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3. Community Capacity Building
Many exemplary examples of culturally competent model programs and
policies have been developed by or in collaboration with community based
organizations. Sometimes these efforts have been successful because of
support from foundation or government grants; sometimes they succeed without
any outside assistance. If one agrees that the best outcomes derive from
community input into programs that serve them, promoting community capacity
building for advocacy and program development in multicultural health
is essential.
3.1 Capacity for Advocacy
There are many kinds of advocacy and awareness promotion activities
that take place around multicultural health, including: legal, policy/political,
working with providers, and coalition building. The target points of advocacy
are many: health/social service providers and the organizations that represent
them, government agencies, and community based or consumer organizations.
The types of activities that may constitute advocacy and awareness promotion
include investigation, reporting, soliciting community input and response,
discussion, negotiating solutions, looking for funding for services, policy
development and promotion, and seeking political/legal support.
The area of Title VI advocacy, complaints, and awareness-raising
is an excellent example of the power of community based activities to
improve services and policies for LEP populations. Because the federal
government has few resources to proactively seek out Title VI violations
and enforce compliance, all the most sweeping compliance activities have
resulted from complaints organized by community agencies or individuals.
The classic example involving Evergreen Legal Services is described
by Fortier in Appendix 16. More recently, a concerned individual in Maine
has nearly single-handedly--and with her own time and money--organized
complaint filing, awareness raising, legislative oversight, and a class
action suit against several providers alleged to provide inadequate services
to LEP clients. A paper written by Carmella Castellano of Public Advocates,
Inc. describes more fully the examples of state law and regulation development
regarding linguistic and culturally competent services pursued by The
Heartland Alliance Chicago, and the Asian and Latino advocacy communities
of California.
Outside the arena of legal or policy oriented advocacy, much work
needs to be done to prepare ethnic communities and consumer groups to
promote the idea of cultural competent health service delivery among their
own membership. In addition to the Chicago and California coalitions mentioned
above, the Cross Cultural Health Care Program of Seattle has done
a superb job of empowering ethnic communities to advocate for appropriate
services; the New York Task Force on Immigrant Health works
on many different levels to educate providers and community representatives
about immigrant health and interpreter services; and a number of community
organizations and coalitions in Massachusetts have long been active
in promoting interpreter and other culturally competent services with
providers, government agencies, and the legislature (Health Care for All,
the Babel Coalitions, MMIA, and the immigrant/refugee advocacy and services
community).
Advocacy work is time-consuming, intensive, and absolutely requires
financial and organizational support. A summary of the factors supporting
effective advocacy for cultural competence and the steps organizations
and coalitions can take are outlined in Appendix 17.
3.2 Capacity for Program
Development and Management
This is an area that has certainly been covered thoroughly by others
for the foundation, and the dimensions of empowering community based organizations
to seek funding for, develop, manage, and evaluate programs have been
well-articulated. One potential intervention would be to sponsor different
levels of introductory and continuing education for community organization
staff to develop their skills in these areas. These could range from evening
or day-long workshops to more intensive week, month, or semester-long
programs. Models for this include the Support Centers classes for
non-profit organizational management, and the Western Consortium for
Public Health's public health leadership institute for professional
public health managers. Unlike these models, such educational programs
would focus specifically on health program development and management,
and be targeted at community organization staff. It would probably require
resources for both training, curricula development, and funds to defray
the cost of attendance, and could be developed and run by a collaboration
between university programs, non-profit organizations, and experienced
community organization leaders.
Summary Recommendations for 3
- Support formation of community coalitions to engage in advocacy activities
around linguistically and culturally competent health care services
and policy.
-
Support community based oversight of health provider organizations
participate policies, and implementation of government policies on
cultural competence.
-
Promote awareness of civil rights laws and other policies on cultural
competence with ethnic communities, community based organizations
and other consumer groups, including insurance purchaser alliances.
-
Support development of a manual on civil rights advocacy and complaint
filing, and the training of ethnic communities and community based
organizations on the awareness and defense of civil rights, especially
related to language access.
-
Support other models of community empowerment, and provider and policymaker
education on cultural competence issues.
-
Support program development and management skills education for ethnic
community based organizations and health providers
Contacts, Resources, References
3
Public Advocates, Inc.
Latino Coalition
1535 Mission Street
San Francisco, CA 94103
415-431-7430
Kathy Poulos-Minott
Crossing Cultures
85 Lester Drive
Portland, ME 04103
207-878-5196
Wendy Siegel
Millenia Consulting
407 S. Dearborn, Suite 600
Chicago, IL 60605
312-922-9929
MILLENIA@IGC.APC.ORG
Bookda Gheisar
Cross Cultural Health Care Program
Pacific Medical Center
1200 12th Ave. South
Seattle, WA 98144
Ernest Winsor, Esq.
Babel III Coalition
Massachusetts Law Reform Institute
617-357-0700
Sherry Hirota
Asian Health Services
818 Western Street
Oakland, CA 94607-4220
510-465-3271
Bob Marra
Health Care for All
30 Winter Street, 10th Floor
Boston, MA 02108
617-350-7279
Francesca Gany
NY Task Force on Immigrant Health
NYU School of Medicine
New York, NY 10016
212-263-8783
GANY@IS.NYU.EDU
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3.
Community Capacity Building