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Charting a True Course for the Frontier of Integration: Eliminating Racial and Ethnic Disparities through Integrated Health Care
Katherine Sanchez, L.C.S.W., Ph.D.Assistant Professor
University of Texas at Arlington
Rick Ybarra, M.A. Program Officer
Hogg Foundation for Mental Health
Octavio N. Martinez, Jr., M.D., M.P.H., M.B.A., F.A.P.A.Executive Director
Hogg Foundation for Mental Health
Collaborative Family Healthcare Association 14th Annual ConferenceOctober 4-6, 2012 Austin, Texas U.S.A.
Session # C4a October 6, 2012
Faculty Disclosure
I/We have not had any relevant
financial relationships during the past 12 months.
Objectives
At the conclusion of this presentation, the participant will be able to identify three barriers experienced by racial and ethnic minorities that result in health care disparities
At the conclusion of this presentation, the participant will be able to delineate three principles and components in the delivery of integrated health care to racial and ethnic minorities
At the conclusion of this presentation, the participant will be able to describe three practice-based examples in the delivery of integrated care to reduce/eliminate health disparities
Learning Assessment
A learning assessment is required for CE credit.
Audience interaction through a brief Question & Answer period at the
conclusion of presentation.
Health Disparities and Health Equity
Health disparities - differences in the incidence and prevalence of health conditions and health status between groups.
Health equity - when everyone has the opportunity to “attain their full health potential” and no one is “disadvantaged from achieving this potential because of their social position or other socially determined circumstance.”
Brennan Ramirez LK, Baker EA, Metzler M. Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.
Health Disparities
Racial and ethnic minority populations are less likely to receive a variety of medical services, from routine procedures to appropriate cardiac medications and bypass surgery.
MORE likely to have limb amputations as a result of diabetes and experience a lower quality of health services overall.
Findings held even when controlling for insurance status, income, age and education level.
Behavioral Health Disparities
Poor doctor patient communication (DPC)
Persistent stigma around issues of mental illness
Racial and ethnic minority populations initiate medication treatment at a much lower rate than whites low use of anti-depressant medication more likely to discontinue their treatment without
consulting their physician
What Factors Contribute to Racial and Ethnic Health Disparities
Socioeconomic status
Residential segregation and environmental living conditions
Occupational risks/exposures
Health risk and health seeking behavior
Differences in access to care
Differences in health care quality
Smedley, 7/21/09
Relationship between Social Determinants and Mortality (2000)
Galea et al, Estimated Deaths Attributable to Social Factors in the United States,
AJPH, August 2011, Vol. 101, No. 8.
Populations at risk for low health literacy
Elderly (age 65+) - Two thirds of U.S. adults age 60 and over have inadequate or marginal literacy skills, and cannot read or understand basic materials such as prescription labels.
“Minority” populations
Immigrant, non-English speaking populations
Low income - Approximately half of Medicare/Medicaid recipients read below the fifth-grade .
People with chronic mental and/or physical health conditions
Low educational attainment
Lack of English fluency is an independent predictor of
Poor control of chronic disease
Poor quality of primary care,
An absence of a source of care
Lack of continuity
Lack of patient satisfaction
Poor quality patient education and understanding of their disorder
Reduced health care use
Other factors that affect access for immigrants and minority populations
Limited health literacy
Geographic inaccessibility
Lack of medical insurance
Citizenship status
Level of acculturation
Duration of residence in the U.S.
Eliminating Racial and Ethnic Disparities through Integrated Health Care
Literature review
Consensus Meeting
Consensus Statements
Recommendations
Innovations from the field
http://www.hogg.utexas.edu/
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Recommendation: Patients/Consumers
Key Strategies Identified Conduct comprehensive assessments that are culturally
and linguistically competent to understand cultural values, beliefs and constructs
Develop patient/consumer-driven treatment plans
Example: Charles B. Wang Community Health Center Mental Health Bridge Program (New York City) No distinction between treatment rooms Combined electronic health record Informal communication encouraged
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Recommendation: Practice
Key Strategies Identified Develop and share appropriate tools that go beyond just
the standard measurement of symptoms Build understanding by cross-training providers and
exposing them to other systems
Example: Center for Native American Health (NM) Use of focus groups and vignettes Women wanted a CHW to make home visits Men preferred to meet and talk with other NA men at a
neutral location
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Recommendation: Communities
Key Strategies Identified Create culturally responsive, asset-based environments Use community-based participatory approaches Identify and empower leaders from within the community Provide health/behavioral health education
Example: Project Brotherhood (Chicago) Hired and trained a barber to provide health education Provide fatherhood classes Produced a comic book that teaches conflict resolution
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Recommendation: Health Care Systems
Key Strategies Identified Provide services where needed Ensure institutions reflect the populations they serve Address cultural and linguistic diversity Evaluate practice for efficacy
Example: Connecticut Latino Behavioral Health System The Cultural Competency Index: instrument designed to evaluate
cultural responsiveness of their clinical services Staff pre- and post-training evaluations Satisfaction with trainings Random tape ratings to assess language fluency and the integration of
Latino cultural values in treatment
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Recommendation: Workforce
Key Strategies Identified Build a diverse multidisciplinary workforce Attract and retain bilingual/bicultural providers Identify and engage health care workers early in their studies/careers Provide in-culture and in-language supervision Build and support diverse, empowered leadership
Example: Cherokee Health Systems (Tennessee) Employed a full-time Burundi interpreter to work at the front desk of
their largest inner city clinic Retained a multilingual psychologist (Spanish, French, Portuguese) who
works via tele-health technology Offers advanced training to bilingual staff to become certified CNAs
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Questions & Answers
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Learning Assessment
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Thank you for your attendance and participation!
Katherine Sanchez, LCSW, PhDAssistant Professor
University of Texas at [email protected]
Rick Ybarra, MA Program Officer
Hogg Foundation for Mental [email protected]
Octavio N. Martinez, Jr., M.D., M.P.H., M.B.A., F.A.P.A.Executive Director
Hogg Foundation for Mental [email protected]
Session Evaluation
Please complete and return theevaluation form to the classroom monitor before
leaving this session.
Thank you!
