Culturally Effective Pediatric Care: Recommendations for Education and Health Policy

1. Culturally Effective Pediatric Care: Recommendations for Education and Health Policy Ethan Alexander Jewett, MA November 20, 2006

2. Why culturally effective care? • A variety of terms: what’s the difference? • cultural competency • cultural sensitivity • culturally effective care • Culturally effective care focuses on the outcome of the interaction between the health care provider and the patient.

3. Race Ethnicity Race Ethnicity Language Religion Sexual orientation Gender Disability Socioeconomic status An expanded definition 1999 2004

4. Acknowledges that other attributes effect the delivery and quality of care beyond race and ethnicity Recognizes that other cultural groups have health disparities In line with policy of other organizations Dilutes focus on race and ethnicity, on which little progress has been made to date More groups sharing limited funds for diversity programs Makes data collection on diversity difficult Pros/Cons of Expanded Definition Pros Cons

5. Recommendation 1 • Develop curricula • Impact of provider’s cultural norms on delivery of care • Education tailored for each stage of educational spectrum • Curricula should include full range of cultural attributes

6. Recommendation 2 • Institutional commitment necessary • Develop policies and plans to identify community needs and support community programs. • Disparities between cultural attributes and health status of providers and those of patients being served.

7. Recommendation 3 • No unfunded government mandates • Burden should not fall disproportionately on payers and providers • Inadequate reimbursement • Financial viability of health systems threatened.

8. Recommendation 4 • Establish federal and state incentive programs on culturally effective care • Must be an evaluative component to measure access and outcomes • Reward physicians for improving care • Establish incentive programs to encourage physician practice to the underserved

9. Recommendation 5 • Medical students and residents should learn a second language • Reward medical students and residents for preparing themselves to care for underserved patients.

10. Recommendation 6 • Pediatricians should be leaders in advocating for culturally effective care • Identify best interest of pediatric patients • Promote public policy in support of children

11. How do we get from theory to practice? • Most resources are conceptual: the feel-good “we need to do the right thing” approach. • Few resources on culturally effective care focus on the nuts-and-bolts of implementation. • There are educational issues, and then there are systems issues. • How do evaluate the success of interventions, and how do measure our improvement?

12. Possible Next Steps for COPE • Identify existing culturally effective care resources for residents and practicing pediatricians. Each has different needs. • Work with other organizations: NHMA, NMA, GLMA, AMA-RFS, APPD, etc. • Produce a resource guide for residents. • Push for advocacy training that focuses on CEPC • Develop an e-learning module for residents/pediatricians on CEPC.