Health literacy strategies. Caring for immigrants, refugees, and migrant workers

Transcription

1 Health literacy strategies Caring for immigrants, refugees, and migrant workers

2 Foreign-born people living in the United States Immigrants 42.4 million or about 13% of the population Refugees 3 million or about 1% of the population Migration Policy Institute and Pew Research

3 Today s agenda Cross-cultural communication Trauma-informed care Overcoming language barriers Strategies to build understanding

4 Cross-cultural communication and trauma-informed care

5 Cross-cultural communication It involves: An awareness and acceptance of cultural differences Self-awareness Knowledge of the client s culture Adaptation of skills Culturally Competent Health Care for Adolescents, AMA, 1994

6 Structural competency

7 Culturally-informed messaging Use words people in the community use Use key informants to check messaging ahead of time Partner relays

8 Features of culturallyinformed organizations Ongoing training for staff and professionals Workforce that reflects client s cultural mix Translation and interpretation services Cultural Competency in Practice Migrant Health News

9 Features of culturallyinformed organizations Services adapted to the specific needs of the client population Treatment outcomes measured by racial, ethnic, and language groups Cultural Competency in Practice Migrant Health News

10 Other strategies for lowering barriers to care Commit to engaging communities by building relationships in the community - leadership councils, patient advisory boards, community outreach committees Building trusting relationships Bringing in providers and resources that the community values shamans, build community gardens Garnering social capital Not collecting or keeping immigration or insurance information Not charting social history using proxy data such as preferred language, race, and ethnicity

11 Other strategies for lowering barriers to care Using mostly spoken communications, not written Support clients in navigating the system - eligibility counseling, enrollment support, case management for referrals and financial assistance, transportation assistance Home health education programs using easy-to-understand tools such as wands, culturally relevant food plates, and tailored evaluation tools Create a welcoming environment

12 Cultural backgrounders Syria Democratic Republic of the Congo Darfur Iraq Cultural Orientation Resource Center

13 More cultural backgrounders immigrantrefugeehealth/ profiles/index.html

14 What is trauma-informed care? A Shifts trauma the focus informed from: approach to care perceives What s wrong trauma with not you? simply to as a past event but What as happened a formative to one you? that may be contributing to the client s current state or circumstances. To be trauma-informed is to understand clients and their symptoms in the context of their life experiences and cultures, with an appreciation that some symptoms may represent efforts at coping. Trauma Informed Care and Mental Health, 2011

15 5 strategies for trauma-informed care Choice Trustworthiness Collaboration Safety Empowerment

16 Working with interpreters

17 Section 1557: It s the law. Qualified interpreter Interpreter must be ethical, medically accurate, and professionally trained. No cost to client Provider is responsible for providing and paying for the qualified interpreter. No children or families Children and families may not interpret unless there is an immediate threat to safety and no available interpreters. Critical Measures, University of Minnesota Medical School

18 Trauma-informed interpreting Experiences of betrayal by authority figures may cause distrust of providers In small communities, clients and interpreters may know each other, which requires training and confidentiality contracts Recognizing that stigma may stop clients from talking about experiences and symptoms Interpreters as cultural ambassadors NPCT Interpreting Guide

19 Working with an interpreter before the visit Learn your client s preferences Try to get the same interpreter for each visit Schedule extra time for the visit Brief the interpreter on the visit Interpreters in Mental Health Minas

20 Working with an interpreter during the visit Introduce everyone Sit so everyone can see each other Keep your sentences short Redirect when needed Interpreters in Mental Health Minas

21 Working with an interpreter during the visit Look at your client, not the interpreter Avoid jargon Pay attention to body language Interpreters in Mental Health Minas

22 Working with an interpreter after the visit Check in with your interpreter after the appointment to hear any comments they have and what they may have found confusing or distressing. Interpreters in Mental Health Minas

23 Resources for translated health materials nlm.nih.gov/ patient-education translations.org/

24 Other strategies to improve health literacy Plain language Teach-back Building client-provider relationships

25 What is plain language? Communication your audience can understand the first time they read or hear it. Plainlanguage.gov, 2016

26 Define or replace jargon Abstinence not doing something Access able to get Acquire get Burden cost or result Contact call or touching Disseminate tell Evaluate test Implement start or set up Initiative program Manage take care of Modify change Outcome result Preparedness ready for Risk chance

27 Focus on the 3 most important points Prioritize the information you give: Choose 3 important points you want to cover in the message Prioritize need-to-know versus nice-to-know information Example: A community member with asthma Need-to-know information is information about an action step, such as how to use an inhaler Nice-to-know information is information that the client won t act on, such as how many people have asthma in the United States Focus on the 3 most important points

28 The Teach-back method Explain a new concept Ask the client to explain the concept back to you again Ask the client to explain the concept back to you Review any points the client missed Schillinger et al., 2003

29 Be conscious of how you speak Tips to create a client-centered environment: Speak slowly about the pace of an audio book Follow the client s lead on eye contact, distance, and seating Speak in a friendly tone of voice Pay attention to how you speak

30 Client-provider relationships matter Use empathy and ask open-ended questions to build trust with your clients When providers used empathy or asked questions, clients were more than twice as likely to follow treatment recommendations When providers didn t use empathy and ask questions, clients were 19% more likely to not follow treatment recommendations Zolnierek & DiMatteo, 2009

31 Get in touch Megan Rooney Twitter.com/HealthLitMedia Facebook.com/HealthLiteracyMedia