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Providing Culturally Appropriate Services:
Local Health Departments and Community-Based Organizations Working Together
This report, from June 1994, describes the work
of the Multicultural Health Demonstration Project of the National Association
of County Health Officials (NACHO). The project linked health departments
with Hispanic and Asian and Pacific Islanders' community-based organizations
in an effort to improve access to care for these populations. The project
solicited participants from 3,000 local health departments; 20 health departments
submitted applications, and the project chose three sites for demonstration
projects: Hawaii Department of Health, Adult Mental Health Division and
Kokua Kalihi Valley Comprehensive Family Services; Howard County Health
Department and the Foreign-born Information and Referral Network in Maryland,
and the San Luis Obispo County Health Agency and Hispanos Unidos de Paso
Robles in California.
Under the requirements of the project, the health
departments had to develop and implement work plans to build collaborative
working relationships, plan and implement services for the target populations,
participate in monthly conference calls with NACHO, write articles about
their experience with the project, develop a leadership workshop for local
organizations, and write a case study on building relationships. In exchange
for their effort, each health department received $10,000 towards the project.
In Hawaii, the project's goal were to form
a collaborative effort between the Department of Health and the community-based
Kokua Kalihi Valley Comprehensive Family Services (KKV) to provide primary
mental health services to the Asian and Pacific Islanders in the area. The
project also sought to train KKV's bilingual staff to identify incidences
of domestic violence, integrate mental health care into KKV, and collaborate
with other service providers. To meet these objectives, KKV contracted with
a psychiatrist to provide its staff with mental health training; the training
focused on domestic violence and post-traumatic stress syndrome, which the
report points out, is common among the immigrant and refugee communities
in Hawaii. The project also conducted a workshop for DOH and KKV employees
on networking.
The Howard County project focused on the Hispanic
and Asian populations and how to make available to Hispanic, Korean, and
Vietnamese women of child-bearing age prenatal care services within the
Howard County Health Department. The project also sought to improve the
Health Department's ability to communicate with non-English speaking
women. To achieve these goals, the Health Department implemented two cultural
awareness workshops in conjunction with the Foreign-born Information and
Referral Network (FIRN), the National Coalition of Hispanic Health and Human
Services Organizations, NACHO, and a local trainer. The workshops convened
public health nurses to educate them about the growing Asian and Hispanic
populations and presented practical discussions on health and cultural practices.
As a result of the workshops' presentations and discussions, participants
agreed to explore additional funding options for FIRN in order to increase
their capability to keep up with growing demand for its services and suggested
that the Health Department invest in and train its staff on a software program
designed to translate conversations from English to Spanish and other foreign
languages.
The project's efforts were not limited to conducting
workshops. FIRN staff served as interpreters for Health Department staff
and patients during weekly clinics; the interpreters worked with Health
Department staff to set appointment, coordinate outreach, complete patient
forms, and arranging access to post-partum and family planning services.
The FIRN interpreters also attended English-as-a-second-language classes
to make presentations in Spanish about the availability of prenatal care;
they also distributed informational fliers at Korean and Vietnamese ESL
classes.
The third project site--San Luis Obispo County,
California, brought together the San Luis Obispo County Health Agency with
Hispanos Unidos de Paso Robles in order to include the Hispanic families
involved with Hispanos Unidos de Paso Robles in the development of more
responsive health services. Towards this effort, the demonstration project
held meetings in the community to alert people about the available health
services, identify barriers to access to care, and develop strategies for
overcoming those barriers. Participants also selected Spanish-language materials
for use in clinics, created a health access information brochure, agreed
to examine the issue of TB testing for preschoolers, and developed the 2nd
Immunization Outreach Day. In conjunction with these projects, participants
publicized the projects' efforts through the media and the Children's
Policy Council, co-sponsored cross-cultural awareness training for staff,
and helped train Paso Robles staff to draw blood for lead testing.
As a separate component of the Multicultural Project,
staff from the University of North Carolina' School of Public Health
evaluated the project to assess the efforts of the health departments and
the community-based organizations in involving the community in health-related
decisions and to make recommendations based on the project's results.
Evaluators concluded that in Hawaii, the mental health community functions
more as a cohesive unit to the benefit of their clients than before implementation
of the project. Similarly, the project in Howard County, Maryland has resulted
in increased use of professional, paid interpreters and of bilingual staff
and materials. The evaluators also point out that the attitude of the health
department changed as a result of the project; they note that interpreters
now are viewed in a "collegial light, as partners in health care delivery."
Finally, in San Luis Obispo County, California, the project resulted in
increased cultural competence and understanding and more frequent use of
bilingual staff and materials.
As a result of these findings, the project administrators
made several recommendations:
- Meet frequently and be willing to invest time
and energy in developing relationships.
- Identify a staff person to act as a liaison with
the other agency.
- Find the right people at the other agency to
build a relationship with and persist in trying to build a relationship
if the first efforts fail.
- Establish trust by following through on commitments.
- Be patient.
- Make an effort to formalize the relationship
in order to maintain a long-term commitment.
- Alert the community-based organization about
the limits and constraints of bureaucracy.
- Develop multicultural workshops.
The report emphasizes relationship building and
open, respectful communication between the groups involved. The project
revealed that collaboration requires persistence, structure, nonhierarchical
attitudes, and professionalism for a successful partnership. The report
concludes that the project met its stated goal of enabling local health
departments to address the health care needs of diverse populations.
Where to Get it:
National Association of County Health Officials,
440 First Street, NW, Suite 500,
Washington, DC 20001 |
