idaho refugee maternal/child health program: input and … · 2010-10-15 · our health advisors...
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Idaho Refugee Maternal/Child Health Program: Input and Inspiration from our Communities
Margie Widener, MSN,CNMSaint Alphonsus Women’s Health
Marla Lipscomb, MSW,LCSWCARE Maternal/Child Health ProgramFamily Medicine Residency of Idaho
Eunice Njiraini, Senior Health AdvisorCARE Maternal/Child Health Program
Judith Hobbs, RN, BSNManagerSaint Alphonsus Family CenterCARE Maternal/Child Health Program
Idaho Refugee Resettlement Program
Boise, Idaho 91% Caucasian
Goals of CARE ClinicAddress and decrease health disparities
Provide quality prenatal and postpartum care to linguistically and culturally diverse populations
Create a model of care that adapts to the needs and strengths ofour patients
Create a safe, supportive, empowering environment for women and their babies
Influence the greater system of care at Saint Alphonsus by strengthening provider’s cultural awareness and sensitivity
Strengthen advocacy for patients in overall healthcare system
CARE Maternal/Child Prenatal Clinic
C – CulturallyA – AppropriateR – ResourcesE – Education
Interpreter and Health Advisor –A New ParadigmInterpreter – serves as a voice for provider and the patient repeating what each of them says without adding additional information.Health Advisor - Provides case coordination to increase access to maternal/child health and family services, assist in increasing healthcare providers’ capacity to deliver culturally appropriate care and assist in improving the health status of refugee mothers and infants
Our Health Advisors(Arabic, Burmese, Farsi, French, Kirundi, Kizigua, Maay Maay,
Nepali, Russian, Somali, Swahili, Uzbek)
Health Advisors – Provide insight into the communities
Help to identify strengths, needs, and concerns within their communities
At the table for curriculum development and decision making
Help pregnant refugee women “navigate” through the American Healthcare System
Reduce barriers to access and a Medical Home – “One-Stop Shop”
Health Advisor Role ContinuedKnowledge of both provider and patient culturesImprove cultural competence of providersHelp the providers understand the diversity of skin color, language, culture, religion, class, skill level, knowledge, life experiences, and personality
RefugeeIdentified
Needs
DEVELOPPROGRAM
ASSESS
Is thisprogram
being practiced?
YES
NO
ASCERTAIN ROOT CAUSE
ADDRESS ROOT CAUSE WITH HEALTH
ADVISORREASSESS
Focus Group: Physician Offices
Focus Group: Refugee Community
Community Assessment Survey
Program EvaluationHow do we know they know?
Presenting Culturally Sensitive Educational Topics
Actively engaging in the contentBuilding on their own experienceLearning new techniques and contentApplying the new content for immediate learning and relevance.Taking away new knowledge and using for skill buildingHealth Advisors – curriculum consultantsExchange of knowledge between providers and clients
AnchorAddApplyAway
Building on their experiences How does your body tell you when it is time to do something?
Building on their experiences How does your body tell you when it is time to do something?Signs of LaborWhen is it time to go to the hospital?We know they know because they get to the hospital in time!
CARE Program Design: Creating Safe, Supportive, Empowering Environment
Pre-Appointment VideoKnow what to expectDecrease anxiety about prenatal examWhy are you taking all my blood?
CARE Program Design: Creating Safe, Supportive, Empowering Environment
Group Model of Care and Education
Group education – multiple languages in each groupMedical interpreters present for each language groupEstablishing group ground rules, and confidentialityConfidential interviews regarding specific concerns
CARE Program Design: Creating Safe, Supportive, Empowering Environment
Individual concerns shared during prenatal examOften report shared concerns of other group membersPatient is asked permission for provider to anonymously share concern/question with group
Safe, Supportive, Empowering Environment
Consistency: Know what to expectFemale Interpreters and Health AdvisorsStrengths Based approach to careRestoration of Dignity and Respect
Safe, Supportive, Empowering Environment
Providers take time to listen and learn from patients Genuine provider compassion can be felt despite language barriers
Shared sense of community within CARE Clinic
“ I feel important about myself because the teacher asks if I have any special recipes to share with the rest of the class. I feel that each culture has something to share”.
Desire to work with refugees – not enough
Get them on the bus!
Job Requirement:CompassionFriendly faceHelp Me Understand…Willingness to listen
“To be culturally competent doesn’t mean you
are an authority in the values and beliefs of
every culture. What it means is that you hold
a deep respect for cultural differences and
are eager to learn, and willing to accept, that
there are many ways of viewing the world.”
- Okokon O. Udo PhD
Lessons Learned by ProvidersCaution: Seeing their knowledge as a deficit rather than seeing strength of knowledge
Limited understanding of healthcare system does not mean limited knowledge or ability
A little “cultural competence” can be more dangerous than none at all
Impact of Provider assumptions on care providedMay stereotype individual vs. seeing their unique strengths and needs
Lessons Learned by ProvidersProviders have realized that it is “US” that needed to adapt
System and provider need to adapt to provide quality care
Recognizing need for providers to be aware of personal bias
Ethnocentric ways of thinkingBelief that Western Medicine is superior
Manar’s Thank You