187535 Cross-cultural and diversity inclusiveness training to reduce "borders as barriers" to health and health care

Monday, October 27, 2008

Grace Damio, MS , Center for Eliminating Health Disparities among Latinos, Hispanic Health Council, Hartford, CT
Karen A. D'Angelo, MSW , Center for Eliminating Health Disparities Among Latinos, Hispanic Health Council, Hartford, CT
Stacey Brown, PhD , Community-Based Education, UConn School of Medicine, Farmington, CT
Karen Powell-Sears, PhD , Center for the Eliminating Health Disparities among Latinos, Hispanic Health Council, Hartford, CT
Rafael Pérez-Escamilla, PhD , Department of Nutritional Sciences and the Connecticut NIH EXPORT Center for Eliminating Health Disparities among Latinos, University of Connecticut, Storrs, CT
Judy Lewis, MPhil , Director, Global Health Education; Professor, Departments of Community Medicine and Pediatrics, University of Connecticut School of Medicine, Farmington, CT
Unequal Treatment, the landmark Institute of Medicine report that documents disparities in health care quality and health outcomes among certain “racial and ethnic” groups, calls for cross-cultural training as one of the needed solutions to this major problem.

The Hispanic Health Council (HHC) has developed an approach to cross-cultural training that offers a profound, participatory process for development of attitudes, knowledge and skills needed for working effectively with diverse groups. The curriculum has been used to train over 200 clinicians, faculty, human service providers and paraprofessionals, all of whom work with women from diverse backgrounds. The curriculum:

• provides a participatory approach to learning, combining theoretical instruction with hands-on skills development;

• presents the concept of “dimensions of diversity,” broadening the consideration of culture to include: gender, class, ethnicity, family and immigration status, educational background, physical and mental ability, religion and sexual orientation; and

• includes the concepts of “blaming the victim”, and external and internalized oppression, and their impact on provider/patient interaction.

Available evaluation data includes (very positive) participant satisfaction survey results, as well as a limited amount of outcome data on use of curriculum material in teaching and service provision. Through CEHDL, the HHC and UConn School of Medicine continue to develop strategies for comprehensive training of faculty, students and clinical providers, and to evaluate outcomes based on observed skill development and behavior change, as well as self-reported changes in satisfaction, knowledge, attitudes and skills.

Funded by CEHDL (NIH-NCMHD grant # P20MD001765).

Learning Objectives:
At the end of the session, participants will be able to do the following: -state the need for cross cultural training as identified in the Institute of Medicine's report, “Unequal Treatment,” as a means of eliminating “borders as barriers” to care and health; -identify dimensions of diversity other than culture that need to be explored as part of “cross-cultural” training; -recognize the need for a participatory and comprehensive approach to cross cultural training; -identify two participatory techniques for exploring discrimination and oppression as they relate to health and quality of health care; and -recognize the high level of satisfaction to this training approach expressed by participants of varied professional contexts and levels, and educational backgrounds

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Working at the Hispanic Health Council, a 25 year-old community-based organization based in Hartford, Connecticut, I have had a long career in public health and nutrition and have always had an interest in the issue of cultural competency in health and human services. In 2003, I formally began working on the issue by developing the first edition of this Cross-Cultural and Diversity Inclusiveness Training Curriculum, and training 150 WIC providers in the state of Connecticut. In 2004, I began partnering with Professors Judy Lewis and Stacey Brown of the University of Connecticut School of Medicine’s Community-based Education Program, where we worked to tailor this curriculum to the needs of medical faculty. With the receipt of the CEHDL (Center for Eliminating Health Disparities among Latinos) grant in 2004, I have continued to lead the partnership between the Hispanic Health Council and the University of Connecticut School of Medicine in the further development and evaluation of this cutting-edge training curriculum, as we move towards tailoring it to the specific needs of medical faculty, students, and clinical providers, and evaluate its effect on behavior change.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Double Jeopardy: Multiple Discriminations as a Barrier to Health
See more of: APHA-Committee on Women's Rights