Second National Conference on
Quality Health Care for Culturally Diverse Populations:
Strategy and Action for Communities, Providers, and a Changing Health System

The Role Of The Health Care Provider In Supporting The Transition Of Culturally Diverse Youth To Successful Adulthood

The Center on Self-Determination of the Oregon Institute on Disability and Development at the Oregon Health Sciences University has integrated equity and diversity as essential components of its mission and therefore, the work it conducts to advance self-determination for persons with disabilities, including the special needs of minority communities. To this end it has initiated and is implementing a series of projects to identify strategies that health care providers and other social service and educators can use to promote equity and cultural competency. The equity and diversity initiative has evolved out of a project funded by HHS/ HRSAÌs Maternal and Child Health BureauÌs Healthy and Ready to Work Initiative. The "Community Solutions" project, one of eight projects funded under this initiative is the only project focusing exclusively on the special needs of minority youth - African American, Native American and Hispanics. This presentation will outline the goals, objectives and activities of the project with a focus on the needs assessment conducted, the interventions designed as a result of the findings and the outcomes of these interventions as well as work in progress in progress. Recommendations for health care providers, advocates, families and youth will be presented.

As a model/demonstration project, Community Solutions, has conducted, and continues to implement, a series of structured assessments, surveys and formal data gathering methods in all aspects of the project. Adolescents, their families, providers and other publics have been included in the assessment and planning phases of the project. Intervention strategies have been designed and their implementation closely monitored to ensure consistency with the designed plan and to document quality and effectiveness. The four core activities being implemented as a result of the assessment conducted in the first phase of the project include: Outreach and support to adolescents and their families using community liaisons; youth leadership and training; systems change to address institutional barriers; and cultural competency training for providers and advocates. The youth leadership program is evolving well both in terms of increased participation and quality of work evolving out of Teen Solutions, as the youth have defined their initiative. The projects being implemented by Teen Solutions include: leadership and outreach; training and speaking engagements at the local, state and national levels; advocacy and education. Outreach and support initiatives compliment the youth leadership activities, as the community liaisons are able to help families by finding resources and minimize barriers to care and services for their children. The systems change and cultural diversity training are the primary activities being targeted during the current phase of Community Solutions.

The major challenges faced by the project can be categorized into three areas: Prevailing misconceptions, bias and discrimination that have perpetuated the inequities and barriers encountered by minorities and persons with disabilities which in the case of minorities with disabilities, places this community in case of double jeopardy; Resistance to change, particularly by systems that have been closed or minimally responsive to community/client participation in self determination; hesitancy to engage in "one more project" by all parties involved; and the challenges resulting by demands and expectations of reform initiatives and the loss of revenues by systems being expected to do more with less.

Key to the success experiences this project has experienced include: Expand the circle in the decision making process and promote maximum collaboration (work with and for those the project is seeking to serve); assess/research before you act - make sure intervention strategies are actually addressing the needs, challenges, and opportunities resulting from the assessment, which must be on-going; beware of cultural bias and insensitivity systems and individuals have internalized and communities have accepted by virtue of the self-fulfilling prophecy.

A number of publications have been prepared and others are being planned to further disseminate information, references will be provided for participants.

Alfonso Lopez-Vasquez, BA, MEd has over twenty-five years as an educator with an emphasis on linguistically and culturally appropriate education, health care and social service delivery. He has been an advocate and catalyst for change by promoting equity and diversity. In the field of disabilities, Alfonso has been a proponent and activist in support of minorities with disabilities. In health care, he has contributed to public policy and advocacy for quality and equitable health care for minorities. He is chairman of the Northwest Latino Health Care Planning Group organized in response to the department of Health and Human Services Latino health initiative.

Alfonso has been involved in a number of innovative education projects in support of cross-cultural medicine including the department of family medicineÌs cross-cultural action committee through which he designed and facilitates a sub-rotation for first year family medicine residents. He designed and implemented a cross-cultural medicine seminar for medical students at the University of Nebraska Medical Center. Alfonso has contributed extensively to other projects including the State of OregonÌs and the Portland, Oregon, Tri-County Turning Point project to transform pubic health and was appointed to the Multnomah County Mental Health Task Force commissioned to assess make recommendations the address the needs of the countyÌs mental health service delivery system.

Alfonso Lopez-Vasquez, BA - Sociology; MEd, Early Childhood Education
Co-Principal Investigator, CDRC Center on Self Determination, Community Solutions Project;
Adjunct Faculty, School of Medicine, Department of Family Medicine.
Oregon Health Sciences University
OHSU Center on Self Determination
3608 Powell Boulevard
Portland, OR 97212
Phone: (503) 794-9676
Fax: (503) 794-1963

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