Bridging Gaps: The Vital Role of Cultural Competence in Healthcare

00:58:51
https://www.youtube.com/watch?v=QasVBqY4uB0

Summary

TLDRThe webcast 'Public Health Live' focuses on the integration of cultural competence within healthcare systems to bridge gaps in health service delivery for diverse communities. Hosted by Rachel Brier, the program discusses how culturally and linguistically appropriate services (CLASS) enhance healthcare outcomes. Guests Wilma Alvarado Little and James Oar highlight the significance of these standards in addressing healthcare disparities and promoting equity. Emphasis is placed on understanding various cultures, communication, and respectful patient interactions to decrease medical errors and improve care quality. The session details the historical context of organizations like Peekskill Area Health Center and initiatives led by Centro Civico to implement these standards effectively. Challenges such as language misunderstandings are examined, alongside solutions like training and integrating a culturally aware workforce. The webcast underscores ongoing efforts to refine health policies and practices, aiming for a more inclusive healthcare environment.

Takeaways

  • ๐ŸŽ™ Public Health Live webcast focuses on cultural competence in healthcare.
  • ๐Ÿ‘ฅ Guests Wilma Alvarado Little and James Oar discuss vital cultural and linguistic considerations.
  • ๐Ÿ“œ 15 CLASS standards guide healthcare organizations in providing culturally appropriate services.
  • ๐Ÿฅ Peekskill Area Health Center exemplifies grassroots efforts in culturally sensitive healthcare delivery.
  • ๐ŸŒ Cultural competence helps address health disparities and improve patient outcomes.
  • ๐Ÿ—ฃ Language and communication are crucial components for effective healthcare service.
  • โŒ Case of misconstrued term 'intoxicado' highlights importance of accurate communication.
  • ๐Ÿ”— Integration of diverse cultural understanding is needed in healthcare practice and policy.
  • ๐Ÿ“ˆ Continuous improvement and accountability are part of maintaining effective CLASS standards.
  • ๐ŸŒ Organizations like Centro Civico play key roles in supporting diverse communities' health needs.

Timeline

  • 00:00:00 - 00:05:00

    The introduction of the Public Health Live webcast focused on encouraging viewers to complete evaluations and discussed the importance of cultural competence in healthcare. The program aimed to address the benefits of culturally and linguistically appropriate health services and featured guests Wilma Alvarado-Little and James Oar.

  • 00:05:00 - 00:10:00

    James Oar explained that culture encompasses language, customs, and learned behaviors that define groups of people and organizations. He emphasized that healthcare must bridge cultural gaps to create a healthy environment for everyone, noting that culture extends beyond racial and ethnic perceptions to groups such as LGBT and individuals with HIV/AIDS.

  • 00:10:00 - 00:15:00

    James Oar highlighted the importance of cultural sensitivity in healthcare, noting that different meanings in healthcare terminology can impact patient outcomes. Wilma Alvarado-Little introduced the National CLAS Standards, which aim to provide respectful services that consider individual cultural health beliefs and practices.

  • 00:15:00 - 00:20:00

    The National CLAS Standards, developed by the Office of Minority Health, aim to advance health equity and eliminate disparities. They were updated in 2013 and include 15 standards to guide organizations in implementing culturally and linguistically appropriate services.

  • 00:20:00 - 00:25:00

    Demographic changes, such as the majority of babies being born into minority groups, necessitate culturally competent healthcare services. Policies like the Affordable Care Act support these services, and some states have passed legislation for cultural competency education among healthcare providers.

  • 00:25:00 - 00:30:00

    Wilma Alvarado-Little discussed how culturally and linguistically appropriate services can reduce medical errors and improve healthcare delivery. They ensure effective communication, reducing readmission rates and length of hospital stays, thus relieving financial pressures on healthcare systems.

  • 00:30:00 - 00:35:00

    Wilma emphasized the importance of understanding cultural perspectives, such as transportation and childcare issues impacting healthcare access. Recognizing barriers prevents discrimination and improves access to healthcare services.

  • 00:35:00 - 00:40:00

    Dina Ayo, director of the Spanish AIDS Hotline, shared how language-specific services are crucial for Spanish-speaking individuals to access accurate health information, demonstrating a practical application of culturally and linguistically appropriate services.

  • 00:40:00 - 00:45:00

    The discussion outlined the National CLAS Standards, which include governance, leadership, workforce, communication, and language assistance to build culturally competent healthcare organizations. Raising awareness and training staff are key components of effective implementation.

  • 00:45:00 - 00:50:00

    Central Civico in New York was highlighted for its multicultural approach in providing services. By integrating cultural competence into community health initiatives, they addressed diverse needs and encouraged community mobilization.

  • 00:50:00 - 00:58:51

    James Oar shared the historical efforts of Hudson River Healthcare to adapt services for cultural sensitivity, driven by demographics changes and funding for migrant health. This adaptation ensured the organization met the varied needs of its expanding patient base.

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Mind Map

Mind Map

Video Q&A

  • What is the main topic of the webcast?

    The vital role of cultural competence in healthcare.

  • Who are the guest speakers on this episode?

    Wilma Alvarado Little, a language access advocate, and James Oar, the migrant health coordinator.

  • What is the purpose of the CLASS standards?

    To advance health equity, eliminate health disparities, and improve service quality.

  • How many CLASS standards are there?

    There are 15 CLASS standards.

  • What inspired the creation of the Peekskill Area Health Center?

    The lack of accessible, affordable, and culturally competent healthcare for the Black community in Peekskill.

  • What are the three themes of the CLASS standards?

    Governance, leadership, and workforce; communication and language assistance; engagement, continuous improvement, and accountability.

  • What is an example of a cultural misunderstanding affecting health outcomes?

    The case of Willie Ramirez, where a misunderstanding regarding the term 'intoxicado' led to a tragic medical error.

  • Who developed the CLASS standards?

    The U.S. Department of Health and Human Services Office of Minority Health.

  • What is the significance of employing bilingual staff at Central Civico?

    To overcome language barriers and provide essential services to the Latino population.

  • Why is cultural competence important in healthcare?

    It improves communication, reduces medical errors, and enhances health outcomes among diverse patient populations.

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  • 00:00:04
    [Music]
  • 00:00:53
    hello and welcome to Public Health Live
  • 00:00:55
    the third Thursday breakfast broadcast
  • 00:00:57
    I'm Rachel Brier and I'll be your
  • 00:00:59
    moderator today
  • 00:01:00
    before we get started I would like to
  • 00:01:02
    ask that you please fill out your online
  • 00:01:03
    evaluation at the close of the webcast
  • 00:01:06
    continuing education credits are
  • 00:01:07
    available after you take our short post
  • 00:01:09
    test and your feedback is helpful in
  • 00:01:11
    planning future programs we encourage
  • 00:01:13
    you to let us know what topics are of
  • 00:01:14
    interest to you and how we can best
  • 00:01:16
    serve your needs as for today's program
  • 00:01:19
    we will be taking your questions
  • 00:01:20
    throughout the hour by phone our
  • 00:01:22
    toll-free number is 1 1800 452 0662 or
  • 00:01:26
    you may send written questions by email
  • 00:01:28
    please email us at any time through
  • 00:01:29
    throughout the hour at pH live.
  • 00:01:33
    gmail.com today's program is bridging
  • 00:01:36
    gaps the vital role of cultural
  • 00:01:38
    competence and Healthcare on today's
  • 00:01:40
    program we will address the benefits of
  • 00:01:42
    culturally and linguistically
  • 00:01:43
    appropriate Health Services methods for
  • 00:01:45
    providing those services and why
  • 00:01:47
    providing culturally competent care is
  • 00:01:49
    essential to improving overall
  • 00:01:51
    individual and population-based health
  • 00:01:53
    outcomes our guests are Wilma Alvarado
  • 00:01:56
    little a language access Advocate and
  • 00:01:59
    James oar the migrant health health
  • 00:02:01
    coordinator for the Northeast region at
  • 00:02:03
    Hudson River Healthcare Incorporated
  • 00:02:05
    thank you both very much for being here
  • 00:02:07
    thank you for having us to be here so
  • 00:02:10
    we've got a pretty big Topic in front of
  • 00:02:11
    us today cultural and linguistic
  • 00:02:13
    diversity um appropriateness of
  • 00:02:15
    healthcare so James can you start us off
  • 00:02:18
    just by talking about some of the key
  • 00:02:20
    Concepts that we're referring to when we
  • 00:02:22
    talk about
  • 00:02:24
    culture well you're right this is a very
  • 00:02:27
    big topic we could probably spend a
  • 00:02:30
    couple of hours just talking about
  • 00:02:32
    culture um culture is actually a very
  • 00:02:36
    old word originally and it's appropriate
  • 00:02:39
    uh because I deal with Farm Workers it
  • 00:02:41
    originally talked about plants and how
  • 00:02:44
    we help plants grow um but in in our
  • 00:02:50
    time that that definition has changed
  • 00:02:52
    and become really expanded and continues
  • 00:02:55
    to expand uh but it refers to the um uh
  • 00:03:01
    the the the language the Customs the um
  • 00:03:07
    uh the learn behaviors that Define a
  • 00:03:09
    particular group of people or um uh it
  • 00:03:13
    can it can define an organization people
  • 00:03:16
    in an organization and how they behave
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    but these are learned behaviors they are
  • 00:03:20
    not handed down from on high uh and
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    there are many many many cultures and
  • 00:03:26
    this is where Public Health uh has to to
  • 00:03:30
    uh Bridge a gap because especially in
  • 00:03:34
    this country where we're a Melting Pot
  • 00:03:36
    of cultures um the uh uh public health
  • 00:03:41
    is intended to create a healthy
  • 00:03:43
    environment for everyone not just one
  • 00:03:46
    group of people not just certain persons
  • 00:03:49
    but everyone that's the mission of
  • 00:03:51
    Public Health and just to clarify when
  • 00:03:54
    we say culture I think a lot of people
  • 00:03:56
    kind of limit their focus to racial and
  • 00:03:58
    ethnic perceptions but you're referring
  • 00:04:00
    to other groups as well aren't you
  • 00:04:01
    absolutely yeah and and that's why I
  • 00:04:03
    said it continues to expand we might
  • 00:04:05
    have meant that 20 30 40 years ago
  • 00:04:08
    ethnic and U uh uh ethnic diversity but
  • 00:04:13
    um but now we're talking about people
  • 00:04:15
    for example who have HIV AIDS sure um
  • 00:04:19
    they have their own culture deaf people
  • 00:04:23
    have their own culture people who use uh
  • 00:04:26
    uh sign language um LGBT
  • 00:04:30
    uh folks they have their own culture and
  • 00:04:33
    any organization has its own culture its
  • 00:04:36
    own individual culture so talk to me
  • 00:04:39
    about how these individual cultures are
  • 00:04:41
    related to health um well because each
  • 00:04:45
    culture has its own language its own
  • 00:04:48
    meanings um it's uh its own
  • 00:04:51
    understandings um in order to provide
  • 00:04:55
    healthc care we have to at least have a
  • 00:04:57
    sensitivity to the fact that
  • 00:05:00
    what we mean and think as health care
  • 00:05:03
    providers uh may not uh may not be the
  • 00:05:06
    same thing we might use words for
  • 00:05:08
    example that uh people understand
  • 00:05:11
    differently and certainly if people
  • 00:05:13
    speak another language and I think
  • 00:05:15
    wilman's going to give an example of
  • 00:05:17
    that um just uh uh how the different
  • 00:05:22
    meanings can uh alter what it is we're
  • 00:05:26
    able to do so having at least again
  • 00:05:30
    cultural competence I think is not
  • 00:05:32
    exactly the right word um it's very
  • 00:05:36
    difficult to be competent in one's own
  • 00:05:39
    culture but uh to be sensitive to uh and
  • 00:05:43
    aware of the fact that there are other
  • 00:05:45
    cultures and they are not less than ours
  • 00:05:49
    um we are not Superior they are not
  • 00:05:51
    inferior but they're different that's
  • 00:05:54
    all so coming from that perspective and
  • 00:05:57
    understanding we address different
  • 00:05:59
    different cultures and trying to build
  • 00:06:02
    more of a sensitivity to how people
  • 00:06:04
    communicate um certainly we can see that
  • 00:06:07
    in healthcare this becomes a really
  • 00:06:09
    important issue so can you talk to us
  • 00:06:11
    Wilma about culturally and
  • 00:06:13
    linguistically appropriate Services
  • 00:06:15
    which are also known as the class
  • 00:06:17
    standards sure sure um the class
  • 00:06:19
    standards are um defined as services
  • 00:06:22
    that are respectful uh and responsive to
  • 00:06:25
    individual cultural Health beliefs and
  • 00:06:27
    practices and as James had said when we
  • 00:06:29
    talk about culture we're not limiting it
  • 00:06:31
    to race ethnicity and language and also
  • 00:06:34
    as uh James mentioned you know you don't
  • 00:06:36
    have uh the organization has its culture
  • 00:06:40
    but there's also cultures within the
  • 00:06:43
    organizations and especially in
  • 00:06:45
    healthcare drawing from the experience
  • 00:06:47
    of being being hospital-based you can
  • 00:06:49
    you can see that you know maybe um the
  • 00:06:52
    physical therapists uh uh have their
  • 00:06:55
    culture within the organization the
  • 00:06:57
    social workers have their culture within
  • 00:07:00
    the organization and so how do we
  • 00:07:03
    provide services and resources within
  • 00:07:05
    the organization so that there is not a
  • 00:07:08
    disconnect and so this is something that
  • 00:07:10
    the class standards help to Define you
  • 00:07:12
    know areas and and services so that they
  • 00:07:15
    are respectful and also taking into
  • 00:07:17
    consideration preferred languages as
  • 00:07:20
    opposed to primary language uh and one
  • 00:07:23
    of the questions that I ask when I work
  • 00:07:25
    with clients or patients is in what
  • 00:07:28
    language do you get sick and what
  • 00:07:29
    language do you access your emotions you
  • 00:07:32
    know these are questions that resonate
  • 00:07:34
    with the individual and with the
  • 00:07:36
    communities and so these are some of the
  • 00:07:38
    things that you know are helpful with
  • 00:07:40
    the class standards so that these can be
  • 00:07:41
    employed by all members of the
  • 00:07:43
    organization you know regardless of the
  • 00:07:45
    size and at every point of contact now
  • 00:07:48
    can you provide some background on the
  • 00:07:50
    class standards and how you were
  • 00:07:52
    involved with that oh sure um it was a
  • 00:07:54
    very very um exciting process the
  • 00:07:57
    national class standards were originally
  • 00:07:59
    developed uh by the uh Health and Human
  • 00:08:02
    Services office of minority Health in
  • 00:08:04
    2000 and so then after 10 years you want
  • 00:08:07
    to know what's going on right and so um
  • 00:08:11
    so the in 2010 the office of minority
  • 00:08:13
    Health they launched an initiative to
  • 00:08:16
    update the standards and that
  • 00:08:17
    incorporated public comment literature
  • 00:08:20
    review and then ongoing consultation
  • 00:08:23
    with an advisory committee and that was
  • 00:08:25
    made up of made up of 36 experts that
  • 00:08:28
    represented you know various professions
  • 00:08:31
    and disciplines and so in 2013 we were
  • 00:08:34
    very excited to release the enhanced
  • 00:08:37
    class standards at the White House and
  • 00:08:39
    so now there are 15 standards each is an
  • 00:08:42
    action step that organizations and
  • 00:08:45
    professions can use in their
  • 00:08:47
    implementation of culturally and
  • 00:08:48
    linguistically appropriate services that
  • 00:08:51
    is very exciting um now what is the
  • 00:08:53
    purpose of the class standards why why
  • 00:08:55
    did these come about oh well the purpose
  • 00:08:58
    of the class standards there intended to
  • 00:09:01
    Advance Health Equity um help eliminate
  • 00:09:04
    uh Health disparities and also improve
  • 00:09:06
    the uh quality of services um before
  • 00:09:10
    there really wasn't a lot of information
  • 00:09:12
    as to how to go about this so HHS office
  • 00:09:15
    of minority Health was able to provide
  • 00:09:18
    guidance in this way and so they
  • 00:09:20
    establish a blueprint for Health and
  • 00:09:22
    healthc Care organizations to implement
  • 00:09:25
    and provide culturally and
  • 00:09:26
    linguistically appropriate Services
  • 00:09:28
    excellent now that we've talked about
  • 00:09:30
    sort of the background of class and
  • 00:09:31
    where it came from let's revisit why
  • 00:09:34
    culturally and linguistically
  • 00:09:36
    linguistically appropriate services are
  • 00:09:38
    important for individuals and Community
  • 00:09:40
    Health um one of the reasons and there's
  • 00:09:42
    so so much to this and as James said we
  • 00:09:44
    could talk about this like like a lot
  • 00:09:46
    right um but um you know there have been
  • 00:09:48
    rapid changes in demographic Trends in
  • 00:09:50
    the US in the last decade you know in
  • 00:09:52
    2011 for the first time the majority of
  • 00:09:54
    the babies born in the US were members
  • 00:09:57
    of racial and ethnic minority groups so
  • 00:09:59
    now we're talking about the majority
  • 00:10:01
    minority right so I think I believe
  • 00:10:03
    Research indicates that by 2050 you know
  • 00:10:05
    this this will be the situation and so
  • 00:10:08
    the nation is projected to grow
  • 00:10:09
    increasingly diverse and so to be able
  • 00:10:12
    to get in front of these issues will be
  • 00:10:16
    so much uh of a benefit not only to the
  • 00:10:20
    individuals but organizations so that
  • 00:10:23
    they have the tools and the resources
  • 00:10:25
    available to provide the best quality of
  • 00:10:28
    care to Those whom they serve and that's
  • 00:10:30
    why one that's one of the reasons why
  • 00:10:32
    this is this is really important and do
  • 00:10:35
    you feel that the importance of
  • 00:10:36
    culturally and linguistically
  • 00:10:38
    appropriate Services has changed healthc
  • 00:10:40
    care delivery and policy yes um the
  • 00:10:43
    national healthc care policies and
  • 00:10:45
    legislation such as the Affordable Care
  • 00:10:47
    Act they've also helped to redefine and
  • 00:10:49
    underscore the importance of culturally
  • 00:10:50
    and linguistically appropriate services
  • 00:10:53
    and so there are some states uh such as
  • 00:10:55
    uh Washington California New Jersey
  • 00:10:57
    Connecticut and Oregon they've or Oregon
  • 00:11:00
    they've all passed legislation regarding
  • 00:11:02
    educating the healthc care providers on
  • 00:11:04
    cultural competency which is a a a
  • 00:11:06
    really a wonderful tool for our upand
  • 00:11:09
    cominging providers so that again they
  • 00:11:12
    have this information before as I say
  • 00:11:14
    before they hit a unit sure right
  • 00:11:15
    because there's so much learning going
  • 00:11:17
    on in their own profession to have these
  • 00:11:19
    resources is really helpful Now The
  • 00:11:21
    Joint Commission has also done an
  • 00:11:23
    amazing amount of work as well they've
  • 00:11:25
    set up several standards that support
  • 00:11:27
    the provision of culturally and linguis
  • 00:11:29
    ically appropriate services and so
  • 00:11:31
    they've developed you know uh works such
  • 00:11:33
    as advancing effective communication a
  • 00:11:35
    road map for hospitals that guide
  • 00:11:37
    hospitals through you know the the
  • 00:11:40
    Journey of providing cultural and
  • 00:11:42
    linguistically appropriate Services
  • 00:11:44
    because you know providing cultural
  • 00:11:46
    competency isn't you know oh let me
  • 00:11:47
    check off this box poof poof we're done
  • 00:11:50
    you know we've done our competencies uh
  • 00:11:52
    but more so it's a journey it's evolving
  • 00:11:55
    you we're always looking at it our
  • 00:11:57
    demographics change within our community
  • 00:11:59
    and these Source resources help keep us
  • 00:12:02
    ahead of ahead of the issues also to the
  • 00:12:05
    liaison committee on medical education
  • 00:12:08
    uh the uh accreditation Council for
  • 00:12:10
    continuing medical education have folks
  • 00:12:12
    that have have done these these pieces
  • 00:12:14
    as well so lots of work is being done
  • 00:12:17
    now how do these Services translate to
  • 00:12:20
    different Health outcomes um one of the
  • 00:12:22
    health outcomes also is involving costs
  • 00:12:25
    so say for example if there's a patient
  • 00:12:27
    who um or a client for example who is
  • 00:12:30
    unable to be able to communicate
  • 00:12:34
    information in a way that's appropriate
  • 00:12:35
    something as basic as being NPO you know
  • 00:12:38
    before a procedure if that information
  • 00:12:41
    isn't communicated in a way that an
  • 00:12:43
    individual does not understand and we're
  • 00:12:45
    talking maybe health literacy as well so
  • 00:12:47
    it's you know our Health Care system is
  • 00:12:49
    complicated English to English so now
  • 00:12:51
    let's add a cultural or linguistic layer
  • 00:12:53
    to it right so there's you know there
  • 00:12:55
    there is you know the decrease of
  • 00:12:57
    medical errors if that information is
  • 00:12:58
    communic at in a way that is culturally
  • 00:13:01
    and linguistically appropriate and again
  • 00:13:03
    I I don't want it to limit it to you
  • 00:13:04
    know race ethnicity and language um and
  • 00:13:07
    then so being ahead of those medical
  • 00:13:09
    errors as well you know in addition poor
  • 00:13:11
    communication and a lack of cultural and
  • 00:13:13
    linguistic competence can lead to higher
  • 00:13:16
    rates of readmission and increase
  • 00:13:18
    lengths of stays so you know in these
  • 00:13:20
    fragile Financial Times this is really
  • 00:13:23
    important to address both from the not
  • 00:13:26
    only from the patient side but from the
  • 00:13:27
    provider side as well now can this also
  • 00:13:30
    impact how a healthc Care Organization
  • 00:13:32
    does its work yes uh adapting the
  • 00:13:35
    framework and the implementation offers
  • 00:13:37
    an organization the opportunity to
  • 00:13:39
    improve the communication and helps
  • 00:13:41
    ensure that the services are going to be
  • 00:13:43
    met so we're looking at quality of care
  • 00:13:45
    we're doing you know we'll be able to
  • 00:13:47
    provide better patient uh adherence and
  • 00:13:50
    utilization of preventive Services right
  • 00:13:52
    especially now that we have the ACA you
  • 00:13:54
    know then we have effective patient
  • 00:13:56
    provider communication and that impacts
  • 00:13:58
    the patient out comes as well so we're
  • 00:14:00
    able to measure patient satisfaction in
  • 00:14:03
    a way that you know will provide the
  • 00:14:05
    data and the information that will be
  • 00:14:07
    helpful to organizations to Providers
  • 00:14:09
    and also the patients themselves and
  • 00:14:12
    then for example um it will also provide
  • 00:14:15
    an opportunity for patients and clients
  • 00:14:18
    to feel much more comfortable in
  • 00:14:20
    expressing their concerns and knowing
  • 00:14:23
    that they have the the the ability to be
  • 00:14:26
    empowered to express their needs in a
  • 00:14:29
    way that's appropriate now I think
  • 00:14:32
    you've you've made a pretty solid case
  • 00:14:33
    both of you that we've got this
  • 00:14:34
    increasingly diverse population and a
  • 00:14:37
    one-size fits-all approach is not going
  • 00:14:39
    to adequately meet the needs of of the
  • 00:14:41
    client population or the patient
  • 00:14:43
    population so how will the class
  • 00:14:45
    standards help to reduce discrimination
  • 00:14:48
    and to improve overall health care
  • 00:14:50
    quality and access um the the class
  • 00:14:53
    standards um provides information to be
  • 00:14:57
    able as I said earlier to get ahead of
  • 00:14:59
    some of the issues um one of the things
  • 00:15:02
    that will help regarding the
  • 00:15:03
    Discrimination is that one of my
  • 00:15:05
    favorite quotes is by na nin that says
  • 00:15:07
    we don't see things as they are we see
  • 00:15:09
    things as we are and so the class
  • 00:15:12
    standards will help us provi by
  • 00:15:15
    providing that guidance to see things
  • 00:15:17
    through the lenses of others so for
  • 00:15:19
    example if we look at it from a from a a
  • 00:15:23
    uh geographical cultural perspective in
  • 00:15:26
    some countries and in some areas
  • 00:15:28
    depending on the you know the the
  • 00:15:30
    socioeconomic levels and different um uh
  • 00:15:34
    uh factors you know issues of keeping an
  • 00:15:36
    appointment can be problematic so if
  • 00:15:39
    we're looking at the needs of somebody
  • 00:15:42
    who is for example in an area where
  • 00:15:45
    transportation is an issue you know are
  • 00:15:48
    we going to keep that in mind when we
  • 00:15:50
    have a provider that schedules an
  • 00:15:51
    appointment are there Child Care issues
  • 00:15:53
    for an individual who has to balance you
  • 00:15:57
    know child care versus keeping an
  • 00:15:59
    appointment not only for him or herself
  • 00:16:01
    but also for their child um how do we go
  • 00:16:03
    ahead and we schedule things so that it
  • 00:16:06
    is uh in a way that will optimize access
  • 00:16:09
    to care for different individuals and
  • 00:16:12
    groups and sometimes not understanding
  • 00:16:15
    why somebody is facing a barrier can
  • 00:16:18
    lead to that discrimination so hopefully
  • 00:16:20
    you know by utilizing some of the
  • 00:16:22
    resources this can open the uh the the
  • 00:16:26
    conversation excellent thank you so much
  • 00:16:28
    for sharing sharing all of that
  • 00:16:30
    information now we've recently spoke
  • 00:16:32
    with Dina aroo who who directs the New
  • 00:16:34
    York State Spanish AIDS or CA hotline at
  • 00:16:37
    Central cico in Amsterdam New York about
  • 00:16:39
    why they have a Spanish language AIDS
  • 00:16:45
    hotline um hi my name is Tina aryo I
  • 00:16:49
    work for Centro civico and I'm the
  • 00:16:51
    program director of the New York St bny
  • 00:16:53
    say hotline the ca hotline has been here
  • 00:16:55
    in central civico since 1988
  • 00:16:59
    that's close to 26 years and it's been
  • 00:17:02
    funded by the ace Institute it's very
  • 00:17:05
    unique because it's the only Spanish a
  • 00:17:07
    Highland in the state of New York there
  • 00:17:09
    is a huge need in the state of New York
  • 00:17:12
    because of the barriers of the language
  • 00:17:14
    there's a lot of people that doesn't
  • 00:17:16
    speak English and all the information is
  • 00:17:18
    mostly in English so the hotline breaks
  • 00:17:21
    this
  • 00:17:23
    barriers and allow the people to know
  • 00:17:26
    the information updated information
  • 00:17:28
    about a vas and the different SDS the ca
  • 00:17:31
    hotline deals with diversity with
  • 00:17:35
    training because there are so many
  • 00:17:37
    people that come from different
  • 00:17:39
    countries and we have to be ready for
  • 00:17:41
    that because not every person explain
  • 00:17:44
    everything the same way so we receive a
  • 00:17:47
    very intensive training to be able to
  • 00:17:49
    deal with that we have operators from
  • 00:17:51
    Puerto Rico from Santo Domingo Costa
  • 00:17:54
    Ricans so we can serve the whole
  • 00:17:57
    diversity of the people who call the
  • 00:18:00
    hotline so they they're great and people
  • 00:18:04
    usually always call back to give them
  • 00:18:07
    feedback if they're positive if they're
  • 00:18:10
    if they came out negative they just call
  • 00:18:11
    us back to let us know so that's good
  • 00:18:14
    they they they make like a connection
  • 00:18:16
    the hotline is supposed to be for New
  • 00:18:19
    York but since we working very close now
  • 00:18:21
    with Facebook and Instagram and all that
  • 00:18:24
    we're receiving calls from all over the
  • 00:18:26
    nation so please don't hesitate call us
  • 00:18:30
    because we're really here to help you
  • 00:18:33
    get the services that you need because
  • 00:18:35
    there's a lot of people out there that
  • 00:18:36
    doesn't know how to get service they
  • 00:18:38
    don't know how to get here and get how
  • 00:18:40
    to get there so we are a very important
  • 00:18:42
    tool for the community right now because
  • 00:18:45
    for what we know and the evaluations
  • 00:18:48
    that we get there's a lot of people
  • 00:18:50
    getting a lot of care getting support
  • 00:18:53
    and getting what they need just because
  • 00:18:55
    they're calling the hotline so I would
  • 00:18:57
    like to let every everybody know they if
  • 00:19:00
    they got any questions related to HIV a
  • 00:19:03
    hepatitis C anything related to hi that
  • 00:19:07
    they can call us Monday through Friday
  • 00:19:09
    from 8 in the morning to 5:00 p.m. the
  • 00:19:12
    hotline number is 1 1800 233
  • 00:19:19
    [Music]
  • 00:19:24
    7432 so now that we have an opportunity
  • 00:19:27
    to see the implementation of some of
  • 00:19:29
    these services in the field Wilma can
  • 00:19:31
    you talk about specific guidelines for
  • 00:19:33
    implementing the standards sure um the
  • 00:19:36
    national class standards they're
  • 00:19:38
    comprised of the 15 standards and then
  • 00:19:40
    what they're they're intended to be used
  • 00:19:42
    together so then if they're being used
  • 00:19:44
    together then they're mutually
  • 00:19:46
    reinforced so as you'll go ahead and see
  • 00:19:48
    on one of the slides there's the
  • 00:19:51
    principal standard and that serves as a
  • 00:19:53
    foundation for all the other standards
  • 00:19:55
    and then the standards are are broken up
  • 00:19:57
    into three themes the Govern leadership
  • 00:19:59
    and Workforce communication and language
  • 00:20:01
    assistance and then the engagement
  • 00:20:03
    continuous Improvement and
  • 00:20:05
    accountability okay well thank you so
  • 00:20:08
    much for framing how the standards are
  • 00:20:10
    are organized now James let's turn to
  • 00:20:12
    you for a minute and hear about how has
  • 00:20:14
    the peak scale Area Health Center led
  • 00:20:17
    the way towards ensuring that you're
  • 00:20:19
    providing culturally competent and
  • 00:20:21
    culturally and linguistically
  • 00:20:22
    appropriate services to your patient
  • 00:20:25
    base well it's it it's quite a story and
  • 00:20:28
    um but as we were talking about culture
  • 00:20:31
    I was thinking it in in a certain sense
  • 00:20:33
    comes out of the 1960s which was a big
  • 00:20:36
    cultural change in this country we had
  • 00:20:39
    the Vietnam War of course we had the
  • 00:20:41
    Civil Rights Movement uh we had the war
  • 00:20:44
    on poverty and we had the establishment
  • 00:20:47
    of Community Health centers federally
  • 00:20:49
    qualified community health centers in
  • 00:20:51
    the mid
  • 00:20:53
    1960s in the early 1970s in Peak Skill
  • 00:20:57
    New York
  • 00:20:59
    despite all of that change and
  • 00:21:01
    particularly the changes of the civil
  • 00:21:03
    rights movement and the war on
  • 00:21:05
    poverty uh the black community in Peak
  • 00:21:07
    Gill still did not have easily
  • 00:21:10
    accessible and affordable and culturally
  • 00:21:14
    competent Healthcare that is to say
  • 00:21:15
    Black Culture did not was was not seen
  • 00:21:20
    as as good as white culture at that time
  • 00:21:24
    and um uh so some neighbors uh
  • 00:21:29
    specifically led by four black women in
  • 00:21:32
    Peak Skill uh got uh together then
  • 00:21:36
    started organizing and they they had
  • 00:21:38
    grown tired they were all mothers they
  • 00:21:40
    had grown tired of uh taking their kids
  • 00:21:43
    by bus because they didn't have cars to
  • 00:21:45
    travel with um and they took their kids
  • 00:21:48
    to the County Hospital Westchester
  • 00:21:51
    County hospital or medical center and um
  • 00:21:55
    they had to drag their kids 20 miles by
  • 00:21:58
    buses and um then spend time in clinics
  • 00:22:02
    waiting spend time waiting for lab work
  • 00:22:06
    go and going and getting uh
  • 00:22:08
    prescriptions filled taking the bus home
  • 00:22:11
    it was a it was a long day uh dragging
  • 00:22:15
    their children around and they got
  • 00:22:17
    really tired of it so they started
  • 00:22:19
    organizing they eventually were able to
  • 00:22:21
    organize not only black neighbors but
  • 00:22:24
    white neighbors and and eventually got a
  • 00:22:27
    Federal grant for for um uh a a Health
  • 00:22:31
    Center and um uh the Health Center
  • 00:22:35
    opened in
  • 00:22:36
    1975 with 12 employees it was called the
  • 00:22:40
    Peak Skill Area Health Center um now
  • 00:22:43
    federally qualified Health Centers
  • 00:22:46
    community health centers are required to
  • 00:22:48
    have a board uh and on that board
  • 00:22:52
    51% of the members are uh required to be
  • 00:22:58
    users
  • 00:22:59
    of the um Health Center so um
  • 00:23:05
    uh the uh that that was the case at the
  • 00:23:09
    Peak Skill Area Health Center and
  • 00:23:12
    because they had begun from a position
  • 00:23:15
    of um a cultural awareness and
  • 00:23:19
    sensitivity because of the way they were
  • 00:23:21
    treated um that really was part of the
  • 00:23:25
    DNA of the uh Peak gallary Area Health
  • 00:23:29
    Center from the very beginning so I
  • 00:23:32
    think part of the point you're making is
  • 00:23:34
    that it's important for an agency to
  • 00:23:36
    have an awareness of or a sensitivity to
  • 00:23:39
    the different diverse cultures and needs
  • 00:23:42
    of individual populations as part of its
  • 00:23:45
    mission for the organization what makes
  • 00:23:47
    this sustainable for
  • 00:23:50
    agencies
  • 00:23:52
    um well in the case of the health center
  • 00:23:56
    uh of the peace skill Area Health Center
  • 00:23:58
    Center during the 1980s we began to see
  • 00:24:02
    um uh a large number of uh of immigrants
  • 00:24:05
    coming into Peak Skill and um uh there
  • 00:24:10
    there were people coming in from uh
  • 00:24:12
    Latin American countries and Central
  • 00:24:14
    American countries uh Colombia Ecuador
  • 00:24:18
    in particular um Puerto Rico um the
  • 00:24:23
    Caribbean and um
  • 00:24:26
    uh the the Center realized that up up to
  • 00:24:30
    that time it had been mostly black and
  • 00:24:33
    white members of the community who were
  • 00:24:35
    being seen but uh as the numbers of
  • 00:24:38
    people uh from other cultures other
  • 00:24:41
    countries other linguistic groups uh
  • 00:24:44
    began to come in um it was uh realized
  • 00:24:48
    that um uh there was more to be done and
  • 00:24:52
    in um uh
  • 00:24:55
    1989 the health center um
  • 00:24:59
    uh was awarded migrant Health funding um
  • 00:25:03
    and uh at that point the health center
  • 00:25:07
    was going Beyond Peak Skill and was in
  • 00:25:10
    five counties of the Hudson Valley um
  • 00:25:13
    and was required to serve Farm Workers
  • 00:25:16
    who came from um Maine from Jamaica from
  • 00:25:21
    Honduras did I say Maine U I'm in Mexico
  • 00:25:26
    U Honduras we still still had
  • 00:25:28
    African-Americans coming up from the
  • 00:25:30
    south another culture entirely uh and we
  • 00:25:34
    had um uh Farm Workers Mexican-American
  • 00:25:37
    Farm Workers coming from the Rio Grand
  • 00:25:39
    Valley of Texas and I think it was
  • 00:25:41
    really at that point when the we became
  • 00:25:44
    migrant health providers that we decided
  • 00:25:47
    we needed to do something about our
  • 00:25:51
    corporate culture uh to ensure that um
  • 00:25:55
    that we had cultural sensitivity
  • 00:25:57
    operating at every level and in
  • 00:25:59
    everything that we did so what are some
  • 00:26:02
    of the ways that you specifically worked
  • 00:26:04
    to build those culturally and
  • 00:26:05
    linguistically appropriate services with
  • 00:26:07
    the
  • 00:26:08
    communities well again coming back to
  • 00:26:11
    the migrant health program um migrant
  • 00:26:14
    Health goes back to uh the early
  • 00:26:18
    1960s um uh it was another big cultural
  • 00:26:21
    change because it was the migrant Health
  • 00:26:23
    act that eventually led to the
  • 00:26:25
    establishment of Community Health
  • 00:26:26
    centers but um the the migrant health
  • 00:26:30
    law was signed into law in
  • 00:26:33
    1962 uh and from the get-go was
  • 00:26:36
    understood that in order to reach Farm
  • 00:26:38
    Workers you had to go to them you could
  • 00:26:40
    not wait for them to come to you uh so
  • 00:26:44
    people were uh at the very beginning
  • 00:26:46
    doing Outreach and it was understood
  • 00:26:48
    that since uh in not everywhere in the
  • 00:26:51
    country because a lot of farmwork was
  • 00:26:53
    was being done by black uh
  • 00:26:56
    African-Americans um but there were
  • 00:26:59
    still large numbers of Mex Mexicans
  • 00:27:01
    coming up from uh
  • 00:27:03
    Mexico and yeah I I guess that and also
  • 00:27:07
    Puerto Ricans um so uh from the very
  • 00:27:12
    beginning migrant Health had a cultural
  • 00:27:14
    component to it uh people spoke Spanish
  • 00:27:18
    uh a lot of the providers spoke Spanish
  • 00:27:20
    and uh and they were doing outre they
  • 00:27:22
    were going into the culture into the
  • 00:27:25
    camps of the of the workers uh so that
  • 00:27:29
    was there from the very beginning and I
  • 00:27:31
    think becoming a migrant Health provider
  • 00:27:35
    uh really uh it it car carried over the
  • 00:27:39
    migrant Health program's cultural
  • 00:27:41
    competency assumed cultural comp
  • 00:27:43
    competency from the very beginning was
  • 00:27:46
    required uh it carried over into the
  • 00:27:48
    health center and its larger corporate
  • 00:27:51
    culture great so it certainly seems like
  • 00:27:54
    the Hudson River Health Center or
  • 00:27:56
    healthc care structure really Chang to
  • 00:27:58
    meet the needs of the population um now
  • 00:28:01
    Wilma can you talk about the additional
  • 00:28:04
    components of the class standards
  • 00:28:06
    because it seems like you know the
  • 00:28:08
    Hudson River Health Center was already
  • 00:28:10
    meeting some of those needs of the
  • 00:28:12
    cultural linguistic appropriateness
  • 00:28:13
    based on the population changes that you
  • 00:28:15
    saw what are some of the additional
  • 00:28:17
    components of class that we need to talk
  • 00:28:18
    about well you know as we saw with the
  • 00:28:21
    work that cro civico is doing and then
  • 00:28:23
    with hrhc you know they were already um
  • 00:28:26
    doing things as you said that are are
  • 00:28:28
    meeting the needs of the communities
  • 00:28:30
    they serve so the First theme that's
  • 00:28:32
    focused on government's leadership and
  • 00:28:34
    Workforce and that emphasizes that you
  • 00:28:36
    know implementing class is the
  • 00:28:37
    responsibility of the entire
  • 00:28:39
    organization and so as we've seen with
  • 00:28:41
    both of these organizations you know it
  • 00:28:44
    wasn't something that was a tap down or
  • 00:28:47
    a bottom up approach it was
  • 00:28:50
    bidirectional and that really helps
  • 00:28:53
    address the needs of the communities and
  • 00:28:55
    also identify what those needs of the
  • 00:28:58
    Community are in addition to providing
  • 00:29:00
    the workforce with the resources that
  • 00:29:03
    they need in order to do the job that
  • 00:29:06
    they really want to do to to serve the
  • 00:29:08
    communities so this you know helps
  • 00:29:10
    address situations that would be
  • 00:29:13
    potential areas of disconnects between
  • 00:29:16
    policy and practice so the standards
  • 00:29:18
    teach us that implementing the class
  • 00:29:20
    standards at every point of contact is
  • 00:29:22
    really a critical way of meeting the
  • 00:29:24
    needs of the community and so when we're
  • 00:29:26
    talking about uh cultural relevance
  • 00:29:29
    cultural awareness cultural sensitivity
  • 00:29:32
    and also linguistic sensitivity um you
  • 00:29:34
    know these are pieces that that the
  • 00:29:36
    class standards can help with and then
  • 00:29:38
    some uh standard number two that helps
  • 00:29:41
    underscore a lot of things that um that
  • 00:29:45
    these organizations have already gone
  • 00:29:47
    ahead and addressed so you know this is
  • 00:29:49
    one of the things that's so helpful when
  • 00:29:51
    you're implementing the class standards
  • 00:29:52
    you know your community you've
  • 00:29:54
    identified some of the challenges and
  • 00:29:57
    then you know leader ERS ship and the
  • 00:29:59
    workforce uh discusses well what do we
  • 00:30:02
    do and how can we do it well and how can
  • 00:30:05
    we do something that's going to make
  • 00:30:07
    sense and so is there work that needs to
  • 00:30:10
    be done to educate you know within
  • 00:30:12
    organizations how do you get
  • 00:30:14
    organizations to really Buy in and and
  • 00:30:16
    decide that it's worth their while to
  • 00:30:18
    start implementing the class standards
  • 00:30:20
    um well what some of the things that
  • 00:30:22
    happens is you know looking back at
  • 00:30:23
    standard three does your Workforce
  • 00:30:25
    reflect the community that you're
  • 00:30:26
    serving or also so the individuals that
  • 00:30:29
    are uh going to be uh uh living within
  • 00:30:32
    your community is there an awareness of
  • 00:30:34
    that so how do we go ahead and educate
  • 00:30:36
    and train our Workforce and that's one
  • 00:30:38
    of the things that the class standards
  • 00:30:40
    helps with you know to identify how can
  • 00:30:43
    you go ahead and educate how can you go
  • 00:30:44
    ahead and train because if you're going
  • 00:30:46
    to train what are you going to train on
  • 00:30:48
    if you haven't educated folks on what
  • 00:30:50
    you need to do so you know these are
  • 00:30:52
    some of the things that we're looking at
  • 00:30:53
    again you know so you're looking at the
  • 00:30:55
    diversity of the professionals as we
  • 00:30:57
    talked about earlier and this is
  • 00:30:59
    something that Centro civico and James
  • 00:31:01
    has discussed you know that that that
  • 00:31:04
    was a big part of the success that they
  • 00:31:07
    have excellent thank you so much Wilma
  • 00:31:10
    now we'll see some examples of how a New
  • 00:31:12
    York state agency Centro cico
  • 00:31:15
    incorporates cultural confidence
  • 00:31:16
    principles into their programs and
  • 00:31:21
    [Music]
  • 00:31:23
    services hi my name is Fabia Rodriguez I
  • 00:31:26
    am the director of community development
  • 00:31:28
    Initiative Program with Central civico
  • 00:31:30
    uh Central civico um was incorporated in
  • 00:31:33
    1988 um and our goal and Mission
  • 00:31:36
    predominantly is to help people become
  • 00:31:38
    self-sufficient so we try to be the
  • 00:31:40
    vehicle um to mobilize that um we serve
  • 00:31:44
    we're in a Latino organization but we
  • 00:31:45
    serve all cultures and try to generate
  • 00:31:47
    unique Services um it's very important
  • 00:31:50
    to understand cultural diversity um
  • 00:31:53
    specifically I would Point here to
  • 00:31:54
    Montgomery and Fon County because in the
  • 00:31:56
    past decade
  • 00:31:58
    um this community has been so diverse we
  • 00:32:00
    have every culture um from Indian Asian
  • 00:32:05
    African-American and different types of
  • 00:32:07
    Latino um cultures have all migrated
  • 00:32:10
    here from different parts of the state
  • 00:32:12
    um additionally we have different
  • 00:32:13
    genders different ages um different
  • 00:32:17
    social economic groups so we have a lot
  • 00:32:20
    Montgomery County in the past decade has
  • 00:32:21
    become one of the most diverse counties
  • 00:32:23
    you'll find um between Albany and uo New
  • 00:32:26
    York the CDI program has various
  • 00:32:29
    components to it um one is mobilization
  • 00:32:32
    and that's the biggest one we are a
  • 00:32:34
    grant funded program by the department
  • 00:32:36
    of health aids Institute that focuses
  • 00:32:39
    primarily on mobilizing the Montgomery
  • 00:32:40
    Fon County communities on educating them
  • 00:32:43
    on HIV issues but also keeping them
  • 00:32:46
    mobilized on being doing prevention work
  • 00:32:49
    and working together the other component
  • 00:32:51
    of the CDI program is advocacy so we
  • 00:32:54
    participate in state lobbying and we
  • 00:32:57
    also partic SP local lobbying where we
  • 00:32:59
    try to keep everybody informed locally
  • 00:33:01
    about what the issues are um with
  • 00:33:03
    legislation with HIV we'll have um
  • 00:33:06
    Statewide or Citywide events such as a
  • 00:33:08
    health fair um we'll do HIV testing day
  • 00:33:12
    so we kind of coordinate all that but
  • 00:33:13
    have everyone else in the community
  • 00:33:15
    participated to actually be the ones who
  • 00:33:17
    actively do the work and then lastly we
  • 00:33:20
    do community assessments every contract
  • 00:33:22
    period our contract period is 5 years um
  • 00:33:25
    within that contract period we're
  • 00:33:26
    required to do at least one Community
  • 00:33:27
    assessment
  • 00:33:28
    to address to see what the needs are in
  • 00:33:30
    the community the CDI Department uh to
  • 00:33:33
    work on community integration we
  • 00:33:35
    collaborate as much as possible and
  • 00:33:37
    again it goes back to the mobilization
  • 00:33:39
    where we host these events and
  • 00:33:41
    coordinate these events but we rely on
  • 00:33:43
    the community to participate um and by
  • 00:33:45
    doing that we're integrating each
  • 00:33:47
    different group for instance um we work
  • 00:33:49
    with The Arc out here so we're getting
  • 00:33:51
    uh a different group from that we work
  • 00:33:53
    with the seniors um Office of Aging and
  • 00:33:56
    that brings in a different population
  • 00:33:57
    work with the school districts we're
  • 00:33:59
    getting the students and then we work
  • 00:34:01
    with the other local nonprofits uh
  • 00:34:03
    prevention groups Catholic Charities Etc
  • 00:34:05
    and and each one has a unique consumers
  • 00:34:08
    that come and and together as you know
  • 00:34:11
    working together with the whatever event
  • 00:34:12
    we're hosting it becomes a community
  • 00:34:14
    integration project language is
  • 00:34:16
    important um we're one of the very few
  • 00:34:20
    organizations that have bilingual staff
  • 00:34:22
    and that's become a biggest hurdle for
  • 00:34:24
    our Latino population because for
  • 00:34:26
    instance they'll have issues with
  • 00:34:28
    housing let's say um and they don't know
  • 00:34:30
    who to go talk to but they know if they
  • 00:34:32
    come to Central civico and meet fbia
  • 00:34:34
    they can talk about HIV resources so
  • 00:34:36
    they'll come here and ask those types of
  • 00:34:38
    questions uh Monday through Friday 9:00
  • 00:34:40
    a.m. to 12:00 p.m. we have Walkin hours
  • 00:34:42
    here at Central civico and any consumer
  • 00:34:44
    can walk in and get assistance
  • 00:34:46
    especially with translation so uh that's
  • 00:34:49
    our number one key we'll have someone
  • 00:34:51
    come in and when we sat down and they
  • 00:34:53
    came in for help with for instance I
  • 00:34:55
    just had someone who came in help with
  • 00:34:57
    daycare funds they didn't understand why
  • 00:34:59
    their daycare funds was taken away so
  • 00:35:01
    it's important that I knew um how to
  • 00:35:04
    help them even though my focus is on HIV
  • 00:35:06
    AIDS they came in with different issues
  • 00:35:09
    um that I at the time had to deal with
  • 00:35:10
    so and it's important for the consumer
  • 00:35:13
    because they don't have anywhere else to
  • 00:35:14
    go I had to be the middle person to call
  • 00:35:16
    down to Department of Social Services
  • 00:35:18
    and clear it out for them being
  • 00:35:20
    culturally competent is a big piece to
  • 00:35:22
    servicing all the needs of the consumers
  • 00:35:25
    that we have that come in um
  • 00:35:27
    specifically
  • 00:35:28
    for instance I'll give you an example
  • 00:35:29
    with diet um if you don't know
  • 00:35:32
    culturally what the consumer you know
  • 00:35:34
    eats on a daily basis you wouldn't
  • 00:35:36
    understand why it's so hard for them for
  • 00:35:38
    example to lower the cholesterol let's
  • 00:35:40
    say if I had a consumer who was American
  • 00:35:43
    Caucasian I also have to be sensitive to
  • 00:35:45
    what their needs are and understand that
  • 00:35:48
    they have a different diet than what I
  • 00:35:49
    grew up but I also have to be mindful of
  • 00:35:51
    why it's challenging for them or not
  • 00:35:54
    even just their cultural upbringing but
  • 00:35:57
    um for instance their economics
  • 00:36:00
    standards um if they're lwi income so
  • 00:36:02
    those are little things here and there
  • 00:36:04
    that's very important because you can
  • 00:36:05
    give as much advice as you want and
  • 00:36:07
    referrals as you want are these goals
  • 00:36:09
    that I'm proposing to them are they
  • 00:36:11
    realistic or should they take baby steps
  • 00:36:14
    you know like what are some things that
  • 00:36:15
    I can talk to them about and also is
  • 00:36:17
    there someone that I can connect them
  • 00:36:19
    with who can relate to them my biggest
  • 00:36:22
    advice for other communities who are
  • 00:36:24
    trying to be culturally linguistic um
  • 00:36:27
    aware are mindful um especially when
  • 00:36:29
    doing social work is to get out there
  • 00:36:31
    whatever population you're working for
  • 00:36:33
    look for those um educational seminars
  • 00:36:36
    but the other main thing to do is speak
  • 00:36:39
    to other organizations that deal um or
  • 00:36:41
    that are bicultural in that culture that
  • 00:36:43
    you're trying to get educated on so
  • 00:36:45
    building those relationships with other
  • 00:36:46
    organizations that deal with the
  • 00:36:48
    population you want to work with daily
  • 00:36:50
    they're your best resources and You' be
  • 00:36:52
    surprised how much they want to help you
  • 00:36:54
    help your consumers
  • 00:37:01
    [Music]
  • 00:37:03
    so it sounds like some of what she's
  • 00:37:04
    talking about really refers back to that
  • 00:37:06
    principle one that you had mentioned or
  • 00:37:08
    the the principal standard so can you
  • 00:37:09
    just elaborate on that a little bit sure
  • 00:37:11
    the the principal standard um that helps
  • 00:37:15
    frame the essential goal of all of the
  • 00:37:17
    standards and so by providing effective
  • 00:37:19
    Equitable and understandable and
  • 00:37:22
    respectful quality of care and services
  • 00:37:24
    you know it creates a safe and welcoming
  • 00:37:26
    environment uh for or at at every point
  • 00:37:28
    of contact and so that's really really
  • 00:37:31
    going to be appre appreciated not only
  • 00:37:33
    by the diversity of individuals but also
  • 00:37:35
    our providers as well and it also helps
  • 00:37:38
    meet the communication needs so that
  • 00:37:40
    individuals understand that the health
  • 00:37:42
    care uh services are receiving they can
  • 00:37:44
    participate in that and also too being
  • 00:37:46
    be empowered to ask their questions to
  • 00:37:49
    ensure that when they speak with the
  • 00:37:50
    provider that they um are communicating
  • 00:37:53
    what they're understanding and that
  • 00:37:55
    opens it up for the provider to do for
  • 00:37:57
    example like a teach back you know is is
  • 00:38:00
    you know tell me a little bit about what
  • 00:38:01
    you're understanding so that's really
  • 00:38:03
    good and then you know it helps to
  • 00:38:04
    eliminate the discrimination and the
  • 00:38:06
    disparities excellent now what are some
  • 00:38:09
    of the other areas that agencies need to
  • 00:38:11
    look at to effectively Implement class
  • 00:38:14
    standards um so some of the other things
  • 00:38:16
    that they'll look at is also you know
  • 00:38:18
    looking at theme two right the
  • 00:38:20
    communication and language assistance so
  • 00:38:22
    we talked about theme one which is
  • 00:38:24
    talking about governance leadership in
  • 00:38:26
    the workforce so we go into theme two
  • 00:38:28
    and this you know these themes they can
  • 00:38:30
    either run parallel MH or they can go
  • 00:38:32
    ahead and run uh um consecutively
  • 00:38:36
    depending on what the again what the
  • 00:38:37
    organization's culture is where are they
  • 00:38:39
    regarding you know their strategic plans
  • 00:38:42
    how are they implementing things so so
  • 00:38:44
    for theme two um the this deals with
  • 00:38:47
    more commun communication language
  • 00:38:49
    assistance so that talks about uh
  • 00:38:51
    meetings of patients communication needs
  • 00:38:54
    whether it be uh sign language Braille
  • 00:38:58
    uh interpreting which is the oral
  • 00:38:59
    communication and translation which is
  • 00:39:01
    the written communication and I just
  • 00:39:03
    have to say that regarding the
  • 00:39:04
    communication and language assistance
  • 00:39:06
    piece you know when uh these two terms
  • 00:39:08
    interpreting and translation are
  • 00:39:09
    unfortunately used interchangeably and
  • 00:39:12
    interpreting is the oral plain and
  • 00:39:14
    simple and translation is the written
  • 00:39:16
    and this impacts uh the uh a provider's
  • 00:39:19
    request when they're asking for either
  • 00:39:21
    an interpreter or a translator because
  • 00:39:23
    they're asking for two different skill
  • 00:39:25
    sets unless for example if your hospital
  • 00:39:27
    base then sometimes you know as
  • 00:39:28
    interpreters we have to have both right
  • 00:39:31
    so um the what what part of what is part
  • 00:39:34
    of the governance for this for um uh
  • 00:39:37
    five six seven and eight of the
  • 00:39:38
    standards and you know this theme helps
  • 00:39:41
    uh organizations comply with title Six
  • 00:39:44
    office for civil rights of 1964 the
  • 00:39:47
    Americans with Disabilities Act of 1990
  • 00:39:50
    uh and then other federal state and
  • 00:39:52
    local mandates that require the
  • 00:39:54
    provision of language access services so
  • 00:39:56
    for example here in New York state we
  • 00:39:58
    have Governor Cuomo's executive order
  • 00:40:00
    number 26 which mandates state agencies
  • 00:40:03
    provide uh culturally and linguistically
  • 00:40:05
    appropriate
  • 00:40:06
    services so this is one of the ways now
  • 00:40:09
    can you share with us an example of how
  • 00:40:11
    cultural and linguistic
  • 00:40:12
    misunderstandings influence Health
  • 00:40:14
    outcomes yes unfortunately one there's
  • 00:40:17
    there's a a few things but unfortunately
  • 00:40:19
    one of the cases is uh a situation where
  • 00:40:22
    poor communication led to tragic
  • 00:40:23
    outcomes so there is a case of Willie
  • 00:40:25
    Ramirez in Florida he was an 18-year-old
  • 00:40:28
    Hispanic female uh fem um Hispanic male
  • 00:40:31
    I'm sorry and what happened was he had
  • 00:40:33
    told his girlfriend uh that he was
  • 00:40:35
    feeling intoxicado which in this
  • 00:40:37
    situation M meant that he felt nauseous
  • 00:40:40
    and then he fainted so when then when
  • 00:40:42
    she and his mother got him to the
  • 00:40:44
    emergency room somebody who had uh a
  • 00:40:47
    sense of the ability of speaking Spanish
  • 00:40:52
    uh and converted that word to mean that
  • 00:40:54
    he was uh it was more of a drug
  • 00:40:57
    situation so he was being worked up for
  • 00:40:59
    a drug overdose instead of the primary
  • 00:41:02
    issue which ended up with uh having uh
  • 00:41:06
    very very serious consequences and he
  • 00:41:08
    has now been diagnosed as a quadriplegic
  • 00:41:11
    uh this resulted in a $71 million
  • 00:41:14
    lawsuit uh for that healthc Care
  • 00:41:17
    Organization um it was a malpractice
  • 00:41:19
    settlement that could have been avoided
  • 00:41:21
    had there been appropriate utilization
  • 00:41:23
    of linguistic Services also Dr Glenn
  • 00:41:26
    Flores has done a lot of work regarding
  • 00:41:28
    issues involving medical uh errors in
  • 00:41:31
    interpreting and outcomes of that and
  • 00:41:33
    then the national health law program has
  • 00:41:35
    a publication as well that's called the
  • 00:41:37
    high cost of uh language barriers in
  • 00:41:39
    medical malpractice which uh again
  • 00:41:43
    document some of these unfortunate
  • 00:41:44
    situations that are due to uh linguistic
  • 00:41:47
    misunderstandings so I think standards 5
  • 00:41:50
    through eight really kind of help to
  • 00:41:51
    address some of that abut um but in the
  • 00:41:53
    interest of time let's move on and talk
  • 00:41:55
    about what theme three is of the class
  • 00:41:57
    standards and what those areas are for
  • 00:42:00
    agencies to focus on oh absolutely theme
  • 00:42:03
    three involves um you know the
  • 00:42:05
    engagement continuous Improvement in
  • 00:42:08
    accountability and so with this sit with
  • 00:42:10
    these situations is you know how are the
  • 00:42:13
    communities being engaged and how are
  • 00:42:16
    organizations continuing to improve
  • 00:42:19
    their services and also how can um uh
  • 00:42:23
    organizations continue to evaluate so
  • 00:42:26
    there's
  • 00:42:27
    um you know these are some of the things
  • 00:42:29
    that the that these themes will focus on
  • 00:42:31
    the necessary adaptions implementation
  • 00:42:34
    and maintenance of culturally and
  • 00:42:35
    linguistically appropriate policies so
  • 00:42:38
    again we're not having that disconnect
  • 00:42:39
    between the policy and the practice and
  • 00:42:41
    we're providing resources not only for
  • 00:42:44
    the patients but the providers as well
  • 00:42:46
    and do you have an example of how an
  • 00:42:48
    organization can be accountable in
  • 00:42:50
    upholding the values yes for example
  • 00:42:52
    there was a a study that was published
  • 00:42:54
    in the Journal of Healthcare Management
  • 00:42:56
    and they described was that they had
  • 00:42:58
    identified that within the Latino
  • 00:43:00
    Community there was a lot of cases where
  • 00:43:02
    moms were bringing their children in for
  • 00:43:04
    ear infections and so what they identifi
  • 00:43:08
    first they identified this as a concern
  • 00:43:10
    and so that was a fabulous uh example of
  • 00:43:13
    Rel of a relationship with um the uh
  • 00:43:17
    leadership and Workforce what they were
  • 00:43:20
    able to do was provide moms with a a
  • 00:43:23
    toolkit that would help check for uh um
  • 00:43:26
    temperature temperes and ear infections
  • 00:43:28
    that basically cost $3 as opposed to
  • 00:43:30
    spending $300 for an ER visit excellent
  • 00:43:34
    that sounds like a really good troubl
  • 00:43:36
    you know way to address the problem and
  • 00:43:38
    be preventive now what are the specific
  • 00:43:40
    class class standards that address the
  • 00:43:42
    third class theme area um so one of the
  • 00:43:45
    things that addresses the the last theme
  • 00:43:47
    area is talking about how do you go
  • 00:43:50
    ahead and you continue to improve and
  • 00:43:53
    engage your community and so um one of
  • 00:43:57
    the things that the class standards did
  • 00:43:59
    with this piece is that it goes ahead
  • 00:44:03
    and has information on how to be able to
  • 00:44:05
    conduct these ongoing assessments so
  • 00:44:07
    when you look at the blueprint it has
  • 00:44:09
    the resources there so what if you're
  • 00:44:13
    doing something if you're doing this how
  • 00:44:15
    are you doing it is it working so
  • 00:44:18
    evaluation is always going to be part of
  • 00:44:20
    this and it's not always at the end you
  • 00:44:22
    know you can have an ongoing evaluation
  • 00:44:24
    piece and then how is this translating
  • 00:44:27
    if you will into accountability for the
  • 00:44:28
    organization and is there something else
  • 00:44:30
    that needs to be done for the community
  • 00:44:32
    to have that that understanding and that
  • 00:44:35
    buy
  • 00:44:36
    in all right now it sounds like um from
  • 00:44:41
    what you're saying it's really important
  • 00:44:42
    to have the staff buy and it's important
  • 00:44:44
    to get staff trained now James can you
  • 00:44:46
    talk specifically about how the Hudson
  • 00:44:49
    River healthc
  • 00:44:50
    care ensured that your staff was both
  • 00:44:53
    culturally and linguistically trained in
  • 00:44:56
    appropriate care
  • 00:44:57
    provision uh sure probably the most
  • 00:45:00
    important thing we did was to a as the
  • 00:45:04
    uh uh populations we served became um
  • 00:45:07
    increasingly diverse was to um go to
  • 00:45:11
    them and bring uh new board members in
  • 00:45:15
    new staff in uh and uh members of the
  • 00:45:19
    communities we were serving uh were
  • 00:45:23
    brought in as advisory and support uh uh
  • 00:45:27
    or uh committees uh for example uh in a
  • 00:45:30
    couple of our health centers where we
  • 00:45:32
    have a very heavy um uh Latino
  • 00:45:35
    population the com Latino is uh uh
  • 00:45:39
    working both to do health promotion in
  • 00:45:42
    their communities uh fundraising for the
  • 00:45:45
    health center to be involved with the
  • 00:45:47
    health center um so I'd say again that's
  • 00:45:50
    probably the most important thing we did
  • 00:45:52
    and it it's also important to say that
  • 00:45:55
    we're not just talking about ethnic
  • 00:45:58
    racial and linguistic diversity here
  • 00:46:00
    because we serve pro we have programs
  • 00:46:02
    that serve um the homeless uh people
  • 00:46:06
    with HIV AIDS um uh members of the uh
  • 00:46:11
    LGBT communities um who else uh I think
  • 00:46:17
    I mentioned uh well we actually probably
  • 00:46:22
    yeah we have many more and uh um so it's
  • 00:46:26
    kind of diversity with a capital D um
  • 00:46:30
    and uh we had a slide up showing members
  • 00:46:33
    of our uh uh PL tree orientation which
  • 00:46:37
    all staff receive uh going through um uh
  • 00:46:42
    the they spend two days of training um
  • 00:46:48
    uh learning about the history the
  • 00:46:50
    mission uh the organizational values gu
  • 00:46:54
    guiding principles of our organization
  • 00:46:56
    and of course amongst those guiding
  • 00:46:59
    principles are um uh cultural competence
  • 00:47:03
    at an organizational level absolutely
  • 00:47:06
    now why is it important to expand your
  • 00:47:08
    sites within the
  • 00:47:10
    community um to expand our sites uh you
  • 00:47:16
    mean create new health centers where
  • 00:47:18
    you're providing Services yeah well we
  • 00:47:22
    because probably in part because that's
  • 00:47:25
    our mission to reach out and serve uh uh
  • 00:47:30
    that's our mission to serve um the
  • 00:47:33
    underserved and uh those who do not have
  • 00:47:37
    access to healthc care and it didn't
  • 00:47:39
    stop at peakville uh by 1994 we had uh
  • 00:47:43
    five sites and the first two sites um
  • 00:47:48
    that were not in peakville were uh farmw
  • 00:47:50
    worker sites um and um uh we have
  • 00:47:56
    continued to expand in fact in um uh by
  • 00:48:01
    now we're up to 30 health centers in uh
  • 00:48:05
    in the Hudson Valley and Long Island um
  • 00:48:08
    but because the need is there and uh
  • 00:48:11
    because that is our mission to serve
  • 00:48:14
    those needs and because we're good at it
  • 00:48:16
    I mean as I have said before uh from the
  • 00:48:19
    very beginning U we were at least
  • 00:48:23
    culturally sensitive and uh and aware
  • 00:48:27
    and uh that has just grown with time
  • 00:48:29
    which is fantastic now can you describe
  • 00:48:32
    specific activities that your Center has
  • 00:48:34
    implemented to respond to the different
  • 00:48:36
    linguistic and cultural needs of your
  • 00:48:38
    client base yeah we we have ongoing
  • 00:48:41
    training continual training um both for
  • 00:48:46
    uh staff and uh uh uh providers
  • 00:48:51
    specifically um and uh uh we are we
  • 00:48:55
    created a cultural competence Committee
  • 00:48:58
    in um in uh
  • 00:49:01
    1994 to um uh to continually explore
  • 00:49:05
    ways in which um our
  • 00:49:08
    organization uh improves its uh uh staff
  • 00:49:12
    cultural competence and organizational
  • 00:49:15
    cultural competence and um uh so uh
  • 00:49:19
    there it's an ongoing thing we have
  • 00:49:20
    members of our staff who serve on this
  • 00:49:23
    committee we have at ad hoc committees
  • 00:49:25
    which um are constantly being created
  • 00:49:28
    for example um when Ebola became an
  • 00:49:31
    issue we um we looked at the possibility
  • 00:49:35
    that we might be dealing with an ebola
  • 00:49:38
    uh somebody from West Africa or somebody
  • 00:49:40
    who'd been infected uh and maybe more
  • 00:49:43
    recently we um we have been working with
  • 00:49:46
    the LGBT communities to um uh uh to make
  • 00:49:51
    sure that those folks are are
  • 00:49:53
    comfortable when they come into the
  • 00:49:55
    health center the other thing we've been
  • 00:49:57
    doing is training patients we have
  • 00:49:59
    workshops for patients in um in working
  • 00:50:02
    with providers communicating with
  • 00:50:04
    providers so that they are feeling more
  • 00:50:07
    confident uh in and and have more um
  • 00:50:11
    more agency dealing with their providers
  • 00:50:14
    which is excellent now where has all of
  • 00:50:16
    this led you to as an agency today I
  • 00:50:19
    know you've got some statistics to share
  • 00:50:20
    about the demographics of your
  • 00:50:22
    population the demographics of your
  • 00:50:23
    board talk to us a little bit about that
  • 00:50:26
    well I'd be glad to um we are as I said
  • 00:50:30
    at the very beginning our um our board U
  • 00:50:34
    is required to have
  • 00:50:36
    51% uh of its members be um uh users of
  • 00:50:42
    one of our health centers sure and uh
  • 00:50:46
    currently uh we have um about close to
  • 00:50:49
    100,000 patients and there's
  • 00:50:53
    94,000 patients and uh so we have 20
  • 00:50:57
    board members and uh we try to keep it
  • 00:51:01
    as close as possible to the breakdown of
  • 00:51:04
    uh
  • 00:51:05
    African-Americans um uh uh Hispanic
  • 00:51:09
    Latinos um and other um uh other uh uh
  • 00:51:16
    racial ethnic or uh other cultures um so
  • 00:51:21
    uh for example LGBT people would be
  • 00:51:25
    represented um
  • 00:51:27
    um homeless maybe HIV AIDS great that's
  • 00:51:31
    uh that's that's that's a continual
  • 00:51:33
    process uh we're constantly looking at
  • 00:51:37
    the the figures we get back from the
  • 00:51:40
    cultural diversity of our patient
  • 00:51:42
    population our UDS every year tells us
  • 00:51:45
    who the folks are that are coming in and
  • 00:51:47
    we reassess do we need more people from
  • 00:51:51
    a different community on our board or do
  • 00:51:54
    we need to create a support MH group in
  • 00:51:57
    that community so it sounds like from
  • 00:51:59
    what you've said I mean your
  • 00:52:00
    organization really grew out of sort of
  • 00:52:02
    a Grassroots culturally sensitive
  • 00:52:05
    situation and you've really maintained
  • 00:52:06
    that even as your organization has grown
  • 00:52:08
    to be able to serve a much broader
  • 00:52:10
    population correct that's really
  • 00:52:12
    terrific now in doing this also we
  • 00:52:16
    sounds like you've really taken the
  • 00:52:17
    class standards and Incorporated those
  • 00:52:19
    I'd like to make sure that everyone
  • 00:52:21
    watching today knows how to find out
  • 00:52:22
    more about information about the
  • 00:52:24
    resources that we talked about so just
  • 00:52:26
    if you look on your screen and also um
  • 00:52:29
    within your slides handouts which are
  • 00:52:30
    available on our website we've got the
  • 00:52:33
    hotline number as well as Hudson River
  • 00:52:35
    healthc Care's number that you can find
  • 00:52:37
    for more information about what we've
  • 00:52:39
    discussed today um so now that we know
  • 00:52:42
    what the class standards are and we've
  • 00:52:44
    heard a little bit about an agency
  • 00:52:46
    that's worked so hard to provide these
  • 00:52:48
    kinds of competent staff Wilma where can
  • 00:52:50
    we go to find more information about how
  • 00:52:52
    to use these standards oh um there's a a
  • 00:52:55
    blueprint for advancing and sustaining
  • 00:52:57
    the class policy and practice that's
  • 00:52:59
    simply referred to as the blueprint and
  • 00:53:01
    that's the new guidance document for the
  • 00:53:03
    class standards and that explains the
  • 00:53:05
    enhancements the concepts found and in
  • 00:53:08
    throughout the standard and we can you
  • 00:53:10
    can find those at
  • 00:53:25
    www.thinkcentral.com but I know there
  • 00:53:26
    were folks you wanted to acknowledge in
  • 00:53:28
    your presentation oh well thank you very
  • 00:53:30
    much uh I wanted to acknowledge Dr
  • 00:53:32
    Nadine Gracia she's a deputy assistant
  • 00:53:34
    secretary for minority health and uh the
  • 00:53:37
    director of the office of minority
  • 00:53:38
    Health US Department of Health and Human
  • 00:53:40
    Services and also Miss Christine
  • 00:53:42
    Montgomery she's the management and
  • 00:53:44
    project analyst uh for a project officer
  • 00:53:47
    for think cultural Health office of
  • 00:53:49
    minority health and uh Mr Godfrey Jacobs
  • 00:53:52
    he's the senior program manager for
  • 00:53:54
    health determinance and disparities
  • 00:53:55
    practice SRA International and his team
  • 00:53:59
    who have done a wonderful job of guiding
  • 00:54:01
    us through the revision of the class
  • 00:54:03
    standards excellent thank you both so
  • 00:54:05
    much we have a couple of questions from
  • 00:54:07
    the audience I'm going to try to get
  • 00:54:08
    through them quickly um the first
  • 00:54:10
    question was in cases where in cases
  • 00:54:13
    where patients are reporting the use of
  • 00:54:15
    herbals in the treatment of a chronic
  • 00:54:17
    medical condition particularly among
  • 00:54:19
    patients of diverse backgrounds how
  • 00:54:21
    would you recommend a medical provider
  • 00:54:23
    effectively navigate through their own
  • 00:54:25
    beliefs regarding non traditional
  • 00:54:26
    treatments if they conflict with that of
  • 00:54:28
    the
  • 00:54:29
    patients we have this very very commonly
  • 00:54:33
    in far the farm worker population and in
  • 00:54:35
    other um uh communities that we serve as
  • 00:54:39
    well but but particularly with um our
  • 00:54:42
    farmw workers and one of the things we
  • 00:54:44
    do is we we get the providers uh the
  • 00:54:48
    nurses and the uh Physicians and nurse
  • 00:54:52
    practitioners Physicians assistants
  • 00:54:53
    whoever is working with them to educate
  • 00:54:56
    themselves about um Herbal Remedies the
  • 00:55:01
    use of kuras which still happens yeah
  • 00:55:06
    promos yeah uh so it's partly an
  • 00:55:09
    education okay and uh you know if those
  • 00:55:15
    remedies are working and people are
  • 00:55:17
    getting
  • 00:55:19
    healthier there's nothing wrong with
  • 00:55:21
    them as long as they're not toxic um or
  • 00:55:24
    have some kind of interaction yeah honor
  • 00:55:27
    we we try to honor that and not make it
  • 00:55:29
    look like they're getting inferior
  • 00:55:30
    medicine or doing something wrong that's
  • 00:55:32
    really important but to show an
  • 00:55:35
    understanding and also too taking it
  • 00:55:37
    back a a a step before that is creating
  • 00:55:40
    that environment where that patient will
  • 00:55:42
    disclose that's right that they are also
  • 00:55:45
    utilizing you know this form because you
  • 00:55:48
    know to other communities and other
  • 00:55:50
    populations were alternative medicine
  • 00:55:52
    here in the states so creating that
  • 00:55:55
    environment where they can disclose and
  • 00:55:57
    then having the provider have an
  • 00:55:59
    awareness of it so that he or she can do
  • 00:56:01
    the best in the interest of of his or
  • 00:56:04
    her patient so I think creating that
  • 00:56:07
    space an excellent would be would be
  • 00:56:09
    really helpful first because you know we
  • 00:56:12
    can get the knad and say uh yes doctor
  • 00:56:14
    I'm going to take what you tell me and
  • 00:56:16
    then go home and do what cultures have
  • 00:56:19
    been doing for a long time so being able
  • 00:56:23
    to have the opportunity to have that
  • 00:56:25
    relationship and then the discuss is
  • 00:56:28
    helpful excellent we see if we can
  • 00:56:30
    squeeze in one more question um as
  • 00:56:32
    racial and ethnic minorities become the
  • 00:56:34
    majority why do Public Health policy
  • 00:56:36
    makers still refer to these groups as
  • 00:56:38
    minorities this is a big question and
  • 00:56:41
    we've only got a couple of minutes so
  • 00:56:42
    let's see what what your thoughts are um
  • 00:56:45
    well um earlier in the presentation I
  • 00:56:46
    had mentioned that you know this is what
  • 00:56:48
    the data is showing this is what the
  • 00:56:49
    research is showing and so as as uh
  • 00:56:53
    James had had had said uh to me ear
  • 00:56:56
    earlier um you said it so beautifully
  • 00:56:58
    this is a a habit it's a habit it's a
  • 00:57:00
    habit a term of art minority majority
  • 00:57:05
    but this is no longer functional and the
  • 00:57:08
    language has to change as we as we
  • 00:57:11
    change yeah and then we'll see how it
  • 00:57:14
    influences policy and then how it'll go
  • 00:57:16
    into practice and let's hope let's hope
  • 00:57:18
    that it does that as things change we we
  • 00:57:20
    develop our policies to respond to the
  • 00:57:23
    changing needs of our population well
  • 00:57:25
    thank thank you both very much for
  • 00:57:27
    starting the conversation on what's a
  • 00:57:29
    very big topic it was great to hear from
  • 00:57:31
    you both today well thank you for having
  • 00:57:32
    us and thank you very much for joining
  • 00:57:35
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Tags
  • Cultural Competence
  • Healthcare
  • CLASS Standards
  • Health Disparities
  • Diversity
  • Inclusion
  • Public Health
  • Patient Care
  • Language Barriers
  • Healthcare Policy