Katherine Sanchez, L.C.S.W., Ph.D. Assistant Professor University of Texas at Arlington

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 Arlingtonksanchez@uta.edu

Rick Ybarra, MA Program Officer

Hogg Foundation for Mental HealthRick.ybarra@austin.utexas.edu

Octavio N. Martinez, Jr., M.D., M.P.H., M.B.A., F.A.P.A.Executive Director

Hogg Foundation for Mental HealthHogg-ED@austin.utexas.edu

Session Evaluation

Please complete and return theevaluation form to the classroom monitor before

leaving this session.

Thank you!