Current and Future Challenges in Diabetes Prevention, Diagnosis

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CDC ConferenceOrlando, FL May 6, 2008 Por Tu
Familia The Latino Outreach Program of the
American Diabetes Association-Colorado
Area Julissa Soto, Project Director
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Addressing Access for Underserved and Uninsured
Latinos in Colorado

• Addressing Access for Underserved and Uninsured
  Latinos in Colorado

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• General Facts About Immigrants
• Foreign- born population
• US 37.5 million or 12.5 population (2006)
• CO 489, 496 or 10.3 of Colorados
  population (2006)
• 58.4 reported Hispanic/Latino origins
• Undocumented immigrant population
• US estimates of 11-12 million adults and
  children
• 5 US Workforce (2005)
• CO estimated undocumented 225,000-275,000
  (2005)
• Source Migration Policy Institute Data Hub Pew
  Hispanic Center

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The Uninsured in Colorado

• 758,200 average uninsured in any given month
• 1.1 million uninsured at some point in 2005
• 69.5 have at least one worker in the family
• 21.3 are non-citizens
• Courtesy of Colorado Center on Law and Policy
  Source Lewin Group for the 208 Commission

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Uninsured Rates Among Racial/Ethnic and Income
Groups, 2004
Poverty Level
White, Non-Hispanic
Hispanic
lt 200 FPL
Black, Non-Hispanic
Asian1
American Indian2
200 FPL
Black, Non-Hispanic
1Asian group includes Pacific Islanders.
2American Indian group includes Aleutian Eskimos.
200 of the poverty level was 38,614 for a
family of four in 2004.
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• ADAs Approach to
• Access to Care for Latinos
• in Colorado

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Por Tu Familia is designed to

• Address socioeconomic and cultural variables
  contributing to health disparities in Latinos
• Address health system barriers contributing to
  health disparities
• Utilize cultural strengths in health promotion
  and disease prevention services.

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Por Tu Familia Colorado Model A Comprehensive
Systems Approach
Culturally Competent Educational Sessions
Global Risk Assessments
Linkage to Treatment Services
Access to Care

• Health and Flavor in the Latino
• Kitchen
• With All My Heart
• Everybody Dance for Your
• Health
• Everybody Move for Your
• Health

• Blood Pressure
• Cholesterol
• Glucose
• 10 yr. Framingham
• Risk Score

• Partnership with
• 41 low income
• clinics

• Ventanilla de Salud
• Diabetes Days

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Phase 1, Feb. 1, 2006-June 30, 2007

• Goal Increase awareness about the risks of
  diabetes for underserved and uninsured Latinos.

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• Objectives
• 1. Educate 10,000 Latinos on the seriousness of
  diabetes by June 30, 2008.
• 2. In collaboration with 20 medical clinics
  conduct free cholesterol and blood pressure
  screenings for 2,000 underserved and uninsured
  Latinos by June 30, 2008.
• 3. In collaboration with 41 medical clinics
  conduct follow-up for those at risk individuals
  no later than 2 weeks after their initial test.
• 4. Evaluate the effectiveness of Por Tu Familia
  by June 30, 2008.

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Results and Conclusions

• The project has exceeded its goal regarding
  outreach by more than 2.5 times.
• There were statistical significant increases in
  knowledge regarding diabetes in 78 of the
  measures.
• There were positive increases in participants
  attitude about exercise and diabetes.

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Phase 2 July 1, 2008-June 30, 2010

• Goal Promote healthier lifestyles and create
  behavior change among underserved and uninsured
  Latinos in the State of Colorado

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• Objectives
• 1. Educate 20,000 Latinos on the seriousness of
  cardiovascular disease and modifiable risk
  factors such as diabetes, physical inactivity,
  nutrition, high blood cholesterol, and obesity by
  June 30, 2010.
• 2. In collaboration with 6 recreational centers,
  provide culturally competent Zumba classes to 100
  underserved and uninsured Latinos by June 30,
  2010.
• 3. In collaboration with 41 medical clinics
  conduct free cholesterol, blood pressure, and
  global CVD risk score screenings for 2,000
  underserved and uninsured Latinos by June 30,
  2010.
• 4. In collaboration with 41 medical clinics
  conduct follow-up for those at risk individuals
  (uncontrolled risk factors, diabetes, or a global
  CVD risk score gt 10) no later than 2 weeks after
  their initial test.
• 5. Evaluate the effectiveness of Por Tu Familia
  by August 31, 2010.

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Program Components

• Awareness
• Diabetes Day
• Access to Care
• Ventanilla de Salud
• Disease Management and Health Promotion
• Todos a Moverse para su Salud!
• (Everybody Move For Your Health!)
• Todos a Bailar para su Salud!
• (Everybody Dance For Your Health!)
• Salud y Sabor en la Cocina
• (Health Flavor in the Kitchen)
• De Todo Corazón, (With All My Heart)

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Diabetes Day

• Increase awareness that diabetes is a serious
  disease
• Increase awareness of modifiable risk factors
• Inform Latinos that they are at high risk for
  developing diabetes
• Introduce the American Diabetes Association as a
  valuable resource for diabetes information

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Promotoras
Philosophy 1) Identify and recruit
Spanish-speaking persons who are
familiar with the community 2) Focus on
those who have demonstrated leadership
skills 3) Focus on hands on training
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Promotoras Deliverables

• Present at church service using script
• Pass out flyers and schedules for the month
• Register at least 40 people/church service
• Call the 40 registrants to remind them of the
  workshops-
• provide them with information
• Send registrants to workshops
• Promotoras are the link
• They reach but dont teach.

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Diabetes DayResults To Date (March 2008)

• 40,690 Latinos have participated in Diabetes
  Day!

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Ventanilla de Salud

• A partnership between the American Diabetes
  Association-Colorado Area and the Mexican
  Consulate-Denver, Colorado.

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Education, Referrals, and Follow up

• Conduct health needs assessments
• Conduct follow-up on health need assessments
  completed
• Provide health insurance information
• Provide referrals to an appropriate clinic and
  follow up services
• Provide health education sessions

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Summary of Results Sept. 1,2007-March 31,2008

• 1,154 people received health information
• 363 people assisted in establishing medical
  homes or community clinics or referred to a
  health center or public hospital
• 85 people able to establish medical homes with
  confirmed first visit/
• 796 people linked to special health programs
• 20 people assisted to receive public health
  insurance in the US

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Salud y Sabor en la Cocina, Health and Flavor
in the Kitchen

• A nutrition-based, culturally specific community
  session
• A highly interactive session to inform
  participants healthier foods preparation,
  correct portion sizes and healthier choices when
  eating outside the home.
• 1,914 participants have attended
• this workshop

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De Todo Corazón, With All My Heart

• A culturally specific workshop created
• for people in the Latino community for
• those at risk of diabetes and CVD.
• Participants will understand the need
• for healthier lifestyles
• Participants are encouraged to make a
• commitment to incorporate healthier
• habits into their daily routines.
• 2,450 participants have attended this workshop

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Todos a Moverse Para Su Salud! Everybody Move
for Your Health!Workshop Goals

• Create awareness that regular physical
• activity is important for losing and
• maintaining a healthy weight, especially for
• people with diabetes.
• Introduce the American Diabetes
• Association as a valuable resource for
• diabetes information.
• 120 participants have attended this workshop

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Todos a Bailar Para Su Salud!Everybody Dance
for Your Health!

• Learn About CVD
• and Diabetes
• Get People Moving!
• Learn Benefits of Physical Activity
• 58 participants have attended
• this workshop

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Global Risk Assessment s

• Blood Pressure
• Cholesterol (total cholesterol, LDL, HDL,
  triglycerides)
• Glucose
• 10 year Framingham Risk Score

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Linkage to Treatment Services
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Linkages To Other Services

• Partnership with 41 low income clinics
• Medical public health services
• Child protection Adult services
• Violence and abuse prevention, including domestic
  violence
• Mental illness or substance abuse treatment
  services
• Short term shelter or housing assistance
• Nutrition programs

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Challenges

• Having the participants understand the importance
  of talking with a physician if the results are
  too high or too low.
• Since only 12.5 of the participants listed a
  physician, there is a need to help them
  understand how to access the health care system.
• Many participants want to continue with their
  cultural diets, including those high in sugars,
  saturated fats, and transfat, despite the risks.
  The primary issue is the increased costs for
  healthier food. Therefore, there is a need to
  help them develop more efficient consumer habits,
  i.e., learning to purchasing healthier foods
  within the same budget.

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Conclusion

• Colorado model is unique
• Having distinct components (Promotoras
  presenters Screeners) provides an efficient and
  effective approach for providing service to the
  Latino community.
• Designed to meet the needs of Latinos in Colorado

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Accomplishments and Awards

• 2006 Denver Hispanic Chamber of Commerces
  Excellence in Education Award
• 2006 and 2007 Colorado Rockies Leadership Award
• 2006 Colorado Coalition for the Medically
  Underserved Lay person of the year In
  recognition for outstanding service to Colorados
  Medically Underserved
• 2007 Outstanding Community Initiatives Award by
  the American Diabetes Association
• 2007 Martin Luther King Jr. Humanitarian Award
  Character, Hope, Inclusiveness
• 2008 Mission Accomplished Award- Team the
  American Diabetes Association

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GRACIAS!
1-800-DIABETES