MCH Federal State Partnership Meeting

1
MCH Federal /State Partnership Meeting

• Building Bridges From Research to Practice
• October 20-22
• Hilton Alexandria Mark Center
• Alexandria, Virginia

2
MCH Federal /State Partnership Meeting

• Incorporating Cultural Competence
• Into Program Priorities States
• October 20 21, 2003

3
The Big Picture
Were getting closer!
Are we there Yet?
How Does Cultural Competence Fit In With MCHB?
4
MCHB Vision Statement

• MCHB believes in and strives to shape a future
  America in which
• There is equal access for all to comprehensive,
  quality health care in a supportive, culturally
  competent environment, which is family centered
  and community based.
• Health disparities by racial, ethnic, geographic
  area and economic status have been eliminated.

• Source MCHB FINAL DRAFT 2003-2007 Strategic Plan
  5/30/03

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MCHB Vision Statement

• MCHB believes in and strives to shape a future
  America in which
• MCH/public health agencies exemplify the highest
  standards of excellence. . . employing a highly
  qualified, diverse workforce and providing a
  respectful and supportive work environment.

• Source MCHB FINAL DRAFT 2003-2007 Strategic Plan
  5/30/03

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MCHB Guiding Principles

• Principles for MCHB Leadership Roles and
  Responsibilities
• Leadership effective
• Collaborative partnerships,excellent
  communication among key stakeholders
• Performance high expectations
• Promoting and maintaining a respectful and
  supportive work environment is key to successful
  performance
• Accountability (GPRA) MCHB, States, grantees and
  other partners

• Source MCHB FINAL DRAFT 2003-2007 Strategic Plan
  5/30/03

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MCHB Guiding Principles

• Principles for Organization of MCH Systems and
  Services
• . . . . Capacity to monitor, assess and address
  changing health needs across populations in a
  timely and effective manner.
• . . . . Is best assured when there is an
  MCH/family health focus within systems and
  services.

• Source MCHB FINAL DRAFT 2003-2007 Strategic Plan
  5/30/03

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MCHB Guiding Principles

• Principles for Organization of MCH Systems and
  Services
• Health systems and services can best reach and
  serve our increasingly diverse MCH population by
  providing . . . culturally competent care
  delivered by . . .a culturally diverse
  workforce.

We can do it!
Yeah Team!

• Source MCHB FINAL DRAFT 2003-2007 Strategic Plan
  5/30/03

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To beor not to be?
An add-onor not an add-on? That IS the question!
That is NOT the question!
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Do cultural competency values, principles,
policies, fit in with your planning,
implementation and evaluation activities?

• Are you inclusive in Block Grant needs/assets
  assessments? How? Do your plans reflect
  identified needs?
• Do you use outreach strategies specific to
  population groups you serve?
• Do you provide in-service training to new intake
  workers?

These are all pieces of what cultural competency
means!
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This is How We Do it
STEP BY STEP
RIDGE BY RIDGE
IN PARTNERSHIP WITH OTHERS
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Joe Gillis (Rick) You're Norma Desmond. You used
to be in silent pictures. You used to be big.
Norma Desmond (Diana) I am big. It's the
pictures that got small.
Dramatizations featuring Players from the Tom
Gloss School of Acting
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Everyone slips or falls at times!
Pick ourselves up and move on.Step by step
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What is Your Approach to Your Program
Goals/Activities?
Cultural Competence Pass
You cant make this journey alone. You need
other partners!
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What Does the Future Hold?

• Model approaches by States
• From baby steps to Statewide approaches
• Champions or mentors
• Tracking of progress
• Evaluation where do we go from here?

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Cultural Competence Summit
17
National Center for Cultural Competence
Georgetown University Center for Child and Human
Development Department of Pediatrics
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National Center for Cultural Competence
Mission
Increase the capacity of health care and mental
health programs to design, implement and evaluate
culturally and linguistically competent service
delivery systems.
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Major Activities of the NCCC

• Training, technical assistance consultation
• Networking, linkages information exchange
• Knowledge, product development dissemination

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Major Emphasis of the NCCC

• Policy development
• Assistance in conducting cultural competence
• organizational self-assessments
• Strategic approaches to the systemic
• incorporation of cultural and linguistic
• competence within organizations
• Values
• Policies
• Structures
• Practices
• Behaviors

21
Evaluation Activities

• NCCC contracted with Public Research and
  Evaluation Services (PRES) to conduct a query
  with CSHCN Directors regarding the extent to
  which cultural and linguistic competence was
  incorporated into program policies, practices and
  activities.
• Twenty-nine of a possible 53 respondents
  completed the survey and/or were interviewed

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Selected Findings of Query of State Title V CSHCN
programs
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Respondent Statesn29

• Arizona Kentucky Nebraska
• Arkansas Louisiana Nevada
• Colorado Maine North Dakota
• Connecticut Maryland Ohio
• Delaware Michigan Oklahoma
• Florida Massachusetts Oregon
• Georgia Minnesota Texas
• Idaho Mississippi West Virginia
• Illinois Missouri Wisconsin
• Kansas Wyoming

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Query Topics

• The query contained 70 questions requesting
  information regarding
• program status re implementation of cultural
  competence
• policies, practices, structures and activities
• preservice, inservice and ongoing training for
  staff and volunteers
• requirements for contractors
• allocation of fiscal resources
• collaborations and partnerships
• monitoring and evaluation
• modifications to service delivery

25
Learning from the States
Directors were asked where their states CSHCN
program was in terms of providing culturally and
linguistically competent services. Planning
stage (i.e., Training, Meetings, Discussions)
24.1 Early implementation 34.5
Mid-implementation 31.0 Full
implementation 6.9 No implementation or
planning has occurred to date 3.4
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Learning from the States

• Directors were asked to identify
  policies/guidelines, practices, structures, that
  incorporate cultural and linguistic competence
• Have policies to support the provision of
  translation and interpretation services
  (materials, consent and application forms,
  patient and civil rights information Statewide
  training conferences
• Use of certified language interpreters for phone
  contacts and at specialty evaluation clinics
• Provide TTY and/or TDD services
• Have/had a cultural competence committee or task
  force

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Learning from the States

• Directors were asked to identify
  policies/guidelines, practices, structures, that
  incorporate cultural and linguistic competence
• Agency vision, mission and guiding principles
  emphasize the need for staff and services to be
  culturally competent
• Virtual Office on Health and Disability (VOHD)
  ensures that staff is attuned to the cultural
  issues of individuals with disabilities
• Health Disparities Task Force addresses issues of
  cultural diversity health disparities among
  different groups of people

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Learning from the States

• Directors were asked to identify
  policies/guidelines, practices, structures, that
  incorporate cultural and linguistic competence
• the states Cabinet for Health Services (CHS)
  has a workgroup comprised of representatives from
  all programs that is looking at the provision of
  information in accessible formatsthis workgroup
  makes recommendations for policies to assure
  consistency of culturally competent services
  across programs

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Learning from the States

• Directors were asked to identify efforts and
  activities that incorporate cultural and
  linguistic competence
• Statewide training conferences
• Discussions at Family Advisory Council meetings
  or state level administrative meetings
• Quarterly Minority Health planning meeting
  addresses cultural and linguistic issues
• Workshops presented by refugee health
• Bilingual staff

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Learning from the States

• Directors were asked the extent to which
  preservice, inservice and ongoing training for
  staff and volunteers included information on
  cultural competence
• Cultural competency training opportunities
• -through the Department of Human Services
• -an organization specializing in Cultural
  Competency training
• Cultural diversity/awareness is included in staff
  training for current and new staff
• Policy outreach materials have been adapted to
  meet the needs of those with low literacy
• Provide administrative leave for staff to attend
  Spanish classes

31
Learning from the States

• Directors were asked about requirements for
  contractors in terms of cultural and linguistic
  competence and service delivery
• Contractors are required to have interpreter
  services available for families
• Contractor programs work closely with family
  support and education agencies to supplement
  cultural and linguistic services
• All contracts have a common language requiring
  cultural competence

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Learning from the States

• Directors were asked about allocation of fiscal
  resources in order to incorporate cultural and
  linguistic competence into program activities and
  service delivery
• Some funds are allocated for translation of
  materials and interpretation services
• Minority Health committee has obtained funding
  from the Office of Minority Health Regional
  Office to provide culturally competent training
  from 5 different ethnic populations.

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Learning from the States

• Directors were asked to report the extent to
  which they engaged in partnerships or
  collaborations with formal and informal
  community-based networks of support and families
  and family serving agencies
• Working with other state Bureaus
• Partnerships with community groups
• Collaboration with parent organizations to
  develop training modules for area offices
• Parent Network Specialists meet regularly with
  community groups to provide information and to
  solicit feedback
• Parent representatives are included at all levels
  of program administration and formulation

34
Learning from the States

• Directors were asked to report the extent to
  which they engaged in partnerships or
  collaborations with formal and informal
  community-based networks of support and families
  and family serving agencies
• Statewide required staff workshops were made
  available to other community organizations

35
Learning from the States

• Directors were asked to provide information
  regarding participation in organizational self
  assessment, monitoring and evaluation activities
  in terms of cultural and linguistic competence
  and service delivery
• Staff standards and evaluations include
  requirements for cultural competency
• Contractors are evaluated on their efforts
  towards culturally competent service delivery
• Each of 14 regional offices was required to
  assess needs specific to the cultures unique to
  their local communities and to develop individual
  plans to address these needs in the local office

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Learning from the States

• Directors were asked to provide information
  regarding participation in organizational self
  assessment, monitoring and evaluation activities
  in terms of cultural and linguistic competence
  and service delivery
• Currently engaged in an organization-wide survey
  to assess cultural competence to assist in the
  development of a five-year plan
• Development of a bureau-wide Cultural Competency
  Plan
• Life Stage Programs and services
• -Contract language
• Developing indicators for contractor training

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Learning from the States

• Directors were asked to identify any
  modifications that were made to program design or
  service delivery to address the needs and
  preferences of diverse communities
• Modifications were made to service practices to
• - Increase access enrollment
• - Improve satisfaction with services
• - Increase parent involvement
• - Increase outreach advocacy
• - Consider diverse literacy levels

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CONSIDERING CULTURAL COMPETENCE WITHIN THE
CONTEXT OF ORGANIZATIONAL CHANGE

• Adaptive Challenge
• Technical Challenge

Reference Heifetz, R.A. (1994). Leadership
Without Easy Answers. Cambridge, MA The Belknap
Press of Harvard University Press.
Slide Source National Center for Cultural
Competence, 2002
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Culturally Competent PracticesPolicy Making Level

• values principles
• mission statement
• consumer community participation
• workforce diversity
• resources for professional development, inservice
  and pre-service training

Excerpt from Policy Brief 1 - NCCC
slide source National Center for Cultural
Competence
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Culturally Competent PracticesPolicy Making Level

• contracting procedures and funding announcements
• provision of interpretation and translation
  services
• community outreach capacity building
• research methodology
• MIS/data systems

(Excerpt from NCCC Policy Brief Series
slide source National Center for Cultural
Competence
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Culturally Competent PracticesAdministrative
Level

• agency self-assessment
• recruit, retain and manage a diverse workforce
• insure for a well-trained and competent workforce
• service delivery adapted to community and
  cultural context

(Excerpt from NCCC Policy Brief Series)
slide source National Center for Cultural
Competence