Preconference

Sunday, September 21, 2008

Preconference Skills-Building Workshops

As in previous years, the conference will offer half-day intensive training sessions on cultural competence training, language access and policy issues.  Advance enrollment is required and participation is limited. These three-hour workshops will offer the opportunity to participate in small, intensive training sessions. Workshops will be team-taught by experts from around the country, and participants will learn specific techniques and receive informational materials to use in their own work settings. "A" WORKSHOPS will run simultaneously from 9:00am-12:00noon. "B" WORKSHOPS will run simultaneously from 1:30-4:30pm. Registration is limited to 30 participants per workshop.  Lunch is included with your registration.

Full session details, including session descriptions and faculty, is available below.

Morning Sessions: Sunday, September 21, 2008: 9:00 AM – 12 Noon

A1: Innovation in Cultural and Linguistic Competency Self-Assessment: Tools and Processes for Health Care Providers and Organizations

Assessing attitudes, practices, structures, and policies of health care organizations and their personnel is a necessary, effective and systematic way to plan for and incorporate cultural and linguistic competency.  The National Center Cultural Competence (NCCC) views cultural competence as a developmental process that evolves over time.  Engaging in self-assessment helps organizations to: (1) gauge the degree to which they are effectively addressing the preferences and needs of culturally and linguistically diverse groups; (2) establish partnerships that meaningfully involve consumers and key community stakeholders; (3) improve consumer access to and utilization of health and mental health services; (4) increase consumer satisfaction with services received; (5) plan for the systematic incorporation of culturally and linguistically competent policies, structures, and practices; (6) allocate resources to improve the quality of services; and (7) determine individual and collective strengths and areas of growth.

A collaborative effort of 18 US medical schools, and funded by the National Heart, Lung and Blood Institute (NHLBI), the National Consortium for Multicultural Education for Health Professionals is a new research initiative to develop and evaluate cultural competence curriculum for medical students, physicians and other health care professionals. Lists of resources developed and used by consortium members will be provided to session participants (e.g., self-awareness exercises, a case-based textbook, discussion guides for the Unnatural Causes video series, a web-based video production, and faculty development guides). Each participant will receive handouts/tools from breakout group leaders at the end of the session, as well as an invitation to consult with the consortium. Additional information regarding the Consortium is available at: http://culturalmeded.stanford.edu/

Following a brief overview of session objectives, participants will select two of four 45-minute sessions: 1) discussion and demonstration of a cultural sensitivity & awareness training CD with exercises, lecture material and facilitator’s manual for 1^st and 2^nd year medical students, 2) discussion of reflective practice as a tool/strategy for cultural competency education, 3) discussion of the use of AAMC’s Tool for Assessing Cultural Competency Training (TACCT) as a tool for curriculum needs assessment and curriculum development, and 4) review of self  reflection exercises, DVD video vignettes, standardized patient role play and paper cases used in gender health disparities training. A workshop leader panel will discuss strategies, challenges, and tactics; and "lessons learned" on curriculum change in this area. The session will conclude with a question and answer period.

The module, Addressing Cultural Mistrust between Patients, Families & Providers, is a training session which addresses cultural mistrust.  It explores this issue as it relates to all populations, but particularly addresses cultural mistrust within the context of the African-American community.  This module helps direct service staff recognize cultural mistrust, and provides insight into the historical and psychological context from which it arises.  Attendees will gain knowledge and skills to improve patient/provider relations, patient customer satisfaction and patient/provider trust, all important aspects of eliminating health disparities. 

This module incorporates interactive role playing scripts, video, power point presentation, discussion and handouts (including a bibliography).  It can easily be adapted by other trainers for specific settings.  If you view patient/provider trust as an important foundation to improved patient/provider satisfaction and outcomes, and if you recognize cultural mistrust as an obstacle in many patient/provider relationships, then you will want to attend this session.

A4: A Model for Improving Language Services in Healthcare from California Public Hospitals’ Experience: Assessing Your Organization’s Readiness and Drawing on Innovative Technologies, Resources and Strategies

Health care providers struggle to provide high quality interpreting across large and complex hospitals, clinics and physician practices. Despite severe fiscal constraints, public hospital systems in California have had tremendous success building high-quality, cost-effective interpreting systems through a combination of: 1) model policies and procedures; 2) a learning collaborative facilitating team-based rapid cycle improvement; 3) targeted grant funding; 4) leadership engagement; 5) peer support; 6) staff training; and, 7) technology innovations. This session will explore each of these strategies and how they can be applied to other settings, provider types and circumstances to spread the use of high-quality, affordable healthcare interpreting. This session will feature administrators from California public hospitals, as well as a technical consultant and innovator, and will be moderated by the director of the California Health Care Safety Net Institute, the quality improvement organization for California public hospitals.

Critical to beginning this journey of improving language access is an organization’s readiness to engage. The Health Research and Educational Trust (HRET), with funding from The California Endowment, evaluated strategies to promote language access in California public hospitals. This session will also feature lessons learned from the HRET evaluation. HRET will identify the system-level factors that facilitate provision of high-quality language services and engage participants in the use of its Readiness to Engage instrument.

Participants will get additional benefit from this workshop if a team of two people from the same organization can attend. Please bring your organization’s policies and procedures on language access to the session.

Community Health Workers (CHWs) and Promotores de Salud are growing in popularity as resources to improve quality of care to diverse populations, yet many providers are unprepared for the distinct needs of this powerful workforce.  To begin with, CHW recruitment and selection are absolutely crucial to the success of a new program.  Proper job design, adequate generic skills training and sensitive supervision are also vital.  This workshop will lay the groundwork for your organization's success in this growing field.  The presenter is an author of HRSA's 2007 national workforce study on CHWs, and former director of both a community college CHW program and a statewide CHW institute.

The EBAN Experience is an interactive, experiential learning environment that will be created in its prototype form for this conference. Stories of four patients, from four different cultures, are presented in a unique fashion that is highly interactive, using museum-type exhibits, video presentations and discussion. Participants will be expected to engage in the learning session, which will include personal reflection and facilitated small group discussion. Each participant will be asked to complete a short assessment of the experience, as part of the formative evaluation of the prototype.

A7: Social Marketing Approach in Designing Public Health Messages - a Step-by-Step Case Study for Methamphetamine Prevention Campaign for Asian American & Pacific Islander (AAPI) community

This session will focus on how to utilize Social Marketing principles, integrated with cultural/language competence, in order to design better public health education materials and effectively disseminate key messages.   The workshop will also utilize the materials
from a successful national Methamphetamine Prevention Public Education Campaign targeting the Asian American & Pacific Islander (AAPI) community, in order to demonstrate a step-by-step process of designing such materials. In addition, the training will also touch on AAPI's "Concept of Health", communication patterns found in within the AAPI community, and relevant information dissemination channels in order for participants to better understand this underserved community in area of health education.

This training is intended to improve the capacity of mainstream health systems to design educational materials in relation to AAPIs' health.  Participants can easily adapt the strategies into their work, and create ripple effects through take-home materials, including AAPI focus group report, Methamphetamine Prevention Campaign package and CDC funded-CDCynergy-Social Marketing CD-ROM.

The Sudanese are among the largest refugee groups to arrive in recent years, and can now be found throughout the Midwest, even in some small rural towns.  These refugees from Africa are particularly diverse, and represent multiple tribes and languages. This session will provide important background information on Sudanese refugees, and will discuss elements of their culture that are important for health providers to understand. 

Recent conflict in Burma has led to an influx of new KaRen refugees to the United States.  The KaRen are an indigenous group who live primarily in the mountainous areas of Burma, although many have fled the military government and live in refugee camps in Thailand.  This session will describe how a partnership between the KaRen community and health and social service providers has sought to care for a population that has had little or no access to medical care, is unfamiliar with Western medicine, and for whom limited interpretation services are available.

Many members of new populations to the United States have fled oppression, war, conflicts, and chaos.  The events of state-sponsored violence strategically destroy communities by creating climates of fear and by breaking the bonds of solidarity among people.  Interventions that help Liberian war refugees in Minnesota regain leadership and strength provide the means for this community to again offer support, meaningful structure, and the capacity to encourage recovery for its members.

This half-day workshop is intended to move participants from understanding the core problems in providing culturally competent care to getting executive buy-in and organizational action. The session begins with an understanding of three core "megatrends" (race, immigration and limited English proficiency). Properly understood, cultural competence involves three key issues related to these underlying megatrends: 1) racial and ethnic disparities in health care; 2) cross-cultural value differences between immigrant patients and Western medical providers and 3) providing language access to LEP populations. From there, participants are exposed to the business, medical (quality/safety) and legal "cases" for cultural competence in health care - a presentation strategically tailored to gain executive buy-in. From there we will discuss ten core cross-cultural differences that can make impact cross-cultural patient and workforce interactions, discuss the emerging "science of bias" and how unconscious attitudes towards differences affect clinical decision-making and racial and ethnic disparities and proscribe a set of critical cross-cultural skills for the culturally competent manager and clinician.

To complete the training, we will discuss how to facilitate action on an organizational level by conducting both a cultural competence organizational assessment (focused on the systems, policies and practices of providing culturally responsive care and language access to culturally diverse patients) as well as a workforce diversity audit. Included in this discussion will be suggestions as to how organizations can compare physicians' practice behaviors against national best practices in cross-cultural medicine and improve their analysis of patient satisfaction data by breaking out the data according to both race and language status. A process will then be described for turning organizational findings into organizational action via the construction of a strategic, organization-specific cultural competence plan.

Racial and ethnic health care disparities are recognized as a major medical and public health problem. The American Medical Association, working with the Commission to End Health Care Disparities, has developed a three hour workshop to educate physicians about the extent of racial and ethnic health care disparities, raise awareness regarding the impact of health care disparities, and provide physicians with potential solutions for change. Patient and health professional video vignettes provide the basis for an interactive discussion format. The workshop focuses on providing physicians with strategies to improve their communication skills, recognize and better serve patients with low health literacy, and incorporate language access mechanisms into their clinical practice. The workshop also focuses on the historical context of racial and ethnic health care disparities, as well as discussions of the role of bias, stereotyping and trust in the medical interaction. By the end of the workshop participants will be able to discuss the range of health care disparities and the impact that health care disparities have; understand the causes for health care disparities; and identify strategies and tools to improve communication between patients and providers.

Cross-cultural health care brings people together who have different health beliefs and practices as well as different health care ethics, which are health-related moral commitments, values, and a system of evaluating right and wrong. Though there is an important lack of consensus on cross-cultural ethical issues, health care providers are routinely forced to decide whether to tolerate, accommodate, or override patients and families’ decisions and actions in health care settings. We will offer health care providers and administrators the opportunity to advance their skills in identifying, assessing, and addressing cross-cultural ethical conflicts as well as resolving the conflicts by partnering with patients, families, community leaders, healers, and other health care team members.

Using case studies (ours and participants’), we will identify common sources of cross-cultural ethical differences, including deeply held Western biomedical beliefs not universally shared by persons from different cultural perspectives. Participants will role play case vignettes; engage in personal and small group reflection; and learn from providers, patients and families directly involved in cross-cultural ethical conflicts. Alternative methods for resolving cross-cultural ethical conflicts will be identified --- including our recommended approach that was published in Healing by Heart: Clinical and Ethical Case Stories of Hmong Families and Western Providers. Finally, participants will practice applying this ethical tool in small groups, distinguishing between challenges to a provider’s personal preferences, moral beliefs, and professional integrity. This seminar may be helpful to clinicians and administrators facing cross-cultural ethical conflicts.

Most health care interpreter training programs have not been informed by empirical research or subjected to rigorous evaluation to determine their effectiveness in increasing the interpreting competencies of participants. Interpreting competencies require the development of multiple skills including, at a minimum, development of cognitive abilities such as anticipation, listening comprehension, oral text analysis, retention, paraphrasing, and culturally meaningful message conversion. The existing interpreter training programs, as well as health and behavioral health organizations, will benefit from increased knowledge and understanding of the interpreting competencies that impact patient safety and quality of care.

Recent research using discourse analysis and drawing from multiple disciplines including medical and cultural anthropology, social and cognitive psychology, and applied linguistics offers new insights about the realities that interpreters experience in health care settings. In addition, incorporating competency-based training strategies, built from professional principles of interpreting pedagogy will strengthen current interpreter training programs. This intensive and interactive training is designed for interpreter trainers, interpreter managers, health care providers, and administrators. It will introduce essential knowledge gained from multi-disciplinary empirical research, demonstrate how to incorporate some of this knowledge into existing training programs, and encourage partnerships between practicing interpreters, trainers, providers, and researchers. 

The focus of this pre-conference presentation and discussion is on promoting culturally based care in nursing education. It is the contention of the presenters that culturally based care starts with an understanding of the cultural self through the process of cultural discovery and encounter. Faculty have the capability of igniting the spark of cultural desire so that culturally based care starts from the inside out, meaning mutual transformation for all involved.   Strategies will be shared during the presentation that will promote teaching and learning for the students, faculty and institutions. 

The pre-conference presentation is based on Camphina-Bacote's model of cultural competence and includes a process that will enliven the cultural discovery of the classroom in order to promote culturally competent care for patients, families and communities. 

Today’s healthcare employees and patients are increasingly diverse and have a vast array of religious traditions.  Not surprisingly, issues involving religion arise more and more frequently.  Whether it is the question of diet, dress/modesty, holiday observance, or end-of-life rituals, understanding how cultural practices and religious beliefs impact treatment can result in more positive (and less costly) health outcomes – and greater trust and loyalty from patients.  This session is designed to provide participants with practical strategies and techniques to improve patient care, thereby diminishing barriers to healing and recovery.
 
Participants will recognize why religio-cultural competence is a critical issue for clinicians today, learn how to quickly identify when religious issues are significant in care and determine how to address those needs.  Attendees will review important demographic trends and learn about some of the more common religions found in the U.S., with a focus on religious symbols, objects and practices they might encounter in a healthcare setting.  Participants will also get to practice communication skills for addressing religious needs effectively and respectfully.  Throughout the session, attendees will engage in skills building activities including small group work, role playing and interactive case studies.

B7: Quality Care for Minority Patients: Small Practice Perspectives 

A substantial proportion of patients receive their primary care in small practices. However, while large health care organizations often utilize quality improvement (QI) techniques to reduce disparities and improve culturally competent care, small practices typically have fewer resources and face unique challenges to successfully implementing and sustaining such activities. In an effort to understand what practices need to improve care to their diverse populations, the National Committee for Quality Assurance (NCQA) launched a demonstration program, funded by The California Endowment, in which 20 small and solo physician practices with little to no experience in QI were provided financial and ongoing technical assistance to develop and implement a one-year QI project aimed at improving care for their minority patients. This session will provide the opportunity for other small practice physicians and staff members to share their experiences and what they learned through the course of the project.

Each physician or small practice staff member will share their individual experiences developing, implementing and sustaining QI projects and, in some cases, choosing, purchasing and implementing electronic medical record (EMR) systems. Participants will speak to the unique barriers and challenges they faced as small practices and the lessons they learned as a result of the undertaking. Participants will also emphasize the additional needs of small practices operating with few resources and ways in which external organizations, including health care organizations and managed care organizations, can support their efforts. Participants will be able to highlight concerns for the future regarding issues such as Pay-for-Performance and physician-level measurement. Small group breakout discussions will focus on experiences, challenges and needs of small primary care practices undertaking these kinds of activities as well as potential partnerships and opportunities for small practices to organize and collaborate with each other and with external organizations.

Over the past 15 years, there has been a vast influx of Somali refugees and immigrants making their new homes in the United States and specifically Minnesota, with the overwhelming majority residing in the Twin Cities area of Minneapolis and St. Paul. While official estimates indicate that approximately 25,000 Somalis are in Minnesota, it is well accepted that there are 50,000—75,000 or more. Since Minnesota has welcomed African immigrants, family members who live in other states within the U.S. and Canada continue to join many newly arrived families. The prospect of Somali immigrants and refugees returning to their homelands is unlikely. Continuing war, civil strife and economic crises make the outlook for return to Somalia bleak.  Therefore it is important that the American mainstream community continue to embrace and welcome Somalis and assist in their acculturation process.

The challenges facing Somali children and families in the United States are complex and their needs are great. Children usually become acculturated faster than their parents. These issues have a significant impact on psychosocial adjustment.  In order to best respond to the needs of Somali clients, it is important to understand their unique experiences and circumstances. Somali children and families face enormous cultural and linguistic difficulties in the acculturation process. This session will offer a brief overview of Somali culture, family dynamics, gender roles and concepts of community and family. The focus will be on understanding the special needs and problems of Somali children and families and specific strategies in working with them.

In the spring of 2008, the United States began resettling 60,000 ethnic Nepalis from the Himalayan country of Bhutan. They are being resettled in New York, Illinois, Missouri, Texas, Arizona, Maryland, and other states. This session, offered by a health care profession and former refugee from Bhutan, will address the health, social service and cultural/linguistic issues posed by caring for this new refugee group. 

Our presentation will feature two of the five vignettes from the film, Shame and Silence: Overcoming the Stigma of mental Illness in Asian Americans, produced and directed by Elizabeth J. Kramer and co-directed by Dr. Francis Lu, who also served as executive scientific advisor for the film. The vignettes will be from different cultures, but their objective is to show how skilled, culturally competent mental health professionals (1) recognize the subtle signs of stigma and (2) how they manage it.  Attendees will view each vignette, followed by facilitated group discussion.

Developing the Joint Commission’s Standards Supporting Culturally Competent, Patient-Centered Care: A Forum for Discussion . Guarantee yourself a voice in the development of Joint Commission standards to deliver culturally competent, patient-centered care. This special session will run from 5:00pm-7:00pm. Limited enrollment, no additional fee required.