|
|
|
Please press CTRL+P to print this page
2012 Model Practice Application (Public)Application Name: 2012 Model Practice Application (Public) : Bloomington Public Health : Public Health Cultural Competence Assessment Applicant Name: Ms. Lisa Brodsky Application Title: Public Health Cultural Competence Assessment Please enter email addresses you would like your confirmation to be sent to. lbrodsky@ci.bloomington.mn.us Practice Title Public Health Cultural Competence Assessment Submitting LHD/Agency/Organization Bloomington Public Health Head of LHD/Agency/Organization Karen Zeleznak Street Address 1900 West Old Shakopee Road Practice Contact Person Lisa Brodsky Title Emergency Preparedness Coordinator lbrodsky@ci.bloomington.mn.us Submitting LHD/Agency/Organization Web Address (if applicable) www.ci.bloomington.mn.us Provide a brief summary of the practice in this section. This overview will be used to introduce the model or promising practice in the Model Practices Database. Although this section is not judged, the judges use it to get an overall idea about your practice. You must include answers to the following questions in your response:
• Size of population in your health department’s jurisdiction
• Who is your target population/audience, for this practice
• Size of target population/audience, if applicable
• The number or percentage of the target population/audience reached, if applicable
• Describe the nature and gravity of the public health issue addressed
• List the goal’s and objective(s) of the practice and clearly link them to the problem or issue the practice is addressing. Briefly indicate what the practice intends to accomplish overall.
• When (month and year) the practice was implemented.
• Briefly describe how the practice was implemented, what were major activities, and any start-up and in-kind costs and funding services.
• Outcomes of practice (list process milestones and intended/actual outcomes and impacts.
• Were all of the objectives met?
• What specific factors led to the success of this practice?
• Lessons learned from the practice Since 1977, BPH has been providing community-based health services to the southern Hennepin County communities of Bloomington, Edina, and Richfield (BER). The three communities have a combined population of more than 168,000 people. The National Standards on Culturally and Linguistically Appropriate Services (CLAS) are proposed as one means to correct inequities that currently exist in the provision of health services and to make these services more responsive to the individual needs of all consumers. BPH worked with Stratis Health to modify their current CLAS assessment tool to reflect the needs of public health, with funding from the UCare Foundation. The project focused on the unique cultural challenges and barriers public health agencies face, including but not limited to, population health issues, system challenges, and coordination with community resources as well as incorporation of national accreditation standards related to culture. Once the CLAS assessment tool was modified, all recommendations from the original CLAS assessment were reviewed for applicability to the public health setting. New and revised CLAS assessment questions were researched for the best recommendations related to improving the cultural issues as it relates to public health and other applicable settings. A gap analysis template was updated with the revised/newly created questions and corresponding recommendations incorporated into the existing template. The gap analysis consisted of a comparison of desired activities needed to meet each standard with activities being conducted in the public health agency linked with the actual scoring from each agency. Stratis Health incorporated recommend strategies that the agency may use to bridge the gaps in each individual CLAS Assessment Gap Analysis Report. Computer and reporting systems were to incorporate the revisions and additions to existing programming and structure. BPH recruited five public health agencies to participate as pilots for the project. Pilot sites included: • City of Minneapolis • Sibley County • Ottertail County • Southwest Health and Human Services • Washington County The Public Health CLAS Assessment was then piloted within the state of Minnesota utilizing supporting material developed. The pilot agencies received an online CLAS assessment tool and instructions for use within their agency. The project began in September 2010 and was completed in July 2011. All objectives were met and results were presented at the Statewide Community Health Services conference in September 2011. Overflow: Please finish the response to the question above by using this text area. Please be mindful of the word limits. Following completion of the Public Health CLAS Assessment, a summary report with gap analysis and recommendations was provided during an onsite visit to each public health agency as well as consultation on how to utilize the report in strategic planning, staff development, systems planning, etc. Pilot agencies received numerous resources to assist them in their efforts to become more culturally competent. An aggregate gap analysis summary of all participating agencies that participated in the pilot is attached.
Goals and objectives included:
1. Revise clinical CLAS Assessment tool to be more public health focused.
2. Provide guidance, resources and tools to increase cultural awareness.
3. Help public health agencies meet the unique and growing needs of Minnesota’s diverse populations.
Describe the public health issue that this practice addresses. (350 word limit)
A growing body of authority provides evidence that racial and ethnic minorities tend to receive lower quality health care than non-minorities—even when access-related factors are controlled, such as patient insurance and income. The Institute of Medicine's 2002 report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care revealed that failing to support and foster culturally competent health care can increase costs for the individual and society through increased hospitalizations and complications.
Medical and public health providers across Minnesota are now providing care to an increasingly more diverse patient population that may not speak English, may not be familiar with Western medical customs, and may be distrustful of the American way of delivering health care.
The National Standards on Culturally and Linguistically Appropriate Services (CLAS) are proposed as one means to correct inequities that currently exist in the provision of health services and to make these services more responsive to the individual needs of all patients/consumers. The national CLAS Standards are a set of 14 mandates, guidelines, and recommendations developed in 2001 by the Office of Minority Health, to inform, guide, and facilitate organizations in their efforts to improve culturally and linguistically appropriate health services. The standards are intended to be inclusive of all cultures and not limited to any particular population group or sets of groups. However, they are especially designed to address the needs of racial, ethnic, and linguistic population groups that experience unequal access to health services. Ultimately, the aim of the standards is to contribute to the elimination of racial and ethnic health disparities and to improve the health of all Americans.
The CLAS standards are primarily directed at health care organizations. The principles and activities of culturally and linguistically appropriate services should be integrated throughout an organization and undertaken in partnership with the communities being served.
What process was used to determine the relevancy of the public health issue to the community? (350 word limit) Bloomington Public Health participated in the initial Stratis initiative with focused on healthcare. BPH Administrative Staff found the results of the survey and the technical assistance from Stratis Health to be very useful, however there were numerous comments from staff regarding the strong “clinic focus” of the survey and how the population-based work of public health staff was not reflected in the survey questions. How does the practice address the issue? Following completion of the Public Health CLAS Assessment, a summary report with gap analysis and recommendations was provided during an onsite visit to each public health agency as well as consultation on how to utilize the report in strategic planning, staff development, systems planning, etc. Pilot agencies received numerous resources to assist them in their efforts to become more culturally competent.
Completion of the CLAS assessment survey by staff increased awareness of the CLAS standards and encouraged reflection on agency activities currently being conducted and possibilities for the future. Awareness of strengths and weaknesses can lead to change and improvement. Is the practice new to the field of public health? If so, answer the following questions. Yes What process was used to determine that the practice is new to the field of public health? Please provide any supporting evidence you may have, e.g. literature review. The CLAS standards are primarily directed at health care organizations; however, individual providers are also encouraged to use the standards to make their practices more culturally and linguistically accessible. The principles and activities of culturally and linguistically appropriate services should be integrated throughout an organization and undertaken in partnership with the communities being served.
Utilizing these standards, Stratis Health, with funding provided by UCare, developed two initiatives to improve the quality of health care delivered through culturally competent services. Through increased clinician-patient understanding and adherence to treatment, the ultimate goal is the reduction of health disparities.
The first initiative, Culture Matters (2005-2008), was very successful. The second, Culture Care Connection began in 2008 and is slated to be complete in July 2010. Throughout both initiatives, Stratis Health provided support to almost 50 Minnesota primary whose patients represented underserved populations or were located in areas with racially or ethnically diverse populations. This approach included development of a package for clinics that highlighted three themes: culturally competent care, language access services, and organizational supports. Stratis Health assisted clinics in completing pre- and post-assessments of the CLAS standards.
BPH worked with Stratis Health to modify their current CLAS assessment tool, a unique product of Stratis Health, in order to create a new tool. There is no other tool that assesses cultural competence of public health agencies and provides strategies specific to individual agencies. How does this practice differ from other approaches used to address the public health issue? This practice created a tool that can be utilized by public health agencies to measure cultural aspects of their agencies. Disbursement of the CLAS Assessment tool among public health agencies assists them to assess their social, cultural, and linguistical approaches to agency processes, programs and interventions. If cultural initiative are implemented, statistically significant improvement between pre-CLAS and post-CLAS Assessment standards among participating public health agencies would be seen. This would lead to an increase in culturally competent care provided by public health agencies and a reduction of racial and ethnic health disparities.
In order to improve the health of the public, the Public Health Accreditation Board has developed a national voluntary accreditation program for state, local, territorial and tribal public health departments. The goal of the accreditation program is to improve and protect the health of every community by advancing the quality and performance of public health departments. Several of the standards developed focus on increasing cultural competency. Measures of success include:
• leading or collaborating in culturally competent initiatives to increase healthcare access for underserved and at-risk populations; and,
• maintaining socially, culturally and linguistically relevant approaches to public health services.
The Public Health CLAS Assessment provides a unique measurement tool that could be used in the documentation for the newly developed voluntary accreditation program for state, local, territorial, and tribal public health departments. Is the practice a creative use of an existing tool or practice? If so, answer the following questions. No What tool or practice (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, etc.); did you use in a creative way to create your practice? (if applicable) (300 word limit total)
a. Is it in NACCHO’s Toolbox; (if not, have you uploaded it in the Toolbox)?
b. If you used a tool or practice to implement your practice, how was your approach to implementing the tool unique and innovative for your target area/population?
What process was used to determine that the practice is a creative use of an existing tool or practice? Please provide any supporting evidence you may have, for example, literature review. How does this practice differ from other approaches used to address the public health issue? Who were the primary stakeholders in the practice? Public Health Agencies and the poluation they serve What is the LHD's role in this practice? This tool was created specifically for the use of local public health in their efforts to become more culturally competent in their service delivery. What is the role of stakeholders/partners in the planning and implementation of the practice? Local public health agencies participated in the pilot project phase of this tool. The provided feedback into the development and relevance of the questions and process. What does the LHD do to foster collaboration with community shareholders? Describe the relationship(s) and how it furthers the practice's goals. Local public health routinely fosters collaboration with community stakeholders by engaging them in program development and analysis of gaps in service delivery. This practice increases awareness of the CLAS standards among shareholders and encourages reflection on local public health activities currently being conducted and possibilities for the future. Awareness of strengths and weaknesses can lead to change and improvement. Describe lessons learned and barriers to developing collaborations There were several themes within the pilot sites. Agencies did well on providing language interpretation as well as offering material in other languages. However, pilot agencies aggregately scored lower on ensuring conflict and grievance resolutions were culturally sensitive as well as implementing strategies to recruit, retain and promote diverse staff and leadership. Both of these standards require collaborative approaches with community shareholders in order to be successful. Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice.
Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).
List up to three primary objectives for the practice. For each objective, provide the following information: (750 word limit per objective)
This initiative modified an existing assessment tool designed for clinics, making it applicable to public health agencies which deliver population-based services. Goals and objectives included:
1. Revise clinical CLAS Assessment tool to be more public health focused.
2. Provide guidance, resources and tools to increase cultural awareness.
3. Help public health agencies meet the unique and growing needs of Minnesota’s diverse populations thus reducing racial and ethnic health disparities.
• Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation. Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback: List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.
BPH worked with Stratis Health to modify their current CLAS assessment tool to reflect the needs of public health agencies. The project focused on the unique cultural challenges and barriers public health agencies face, including but not limited to, population health issues, system challenges, and coordination with community resources as well as incorporation of national accreditation standards related to culture. Once the CLAS assessment tool was successfully modified, all recommendations from the original CLAS assessment were reviewed for applicability to the public health setting. New and revised CLAS assessment questions were researched for the best recommendations related to improving the cultural issues as it relates to public health and other applicable settings.
A gap analysis template was updated with the revised/newly created questions and corresponding recommendations incorporated into the existing template. The gap analysis consisted of a comparison of desired activities needed to meet each standard with activities being conducted in the public health agency linked with the actual scoring from each agency. Stratis Health incorporated recommend strategies that the agency may use to bridge the gaps in each individual CLAS Assessment Gap Analysis Report. Computer and reporting systems were to incorporate the revisions and additions to existing programming and structure.
The Public Health CLAS Assessment was then piloted within the state of Minnesota utilizing supporting material developed. The pilot agencies received an online CLAS assessment tool and instructions for use within their agency. Overflow (Objective 1): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Following completion of the Public Health CLAS Assessment, a summary report with gap analysis and recommendations was provided during an onsite visit to each public health agency as well as consultation on how to utilize the report in strategic planning, staff development, systems planning, etc. Pilot agencies received numerous resources to assist them in their efforts to become more culturally competent. Feedback was obtained on the relevance of the assessment questions as well as the tools and resources offered. Overflow (Objective 2): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Objective 3: The results indicated that while the participating agencies have made inroads toward becoming more culturally competent, there is still a lot of work that needs to be done. All participating pilot agencies provided feedback that the tool created offered assistance in helping them become more culturally competent. Overflow (Objective 3): Please finish the response to the question above by using this text area. Please be mindful of the word limits. What are the specific tasks taken that achieve each goal and objective of the practice? BPH worked with Stratis Health to modify their current CLAS assessment tool to reflect the needs of public health agencies. All recommendations from the original CLAS assessment were reviewed for applicability to the public health setting. New and revised CLAS assessment questions were researched for the best recommendations. Once revisions and recommendations were finalized, Stratis Health worked with BPH to undergo a cross-sectional review by appropriate public health individuals, public health agencies and others.
A gap analysis template was updated with the revised/newly created questions and corresponding recommendations incorporated into the existing template. The gap analysis consisted of a comparison of desired activities needed to meet each standard with activities being conducted in the public health agency linked with the actual scoring from each agency. Stratis Health incorporated recommend strategies that the agency may use to bridge the gaps in each individual CLAS Assessment Gap Analysis Report.
BPH recruited five public health agencies to participate as pilots for the project. The Public Health CLAS Assessment was piloted within the state of Minnesota utilizing supporting material developed. The pilot agencies received an online CLAS assessment tool and instructions for use within their agency.
Following completion of the Public Health CLAS Assessment, a summary report with gap analysis and recommendations was provided during an onsite visit to each public health agency as well as consultation on how to utilize the report in strategic planning, staff development, systems planning, etc.
What was the timeframe for carrying out these tasks? 1) CLAS assessment Modification/Revision, Recommendations, Cross-Sectional Review, and Supporting Materials (September 1, 2010 – February 28, 2011)
2) Programming and Data Analysis (March 1, 2011 – March 31, 2011)
3) Pilot and Summary Reports (April 1, 2011 – May 31, 2011)
4) Data Analysis and Summary Reports (June 1, 2011 – August 31, 2011)
Is there sufficient stakeholder commitment to sustain the practice? Describe how this commitment is ensured. We received several requests from other public health agencies throughout Minnesota to have access to the tool. We are currently investigating how to make this available. Describe plans to sustain the practice over time and leverage resources. Discussions with Stratis Health have begun to enable the tool to be accessible to other local public health agencies. Interest has been expressed by the Minnesota Department of Health. Practice Category Choice 1: Cultural Competence Practice Category Choice 1, Part 2: Practice Category Choice 2: Practice Category Choice 2, Part 2: Practice Category Choice 3: Practice Category Choice 3, Part 2 Check all that apply. E-mail from NACCHO NACCHO Connect |
|
|