HRSA/MCHB 2005 FEDERAL/STATE PARTNERSHIP MEETING

PUBLIC HEALTH ACROSS THE LIFESPAN

Partnerships to Advance Cultural and Linguistic Competency

Within State Title V Programs

BRIAN ROGERS: Good morning everyone. I'm Brian Rogers. First of all it's a pleasure to be here with all of you. And I wanted to first tell you that I'm a developmental pediatrician by training and not only in my capacity as director of CDRC, it certainly takes up most of my time, but I’m also a practicing physician and so I see patients on a weekly basis at CDRC. And I mention that because when I really look at this issue of cultural linguistic competence I really look at this as quality care at all levels of our organization and I also want to state now that I think that our technical assistance visit at CDRC was a tremendous success for us and we look forward to further ongoing work with our team, Tawara and Wendy and Diana. So to get started what I'd like to do is… I have to switch, okay good, I'll just tell you, that's fine.

First of all you can't see Mt. Hood there very well, I was going to tell you this was from my backyard but if you believe that. Actually, you know moving from upstate New York 4 years ago, it certainly has been a great move for me personally. The splendor of Oregon obviously the, I think most of you know, the geography and all the things that Oregon can offer to people, but I think first and foremost I think the splendor of Oregon is, to me, has been the Child Development and Rehabilitation Center as well as Oregon Health and Science University. And also I think the, what I have found, particularly being at a university, that we have a much more community based state wide effort than what I'd been used to in terms of universities. It's much more of an outreach approach from our university and I think to me that's the splendor of Oregon as well as the geography. Next slide.

First of all I just want to tell you a little more about Oregon. On this slide, as you can see here, in our demographics you can see that this tells you a little bit in terms of our diversity. That it only tells you a little bit in a sense that not only these are state wide figures and are very applicable in our Title V program for Children with Special Health Needs, but in our clinics we really serve even a greater diversity of patients. Our center really in many ways represents a resource to many, many children and families that may not have the--we really represent an opportunity for families that doesn't exist elsewhere in Oregon. So I think that this Census data, if you look at the figures also, it doesn't add up totally to 100% and I think this is from the US Census. Our population is about 3-1/2 million in Oregon but some of it; some of these surveys were counted twice. But it gives you an overall perspective in terms of our Hispanic population has grown dramatically over the last 5 years, almost 20%. Next slide.

Also it's interesting in terms of Oregon, I think that our Native American population, even though it is only about 1.3% of the population, we have Reservations across the state. In fact we have over 10 Confederated Tribes and Reservations and an additional six federally unrecognized tribes and they're spaced out throughout the state, which I think is somewhat unique. Next slide.

This gives you a little bit, a little snapshot in terms of particularly the special healthcare needs in Oregon, the children, as it relates in comparison to, well national figures on the uninsured. Oregon ten to fifteen years ago particularly had a ground breaking, what's called Oregon Health Plan, which was directed towards the uninsured, Medicaid population. But over the recent years because of state funding challenges, we've had reductions in our Oregon Health Plan and this reflects some of the figures here. I'm sorry I don't have a pointer, but when you look at this slide in terms of comparing Oregon to nation's populations particularly in terms of our Hispanic and multi, and black population that this is a increasing prevalence of uninsured in those populations in Oregon and we need to address this sooner than later in Oregon as well. I'm sure some other states are facing this as well. Next slide.

On your handout there's a slide that I'm going to skip over called Oregon versus nationwide slate stated 2001, and we'll go to this slide. And when you, this just reflects the fact that when we look at some of the outcome variables and for families and Children with Special Healthcare Needs partners in decision making and satisfied with services, we do compare very, we have comparable figures in terms of, in this one variable, in terms of satisfaction in Oregon versus the nation in Children with Special Healthcare Needs. Next slide.

What I'd like to now focus on a little bit is CDRC, or the Child Development and Rehabilitation Center. And then we'll go on to our technical assistance visit to give you some background. First of all at the Child Development and Rehabilitation, we've went to a strategic planning over the last few years and our values have traditionally been family centered care as Wendy has eluded to. We also have self-determination as a commitment and cultural effectiveness. Recognizing, and respecting and honoring the individual's and family's cultural values, language and traditions. In spite of the fact that we're called the Child Development and Rehabilitation Center we are a life span program. We have many of our grants programs are community based, which I'll tell you about briefly a little bit more that really directed towards adults with disabilities as well. We also very invested in traditionally in terms of community collaboration and accountability and collegiality. Next slide.

What do we do? When we look at the Child Development and Rehabilitation Center as our organization we have three major components. We have tertiary clinics, clinical services, we also have the Oregon Institute on Disability and Development, which is our University Center of Excellence in Disability and Development as well as our LEND training program, or Leadership in Neurodevelopmental Disabilities which is, as many of you know, an interdisciplinary training program. We also have our Oregon Center and recently it was cited as our center for the university for Children and Youth with Special Healthcare Needs. We have over 220 staff and we have about 80 faculty members in about 4 to 5 departments at the university. Our services, direct clinics are quite extensive. Direct services to over 6600 children annually and over 34,000 services throughout the state. Our Oregon Institute on Disability and Development, we currently have about $7,000,000 annually in grant funding and we train approximately 40 long-term students and 150 intermediate and short-term trainees per year. The Oregon Center, our Oregon Center for Children with Special Healthcare Needs we have outreached all 36 counties serving about 2,000 children and families per year through both community based clinics as well as what's called our cocoon program which is really a partnership with public health nursing throughout the state. We serve, in our clinical service, we serve about 50% Medicaid population and we have a quite a diverse cultural background in the children and families that we serve. Next slide.

Now let's go on to our technical assistance visit. First of all as an organization, our CDRC as an organization are willing to commit to the work and process and change of increased cultural competence. And we wanted to identify what we were doing well, what we were not doing, and what we should be doing, as well as what we could do better. Now we were familiar with that National Center in Cultural Competence and some of our staff had worked with them previously. It was, we have a multicultural task force at CDRC and our task force recommended, and we embraced the technical assistance visit for us. Next slide.

How we structured this was really through a, we have what's called a Visiting Scholars Program at Child Development and Rehabilitation Center. The Visiting Scholars Program we usually have on a quarterly basis, international, national, nationally recognized experts that are invited to spend two to three days with us and our staff, and this is how we structured the technical assistance. We wanted to recognize it at the highest level in terms of a scholarly, highest cutting edge quality presentations that we had. So really presented this to our staff as a really one of the major visits to CDRC and we also incorporated into, we have a weekly grand rounds at Child Development and Rehabilitation Center, and we incorporated some of the presentations as well into the grand rounds. We purposely allocated to our staff protected time to do this. So in spite of all our budgetary challenges as an organization, that many of you are facing as well, we really gave staff time away from their, either administrative or clinical duties, to span a concerted time to do this. And so this was a major commitment for our organization. Next slide.

With working, working with NCCC we really structured this at all levels of our organization. What we attempted to do is really have sessions specific to our clinical services, our CSHCN program, research and public health, teaching and training, our administrative staff, and university wide issues. And we really, you know, we look at this as a start, this is an ongoing process, but I think we really had sessions. We kept them quite busy during their visit and we anticipate future visits. Here's some photos of the visit. And again, in a variety of settings. Next slide.

Let me share with you some of the impacts organizationally. First of all, right off the bat what we learned, we really, immediately increased our knowledge particularly we learned, particularly in terms of state wide, that we had over a 140 different languages, we have, we particularly had an emphasis and a knowledge base in terms of the power of linguistics. Particularly in families with English as a second language. But also gave us the framework for thinking about how to address barriers, time, and lack of diversity among our own staff. In looking at internal barriers and challenges we thought, you know first of all when you looked at some of our budgetary struggles, we realized that we needed to reprioritize. We also looked at, we also learned a lot about ourselves, and particularly how each of us defined cultural competence, cultural linguistic competence. We learned a lot about the, how many of our staff, all of us, really looked at it in different ways and I think that was enlightening for us.

Some of our immediate changes that, some immediate small changes that had large impacts is that we are engaged in using the NCC Cultural broker program and revising our LEND curriculum which is our interdisciplinary training program. And I'll tell you a little bit more about that. Specifically in terms of our CSHCN program, one of our goals is for families who live in rural areas to report their needs as usually or always being met as one of our goals for the future. We also wanted to partner with parents who reflect diverse cultures in those communities. And these are steps that have resulted from our TA visit. Partner with parents and community mapping of cultural resources. And continue a needs assessment that include perspectives of diverse groups in Oregon. Next slide.

Our teaching or training program we had, right now we've revised the specific modules on cultural competency in our curriculum. Essentially we revised the entire curriculum to insure cultural issues in every module, and we prioritize diversity for recruitment and retention of staff and our trainees as well. Next slide.

In looking at our clinical services, we've recruited bilingual staff in key positions. And I can tell you that that's, that has really been noticeable in our clinics. It's been a wonderful resource for us. We do currently, and I'll talk to you a little bit more, in our clinical services we're the only center at OHSU that pays for interpreters to be on site with us. So we have a partnership with an agency that we pay, and we pay pretty well to have interpreters be present at family conferences and throughout patient visits to be present in the room with us. Many universities now currently, and what I was used to, was really seeing a family, having them come in, and then having to dial up a service and work over the telephone. And I found, you know that was a quite unsatisfactory situation for families as well as for myself. And now we've, as an organization, committed to this and I think that we've had a history of this, and we're continuing to preserve this resource as the only center here at Oregon Health and Science University that commits to this. And what the children and families that we serve in youth with the complexity of problems, we feel this is the only way of going about it.

The, we also have started; we plan to continue to move towards a self-reported data collection among ethnicity. I don't know, many of you in the audience that run clinical programs, but when we really look at who we serve, if someone came in to our organizations, now who do you really serve? It's very difficult to get that information from hospital data bases and what we really want, really going to revise that and really get more information from families, more specifically rather than the boiler plate that they fill out in terms of registration. The other important thing is the commitment organizationally is that we've started, particularly over the last two years at CDRC, a continuous quality improvement projects in our clinical services program. And as you know, many of, this is a word that tends to put people away and tends to shut people down in terms of interest, but we really have reinvigorated this effort and part of it you know, as you know we focus on areas of improvement in clinical service but we really want to integrate cultural linguistic competence into the issue of quality care, and so where we're going to have specific projects in our continuous quality improvement program to look at this specifically in our clinics across settings. Next slide.

In terms of outcomes in our administration. Our plan is to develop a comprehensive plan to address recruitment, diversity and retention. I think also, as a director, I felt that we plan after the first of the year to totally revamp our performance reviews for our staff. And part of this will be to build into that, how our staff at all levels are addressing, and how well they're doing in terms of cultural linguistic competence. I felt that this is an important part of performance for all our staff and I think to put a little bit more commitment to this, we built this, we build this into their performance reviews as an organization. We also have a multicultural council. And I think that, I believe that this is an important part of CDRC, many universities will have this centrally. We have some unique needs that we want to continue to multicultural council and we will.

The other important areas that we tried to integrate this into our environment at CDRC is to incorporate. We have weekly grand rounds and basically these are presentations, state of the art presentations, to talk about various topics and developmental medicines, public health, and what we've done this year as well as we plan to continue, is topics in cultural competence. So that's really up there, up front on a continuous basis. Up until now this past year we've had presentations from our interpreter services and how we've learned about, you know how to work with families and interpreters in that whole process of communication and so we've had some presentations at grand rounds after our TA visit and we continue to plan to have those the second part of this year as well. And in fact I would like to see us use some case presentations, in other words, families that come in that we are interacting with and use as an illustration of issues of our understanding and working with families. Also what we're planning, which isn't on this slide, but we are planning this year, is management training for our leaders. As Tawara had said earlier, we have to have leaders in the organization that are models for cultural and linguistic competence and part of our management training, part, is the issue of how as leaders how we can commit and continue to proceed with cultural training in our organization. Next slide.

Outcomes in our research programs. We have a cultural, we have instituted a cultural competency checklist and research proposals. We also have collaborated on research project. The school of nursing at the Oregon Health and Science University has a center on health disparities, and in fact I was happy to be there last week and we are starting to have more collaboration with our researchers with that center on health disparities. We also are proud, and really it's been a great experience for us, to have what's called a High School Minorities Projects and Summer Youth Program. And every summer we have minority youths spend the summer with us and they'll come to our clinics, they'll come and spend time with some of our researchers, and it's a marvelous way of having young people be with us shoulder to shoulder in our work and talking about the future and their career planning as well. Next slide.

Our next steps. Basically to monitor and celebrate our progress. Review summaries of our first TA visit with discussion. We plan a second TA from NCCC and we hope to, even we find and develop a more strategic plan for our organization. Continue to develop our plan of action and accountability and continue to work over the next few years with NCCC. Next slide.

To summarize for you, we recognize cultural linguistic competence is a continuum; we're moving along that continuum. As an organization we, this is a, for me is a lifetime endeavor, so we're along the continuum. I'm not sure exactly where we are, but we are moving, I think, in the right direction. But we need to reevaluate, we need to continue to reevaluate. We wanted to create an organizational environment that values diversity. I really look at this, as you know stressing the obvious is that it really involves quality of care at all levels. And we want to address this not only in terms of clinical service but our training and research.

And our last slide. Thank you.