and birch bark basket-making circles in order to use the mechanisms of the culture's social life to assist in its recovery. Source: HHS, 2003 ”

15. Cultural Competency is a journey, not a destination Starting Off: Self Assessment Community Services Assessment The Cultural Competency Journey

16. Communicating with the Community: Ensure that your organization’s early warning system is culturally and linguistically competent The Cultural Competency Journey: Preparation Phase “ Community engagement and collaboration may be the only means for achieving appropriate planning.- Office of Force Readiness and Deployment, HHS ” • Know and understand cultural norms and mores • Use appropriate languages and language access services • Recognize strengths and limitations • Take advantage of a community’s strengths

17. Just-in-time training offers: just the right information, at just the right time, and in just the right form. The Cultural Competency Journey: Response Phase

18. Video Case Study: Just-In-Time Training Tornado on the Reservation: Providing Culturally Competent Care and Organizational Supports while Responding to a Disaster The Cultural Competency Journey: Response Phase

19. Video Case Study: Just-In-Time Training – What questions might you have asked when going into this situation? If it were necessary to provide just-in-time training to responders coming into your city/region, do you know who to contact to deliver such training? You may want to consider making a list of these individuals and including that in your disaster plan. The Cultural Competency Journey: Response Phase

20. Disparities in Recovery The Cultural Competency Journey: Recovery Phase Recovery involves both short-term and long-term action. Source: DeWolfe 2000

21. Evaluation Transparent Independent Consultative Relevant The Cultural Competency Journey: Recovery Phase

22. Think Cultural Health An HHS Office of Minority Health initiative Advancing health equity at every point of contact http://www.thinkculturalhealth.hhs.gov

23. Think Cultural Health Continuing education programs that equip health professionals with awareness, knowledge, and skills to serve diverse patients Up-to-date information on issues related to cultural competency and health disparities Tracking of cultural competency legislation around the country “Join the CLCCHC”: e-newsletter and other resources

24. E-learning programs: A Physician’s Practical Guide to Culturally Competent Care – 2004 Culturally Competent Nursing Care: A Cornerstone of Caring – 2007 Cultural Competency Curriculum for Disaster Preparedness and Crisis Response – 2009 Cultural Competency in Oral Health – Coming Soon Think Cultural Health

25. Think Cultural Health:Why Online Continuing Education? • Reach a larger target audience for greater impact • Convenient: courses can be completed when and where an individual’s schedule permits • Learning tailored to the individual: participants can proceed through the courses at their own pace “ Appropriately designed, evidence-based online CME can produce objectively measured changes in behavior as well as sustained gains in knowledge that are comparable or superior to those realized from effective live activities. - Fordis et. al, 2005 ”

26. Cultural Competency Curriculum for Disaster Preparedness and Crisis Response Free, online continuing education course accredited for up to 12 continuing education hours for first responders, emergency managers and disaster mental health workers Equips disaster personnel with the knowledge, awareness, and skills needed to provide emergency health care services to diverse populations 2,000 registrants and 7,000 credits awarded since 2009 launch

27. Development Process: Cultural Competency Curriculum for Disaster Preparedness and Crisis Response

28. The curriculum contains four courses: Course I: Introduction to CLAS in Disaster Preparedness and Crisis Response Course II: Implementing CLAS in the Preparation Phase of a Disaster Course III: Implementing CLAS in the Response Phase of a Disaster Course IV: Implementing CLAS in the Recovery Phase of a Disaster Cultural Competency Curriculum for Disaster Preparedness and Crisis Response

29. Features of the Curriculum: From the Field: examples and case studies that demonstrate how culture influences situations and reactions Video Clips: case studies depicting scenarios involving people affected by disasters Taking Vitals: questions about the case studies and videos Fast Facts: information, research, and statistics related to diversity CLAS Acts: creative ways to implement the CLAS Standards In addition, a small group learning option, complete with a Facilitator's Guide and materials, will be available in 2011 Cultural Competency Curriculum for Disaster Preparedness and Crisis Response

30. 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

31. 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

32. Programmatic Evaluation: Findings Preliminary results indicate the program has been well received “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

33. 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 2011

34. Summary 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.

35. Questions?

36. For More Information: Guadalupe Pacheco, MSW HHS Office of Minority Health Guadalupe.Pacheco@hhs.gov