Helping our Neighbor Webinar Series

Transcription

1 Helping our Neighbor Webinar Series Lending a Helping Hand: Implementing HUD s Smoke-Free Public Housing Rule Presented by: Tobacco Prevention and Control Branch, N.C. Division of Public Health

2 Joining the Audio TO USE YOUR COMPUTER'S AUDIO: When the webinar begins, you will be connected to audio using your computer's microphone and speakers (VoIP). A headset is recommended. --OR-- TO USE YOUR TELEPHONE: If you prefer to use your phone, you must select "Use Telephone" after joining the webinar and call in using the numbers below. +1 (562) Access Code: Audio PIN: Shown after joining the webinar

3 Housekeeping All participants are automatically muted. To ask a question please type your question in the question box. Questions will be answered at the end. If you are joining via phone ONLY, you will not be able to ask questions. Please us any questions you have after the webinar. During the question and answer session at the end, please click the Raise Hand button to indicate that you would like to speak.

4 Overview In November 2015, the U.S. Department of Housing and Urban Development (HUD) proposed a rule to make all public housing smoke-free. On November 30, 2016 HUD Secretary Julian Castro announced that public housing developments in the U.S. will be required to provide a smoke-free environment for their residents. The final rule includes input from more than 1,000 comments received from the public, including Public Housing Agencies (PHAs), housing and public health organizations, and residents. TPCB began offering this train-the-trainer webinar series for public health staff on October 13, The webinars teach public health staff how to engage residents and staff of public housing in the process of going smoke-free.

5 Purpose Brings you: Evidence-based and culturally relevant strategies to assist with smoke-free public housing implementation Tools that are supported by the: Tobacco Prevention and Control Branch Office of Minority Health and Health Disparities HUD NAATPN Local Health Departments and other partners Is intended for: Local Health Departments, health educators, public health, partners

6 Helping our Neighbor Webinar Series Date Presenter / Topic October 13 RECORDED December 6 TODAY! RESCHEDULED 2:00pm - 3:30pm January 12 10:00am-11:30am February 9 10:00am-11:30am March 9 10:00am-11:30am Anna Stein and Pam Diggs Chronic Disease and Injury Section, N.C. Division of Public Health Preparing for HUD s Smoke-Free Housing Rule Lucretia Hoffman Office of Minority Health and Health Disparities, N.C. Division of Public Health Implicit Bias and Cultural Competency: Preparing to Engage Residents Cornell P. Wright Office of Minority Health and Health Disparities, N.C. Division of Public Health Community Engagement and Cultural Humility: How to Engage Residents Michael Scott National African American Tobacco Prevention Network Pathways to Freedom: Tailored Tobacco Cessation Resources for African Americans Tamara Atkinson Tobacco Prevention and Control Branch, N.C. Division of Public Health The Spirit of Motivational Interviewing: Fostering Collaboration and Support

7 HUD s Smoke-Free Public Housing Final Rule Posted in the Federal Register on December 5, 2016: Instituting Smoke-Free Public Housing

8 The Final Rule Will Require more than 3,100 public housing agencies to implement smoke-free policies within 18 months of the final rule being adopted. Prohibit the use of cigarettes, cigars, pipes, and hookah (waterpipes) in all living units, indoor common areas and administrative offices. Prohibit the use of tobacco products covered by the policy in outdoor areas within 25 ft. from buildings. Allow for further restrictions (e.g., buffer around playgrounds, restrict smoking to designated outdoor areas, property-wide smoke-free policy). Apply to all housing types, including single family units.

9 The Final Rule Will (cont d) Require PHAs to document their smoke-free policies in their PHA plans, a process that requires resident engagement and public meetings. Help improve the health of more than 2 million public housing residents, including 760,000 children. Save an estimated $153 million every year in costs from secondhand smoke attributable healthcare, repairs of smokepermitted units and smoking attributable fires. Impact the more than 940,000 units that are currently not smokefree, including more than 500,000 units inhabited by elderly individuals.

10 The Final Rule Does Not Cover Housing units in mixed finance developments Privately owned, federally subsidized multifamily housing (i.e., referred to as Project-based Section 8 housing) Electronic cigarettes o Public housing authorities may find it beneficial to include e- cigarettes in their individual smoke-free policies.

11 What Can Local Health Departments Do? Local health departments can: Help train housing staff Provide an information session to residents on the health impacts of secondhand smoke Discuss the benefits of a smokefree policy Provide information on QuitlineNC Possibly provide on-site cessation classes and other resources to help residents quit smoking Assist with compliance issues

12 Smoke-Free Housing Resources

13 Available Resources CDC Infographic HUD Backgrounder HUD Action Guide Message Map Window Clings October 13 Preparing for HUD s Smoke-Free Public Housing Rule Webinar Listening Session Guide Resident Flyers

14 14 o Incorporates information from HUD s October 2012 Federal Register Notice soliciting feedback on the Department s smoke-free housing initiative (summarized in Appendix) o Reasons to go smoke-free o Steps to adopt + implement a smoke-free policy o Recommendations from 9 housing managers with experience implementing smoke-free policies o FAQs

15 Message Map

16 Window Clings

17 Resident Flyers

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19 2 Karen Caldwell David Willard Northampton Camden Alleghany Rockingham Gates Currituck Ashe Surry Warren Stokes Caswell Person Vance Hertford Pasquotank Halifax Mitchell Watauga Wilkes Granville Perquimans Yadkin Forsyth Orange Avery Guilford Franklin Bertie Chowan Yancey Caldwell Alexander Davie Alamance Durham Nash Madison Edgecombe Washington Burke Iredell Martin Dare Buncombe Davidson Wake Tyrrell Tyrell Haywood McDowell Catawba Randolph Chatham Wilson Swain Rowan Pitt Beaufort Graham Rutherford Lincoln Johnston Hyde Jackson Henderson Lee Greene Cabarrus Gaston Stanly Moore Harnett Cherokee Macon Transylvania Polk Cleveland Wayne Lenoir Montgomery Craven Clay Mecklenburg Pamlico Cumberland Union Anson Richmond Sampson Jones Hoke Duplin Scotland Carteret Onslow Robeson Bladen Pender 1 Tobin Lee tobin@mountainwise.org Tobacco Prevention and Control Branch (TPCB) Funding Regions Carleen Crawford Carleen.Crawford@mecklenburgcountync.gov 5 Mary Gillett David.Willard@apphealth.com Catherine.Mulvihill@wakegov.com mgillett@myguilford.com Lead Counties 6 Ashley Curtice acurtice@co.cumberland.nc.us 7 Michelle Mulvihill Columbus Brunswick New Hanover 9 Lisa Phillips Lisa.Phillips@arhs-nc.org 10 vacant, contact Allison Swart allison.swart@pittcountync.gov 1. Macon County Public Health 2. Rutherford-Polk-McDowell District Health Department 3. Appalachian District Health Department 4. Mecklenburg County Health Department 5. Guilford County Department of Health and Human Services, Public Health Division 6. Cumberland County Public Health Department 7. Wake County Human Services 8. Robeson County Department of Public Health 9. Albemarle Regional Health Services 10. Pitt County Health Department 8 Ernest Watts ernest.watts@hth.co.robeson.nc.us As of December 2016

20 For Further Information or Assistance from the Tobacco Prevention and Control Branch Sally Herndon, MPH Branch Head (919) Jim Martin, MS Director of Policy and Programs (919) Pam Diggs, MPH Director of Local Program Development and Regulations (919) Ann Staples, MA Director of Communication and Education (704) Joyce Swetlick, MPH Director of Tobacco Cessation (919) Tamara Atkinson, MSW, LCSW Tobacco Treatment Specialist (919) Anna Stein, JD, MPH Legal Specialist (919) Courtney Heck, MPH Director of Surveillance and Evaluation (919)

21 Questions??

22 Helping our Neighbor Webinar Series Date Presenter / Topic October 13 RECORDED December 6 TODAY! RESCHEDULED 2:00pm - 3:30pm January 12 10:00am-11:30am February 9 10:00am-11:30am March 9 10:00am-11:30am Anna Stein and Pam Diggs Chronic Disease and Injury Section, N.C. Division of Public Health Preparing for HUD s Smoke-Free Housing Rule Lucretia Hoffman Office of Minority Health and Health Disparities, N.C. Division of Public Health Implicit Bias and Cultural Competency: Preparing to Engage Residents Cornell P. Wright Office of Minority Health and Health Disparities, N.C. Division of Public Health Community Engagement and Cultural Humility: How to Engage Residents Michael Scott National African American Tobacco Prevention Network Pathways to Freedom: Tailored Tobacco Cessation Resources for African Americans Tamara Atkinson Tobacco Prevention and Control Branch, N.C. Division of Public Health The Spirit of Motivational Interviewing: Fostering Collaboration and Support

23 Implicit Bias & Cultural Competence Webinar Lucretia Hoffman MPH, MBA Cultural and Community Health Initiatives Consultant II Office of Minority Health & Health Disparities NC Department of Health & Human Services

24 Welcome from the Presenters Lucretia Hoffman, MPH, MBA MDPP Program Contact Cultural & Community Health Initiatives Consultant NC Office of Minority Health & Health Disparities 2

25 About the Office of Minority Health & Health Disparities (OMHHD) OMHHD Established in in 1992 by by the the North Carolina General General Assembly Assembly Minority Health Council Minority Health Council Mission: To promote and and advocate for for the the elimination elimination of of health health disparities disparities among all racial and among ethnic all racial minorities and ethnic and other minorities and underserved other populations underserved in North populations Carolina. North Carolina. Vision: All North Carolinians will will enjoy good good health health regardless regardless of of race/ethnicity, disability race/ethnicity, or socioeconomic disability or status socioeconomic status Consultation & Support: Governor Governor Minority Minority Health Health Council Council Division of Public Division Health of Public (DPH) Health (DPH) Local Health Departments (LHDs) Citizens

26 4 Thank you

27 Today s Agenda Overview of Implicit Bias Implicit Bias in Public Health Strategies for Combating Implicit Bias Including Cultural Competence & Health Equity Principles National CLAS Standards Strategies for Working with Public Housing Residents Audience Questions 5

28 6 Before We Get Started

29 Questions for Audience How strong/important is your racial or ethnic identity to you? Very Strong/Important Somewhat Strong/Important Not Strong/Important I ve never thought about it 7

30 Questions for Audience In an average week, how many hours do you spend with people who are racially or culturally different from you at work? <10 hours hours hours hours 8

31 Questions for Audience In an average week, how many hours do you spend with people who are racially or culturally different from you in your private life? <10 hours hours hours hours 9

32 Questions for Audience On average, what percentage of your time is spent talking about or working on issues related to tobacco? <25% 50% 75% 100% 10

33 Questions for Audience On average, what percentage of your time is spent having conversations or interacting with people who live in public housing? <25% 50% 75% 100% 11

34 Questions for Audience How would you rate these experiences? Mostly positive Positive Neutral Negative Mostly negative 12

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36 What is Implicit Bias An unfavorable opinion, evaluation, or feelings toward a group of people Automatic Unconscious Not explicit You don t have to endorse it May contradict your stated beliefs Activated quickly by situational cues Skin color, accents, body language Influences our perception, memory, and behavior

37 Can people of color or members of stigmatized groups be biased against other people of color or members of their affinity group? YES. 15

38 16 Where Does Implicit Bias Come From?

39 Stereotypes about Public Housing & Residents Source: Gage Gallery - Roosevelt University Source: Clip art Source: Chicagoist.com Source: News & Observer 17

40 HUD Resident Characteristic Report: Public Housing in NC vs. USA Characteristics North Carolina United States 18

41 What Implicit Bias Looks Like in Public Health and Health Care Biased Policies Paternalism Health Disparities Clinician Bias Unequal Access to Care Source: Under the Radar: How Unexamined Biases in Decision-Making Processes in Clinical Interactions Can Contribute to Health Care Disparities, American Journal of Public Health

42 What Implicit Bias Looks Like in Public Health and Health Care Racial Empathy Gap Six (6) experiments Looked at how White participants brains responded to viewing pain inflicted on others People assume that, Blacks feel less pain because they have faced more hardship (relative to Whites) Unconscious Bias Among Primary Care Providers 40 PCPs and 269 patients in Baltimore PCPs with U.R.B. Dominate conversations with African-American patients during routine visits Paying less attention to patients' social and emotional needs Make patients feel less involved in decision making related to their health Source: Racial Bias in Perceptions of Others Pain. Trawalter et al Source: "Unconscious" Racial Bias Among Doctors Linked To Poor Communication With Patients, Dissatisfaction With Care. American Journal of Public Health Implicit Bias Among PCPs vs. Community Members 210 PCPs in Colorado working in different settings No significant difference between PCP and community bias Almost 2/3 of PCPs showed a implicit bias towards Latinos Confirmed previous findings about bias against African Americans Source: Assessment of Biases Against Latinos and African Americans Among Primary Care Providers and Community Members American Journal of Public Health,

43 "It's hard to change subconscious attitudes, but we can change how we behave once we are made aware of them. ---Lisa A. Cooper, M.D., M.P.H. Johns Hopkins University School of Medicine.

44 Assess Your Bias Project Implicit is a non-profit organization and international collaboration between researchers Test Types: Age Presidents Weapons Sexuality Skin-tone Gender-Career Disability Asian Arab-Muslims Weight Race Gender

45 Strategies to Combat Implicit Bias National Center for State Courts: Raise awareness of implicit bias Seek to identify and consciously acknowledge real group and individual differences Routinely check thought processes and decisions Identify distractions, sources of stress and ambiguities Institute feedback mechanisms Increase exposure to stigmatized group members and reduce exposure to stereotypes Practice cultural competence and health equity Source: Clip art 23

46 24 Cultural Competence & Health Equity

47 What is Cultural Competence? On-going and continuous process Learning and building new skill sets Cultural Competence Enable us to work and live in diverse situations with diverse people.

48 Levels of Cultural Competence Individual Organizational

49 Why is Cultural Competence Important? Culture is Important! Shapes identity and experience Has major impact on health Lack of culturally responsiveness can lead to health inequalities and disparities.

50 Why is Cultural Competence Important? North Carolina is Changing The 9 th largest state in the USA Population increased by 1.87 million people between 2000 and 2014 Major shifts Types of Employment Rural to Urban More racially and ethnically diverse Growing Immigrant Population

51 North Carolina s Aging Population 3.6 million people ages 60 and over People ages 60+ People 65 and over: 9th largest population in the USA of NC Population 20% are minorities; 2% speak English less than very well 1.4% are responsible for grandchildren People ages 65+ More than 20,000 migrated from other states and abroad Expected to double: 1.5 to 2.5 million in 20 years of NC Population In 2025, 1 in 5 North Carolinians will be 65 and older. Source: NC DHHS: Aging and Adult Services,

52 The Other Reasons Cultural Competence is Important Address and counter the effects of racism Institutionalized Personally-mediated Internalized Prevent bias and discrimination Identify barriers to quality care and effective interventions Promote Health Equity

53 Health Equity Healthy People 2020: The attainment of the highest level of health for all people. Centers for Disease Control and Prevention: When every person has the opportunity to attain his or her full health potential

54 National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care Principle Standard Governance, Leadership and Workforce Communication and Language Access To advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations Engagement, Continuous Improvement and Accountability

55 National CLAS Standards A copy is included in the handouts. Can be found online: 33

56 CLAS in Action Principal Standard Governance, Leadership & Workforce Communication & Language Access Engagement, Continuous Improvement & Accountability Effective & Equitable Diversify Your Leadership & Workforce Materials & Services Available in Multiple Languages (Written & Non- Written) Partner & Collaborate with Community Members Respectful & Understandable Allocate Resources Materials & Signage are Easy to Read & Understand Assess Responsive Strategic Planning Hire and/or Train Certified Interpreters Share Information & Communicate Educate & Train Use Culturally- Specific Media, Cultural Brokers or Patient Navigators Conflict Resolution

57 Health Literacy Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. -- US Department of Health & Human Services Identify and understand your target audience Keep it simple Use plain language Avoid jargon Use visuals Offer assistance Pretest with your target audience 35

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59 Working with Blacks/African Americans: Things to Remember Black people/african Americans are not a monolith: Differences: Belief systems, Countries, Socio-economic status Cultures Dialects/vernacular Foods Religions Interpretations Education levels, etc.

60 Working with Blacks/African Americans Things to Remember Black people are not dark-skinned white people. Thomas J. Burrell

61 Tobacco Ads Targeting African Americans in the 1980s & 1990s Source: National African American Tobacco Prevention Network & NC Tobacco Prevention & Control Branch

62 Working with Blacks/African Americans Things to Remember Strengths-based approach Culturally-centered messaging and programs National African American Tobacco Prevention Network (NAATPN) webinar in February 2017 Understand roles, values and history

63 African- Americans in North Carolina: At a Glance African American Population: 2.19 million in 2014; Source: NC State Center for Health Statistics, 2015

64 African- Americans in North Carolina Mary Jane Patterson Educator & First African American woman to earn a Bachelor s degree Hiram Revels Academic & First African American in the United States Senate. Charlotte Hawkins Brown Educator & Founder, Palmer Memorial Institute Harriet Ann Jacobs Writer & Abolitionist Loretta Lynch Attorney General of the United States The Greensboro 4 Students & Civil Rights Activists 42

65 African Americans in North Carolina Thelonius Monk Nina Simone Musician & Activist Romare Bearden - Artist Chris Paul - Athlete John Coltrane -Saxophonist, Musician, Composer Roberta Flack Singer & Songwriter 43

66 NC s Historically Black Colleges & Universities Barber-Scotia College (1867) Bennett College (1873) Elizabeth City State University (1891) Fayetteville State University (1867) Johnson C. Smith University (1867) Kittrell College ( ) Livingstone College (1879) North Carolina A & T State University (1891) North Carolina Central University (1910) St. Augustine s University (1867) Shaw University (1865) Winston-Salem State University (1892) 44

67 African-American Health in North Carolina: At a Glance

68 African-American Health in North Carolina The Good News HBCUS with Tobacco Use Policies 100% Tobacco-Free Private Institutions: Barber-Scotia, Johnson C. Smith, Bennett College 100 Perimeter Public Institutions: Elizabeth City State University, Winston-Salem State University 50 Perimeter Public Institutions: NC Central University

69 African Americans & Tobacco in NC North Carolina is the largest tobacco producer Black working and middle class Rocky Mount, Durham and Winston-Salem African American women were majority of tobacco labor force in 1930s Majority of workers at R.J. Reynolds Financial support of HBCUs Impact of anti-tobacco policies and laws on economic stability in those communities Public health victories and negative economic impacts for many communities Factory workers Tobacco growers Complementary industry workers Source: Clip art 47

70 Strategies for Engaging Public Housing Residents & Managers Identify leaders or gatekeepers within the community Understand roles and values of the community Have a diverse workforce that utilizes culturally and linguistically proficient and competent interventions: Developed within the target communities Adaptation of evidence based practices Understand/ have an awareness of structural and social barriers Continuous evaluation and improvement 48

71 Outreach Strategies for Public Housing Multigenerational approach: Pre-adolescents through Seniors Craft your messages National Center for Health in Public Housing: Door to Door Work with Established Groups: Community Events Host and participant/volunteer Individual/One on One Remember the Importance of Word of Mouth Source: National Center for Health in Public Housing 49

72 Resources Available to You North Carolina: NC Division of Aging and Adult Services: North Carolina Office on Disability and Health www2.ncdhhs.gov/dph/wch/aboutus/disability.htm Nationally: National Institute on Aging: Quitting Smoking for Older Adults U.S. Administration on Aging: A Toolkit for Serving Diverse Communities: Centers for Disease Control and Prevention: A Practitioner s Guide for Advancing Health Equity: Community Strategies for Preventing Chronic Disease National Council on Aging: Cultural Competence and Benefits Access Issue Brief SAMHSA: Smoking Cessation for Persons with Mental Illness 50

73 51 Resources Available to You

74 Remember Assess your bias Health Equity in all policies, practices and procedures Stay engaged, informed and work collaboratively

75 53 Additional Questions

76 Contact Us N.C. Department of Health and Human Services Office of Minority Health and Health Disparities 5605 Six Forks Road Raleigh, NC Telephone: Lucretia M. Hoffman MPH, MBA Program Consultant II Office of Minority Health and Health Disparities Division of Public Health

77 Thank you! 55

78 Sources: Blair, I. V., Steiner, J. F., & Havranek, E. P. (2011). Unconscious (Implicit) Bias and Health Disparities: Where Do We Go from Here? The Permanente Journal, 15(2), Bodenner, C. (2015, June 22). When Do Multicultural Ads Become Offensive? Your Thoughts. Retrieved December 2016, from Yahoo News website: html?ref=gs Centers for Disease Control and Prevention Division of Community Health. A Practitioner s Guide for Advancing Health Equity: Community Strategies for Preventing Chronic Disease. Atlanta, GA: US Department of Health and Human Services; Cooper, L. A., Roter, D. L., Carson, K. A., Beach, M. C., Sabin, J. A., Greenwald, A. G., & Inui, T. S. (2012). The Associations of Clinicians Implicit Attitudes About Race With Medical Visit Communication and Patient Ratings of Interpersonal Care. American Journal of Public Health, 102(5), Dovidio, J. F., & Fiske, S. T. (2012). Under the Radar: How Unexamined Biases in Decision-Making Processes in Clinical Interactions Can Contribute to Health Care Disparities. American Journal of Public Health, 102(5), Famous People Born in North Carolina. (2016). Retrieved November 2016, from Biography.com website: Gale, H.F, Foreman, L. & Capehart, T. Tobacco and the Economy: Farms, Jobs, and Communities; Economic Research Service, U.S.Department of Agriculture, Agricultural Economic Report No

79 Sources: Groneman, Carol.Norton, Mary Beth. (Eds.) (1987) "To toil the livelong day" :America's women at work, Ithaca, N.Y. : Cornell University Press, HUD Resident Characteristics Report ng/systems/pic/50058/rcr National Initiative for Building Community Trust and Justice. (2016). Implicit Bias. Retrieved October 2016, from National Center for State Courts. (2012). Strategies to Reduce the Influence of Implicit Bias. Retrieved October 2016, from Fairness/IB_Strategies_ ashx National Council on Aging. (2011, November). Cultural Competence and Benefits Access Issue Brief. Retrieved 2016, from National Centers for Outreach and Benegits: NC DHHS: Aging and Adult Services. (2015, December). North Carolina is Aging. Retrieved from NC DHHS: 57

80 Sources: NC Office of Minority Health & Health Disparities. (2006, August). Cultural Diversity Foundation Training Initiative Participant Training Guide. Raleigh, North Carolina National Council on Aging: Cultural Competence and Benefits Access Issue Brief NCPedia.org. (2012, January 1). North Carolina's Historically Black Colleges and Universities (HBCUs). Retrieved 2016, from North Carolina Office of State Budget and Management. (n.d.). Facts & Figures. Retrieved 2016, from North Carolina Office of State Budget and Management: NC State Center for Health Statistics. (2015, November). North Carolina Resident Population Health Data by Race and Ethnicity. Retrieved from Plain Language. (n.d.). Retrieved 2015, from National Institutes of Health : Population Growth, A J2014. (n.d.). Retrieved 2016, from NC State Office of State Budget and Management: 58

81 Sources: Project Implicit. (2011). About Us. Retrieved September 2016, from Project Implicit website: Project Implicit. (2011). Frequently Asked Questions. Retrieved September 2016, from Project Implicit websit: SAMHSA.Gov. (2009, January). Smoking Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health Providers. Retrieved December 2016, from SAMHSA.gov website: Trawalter S, Hoffman KM, Waytz A (2012) Racial Bias in Perceptions of Others Pain. PLoS ONE 7(11): e doi: /journal.pone University of North Carolina at Chapel Hill. (2016, May 9). Center for Women s Health Research. Retrieved June 2016, from University of North Carolina at Chapel Hill: U.S. Administration on Aging: A Toolkit for Serving Diverse Communities: U.S Department of Health and Human Services.(n.d).Quick Guide to Health Literacy: Fact Sheet. Retrieved from: Watkins, M. D. (2013, May 15). What Is Organizational Culture? And Why Should We Care? Harvard Business Review. 59