Culturally Engaged Health Care in Buffalo, NY

Kim Rook, Outreach Coordinator, MPH Coordinator Pavani Ram, Director, Office of Global Health Initiatives, Associate Professor Jessica Scates, Coordinator, Office of Global Health Initiatives Paul Wietig, Vice President, Interprofessional Education University at Buffalo School of Public Health and Health Professions June 19, 2014

Arrivals by State for the Reporting Period of 1-October-2013 through 30-April-2014Data

Texas 3888 California 3237 New York 2256 Data extracted from the Worldwide Refugee Admissions Processing System (WRAPS)

Refugees resettled in New York State Total: 3829

*Federal Fiscal Year 2013 New York State Bureau of Refugee and Immigrant Assistance

Sites of Refugee Resettlement in NY Erie County welcomes 36% of refugees in New York State!

*Federal Fiscal Year 2013 New York State Bureau of Refugee and Immigrant Assistance

Background and Objectives

• • •

Refugee health in Buffalo UB/Community engagement Refugee Health Summit

University County department of health Medicaid Resettlement agency State department of health Funding organizations

Refugee

Insurers Medical specialists Community organizations Refugee leaders State bureau of refugee and immigrant assistance Primary care providers

Health Needs & Gaps

Health needs to address Lead poisoning Trauma and torture STIs/STDs Tuberculosis Diabetes Cancer Mental illness – depression Suicide Other chronic conditions

Planning Committee Members

Education Buffalo Public Schools Refugee Community Support Burmese Community Support Center H.E.A.L. International Resettlement Agencies Inc.

Catholic Charities of Buffalo Health Department Health University at Buffalo Jewish Family Service of Buffalo & Erie County Journey’s End Refugee Services, International Institute of Buffalo Primary Care Provision and Health Assessments Community Health Center of Buffalo New York State Department of Global Health Initiative GSA Office of Global Health Initiatives Office of Interprofessional Education Office of Public Health Practice School of Dental Medicine School of Management School of Medicine & Biomedical Sciences School of Nursing School of Pharmacy and Pharmaceutical Sciences School of Public Health & Health

Refugee Health Summit Goal:

Examine barriers and explore solutions to culturally engaged health care provision for refugees in Buffalo • • •

Objectives:

Describe existing barriers of culturally engaged health care provision for stakeholder groups in WNY Learn about successful models to providing engaged health care for refugees in Buffalo and beyond Identify potential linkages and spark collaborations to adapt and implement solutions to expand culturally engaged health care for refugees in Buffalo

12:30-1:00 1:00-2:00 2:00-3:00 3:00-4:00 4:00-4:30 4:45-5:00 5:30-6:30 6:30-7:15 7:15-7:30

Summit Program

Introduction Panel Share Fair Informational talks Next steps Dinner Breakout groups Large group reporting and discussion Closing

Panelists

Bishnu Adhikari Employment Specialist, Journey’s End Refugee Services, Inc. Refugees Resettlement agencies Providers State Denise Phillips Beehag Director of Refugee and Employment Services, International Institute of Buffalo Cheryl Brown Refugee Health Program, Public Health Representative II, New York State Department of Health, Western Region Oma Chapagain Bhutanese Nepali Community Member Dianne M. Loomis Associate Clinical Professor, School of Nursing, Department of Family Medicine, University at Buffalo Chan Myae Thu Client Services Coordinator, Burmese Community Support Center

Culture Language Trust Religion Gender Definitions of good and poor health Health as a priority Preventive health vs. curative Interpretation Accessing personal health information Accessing preventive care Accessing knowledge about prevention Translating medical terms Non-verbal language Many other issues as well… Mental health History of trauma The doctor and other ‘authority’ figures Power within the family

Barriers to Healthcare

• • • • • • Access to medical care (primary care) Cultural unfamiliarity among providers Grouping refugees into one generalizable group Health insurance Language Mental health and screening

Informational Talks

Dr. Myron Glick Dr. Kim Griswold Jim Sutton, RPA-C

Models for Community Engagement & Care

• Rochester Model RSMI – Remote Simultaneous Medical Interpreting Empowered oversight committee Coordinated providers and care Jericho Road Community Health Care Model Hire a diverse staff, encourage diversity Invest in community relationships Built walk-ins into the system

Models for Community Engagement & Care

• Mental Health Provision • Train bi-lingual / bi-cultural mental health care providers • Adjust screening methods • Increase mental health value among refugees • Ethnic community support groups Burmese Community Support Center Others: Bhutanese Iraqi

Breakouts to Address Barriers

• • • • • Coordination of stakeholders Mentorship of providers Mobilizing human capital / leadership among refugee community Interpretation Improving linkages of care, addressing gaps in care

Solutions to Barriers

•

Coordination of stakeholders

 Day-to-day agency partnerships through agreements  Community-based steering committee or council  Annual summit to reassess  Culturally engaged healthcare assessment available online • Provider mentorship, education  Referral / map app and web based resources  Hiring of bilingual health providers and front office staff  Relocate specialists to primary care locations  Culturally engaged health care grand rounds

Solutions to Barriers

• Refugee mentorship, education, leadership  Platform for ethnic community-based support organizations  Identify leaders in the community for continued education training • Interpreter services  RSMI (UN-like headsets)  Interpretation phone apps  Hire local community members and bi-lingual employees  Web-based portal with language resources  Educate providers in second languages

Solutions to Barriers

• Improving linkages of care, addressing gaps  Health-e-Link health assessment  Mental health providers in community health centers  Mapping system addressing transportation issues  Referral / map app  Agency partnerships  Health education – preventive care

Takeaways

• • • • • • 110 registrants, 130 participants 30 agencies and University Schools Collaborations among agencies and refugee maximizes resources Meaningful interagency relationships Task forces and action plans created UB will be leader in steering committee, exploration of interpretation models, among other areas

Takeaways

• • • • • Improving Linkages of Care (10) Mentorship of Providers (15) Coordination of Stakeholders (7) Mobilizing of Human Capital (4) Interpretation (5)

Next Steps

• • • • Dissemination of Refugee Health Summit Report Exploratory meeting with Refugee Advocates (June) Task force development Health for Refugee Populations Course

Next Steps

• Solidify University at Buffalo’s role moving forward • School of Pharmacy continuing education • School of Social Work build capacity and linkages • School of Public Health provide field placement • IT involvement • Recruitment of talent from the refugee community • Best practice research and assessments

Thank You

Acknowledgements: Office of Global Health Initiatives Dr. Pavani Ram Jessica Scates Dr. Arthur Goshin School of Public Health and Health Professions UB Office of Interprofessional Education Dr. Paul Wietig Community Agencies