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Challenges and Best Practices for LLD Populations: Sahra Noor's NCIHC Keynote Presentation

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Engaging presentation discussing the challenges and best practices for LLD populations, delivered by Sahra Noor, CEO of People's Center Health Center.

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Challenges and Best Practices for LLD Populations: Sahra Noor's NCIHC Keynote Presentation

  1. 1. SAHRA NOOR, CEO KEYNOTE PRESENTATION: CHALLENGES AND BEST PRACTICES FOR LLD POPULATIONS JUNE 6, 2015
  2. 2. People’s Center Health Services  Nonprofit, community-directed health center  Internationally recognized for serving large number of Somali/East African immigrants  Reputable, culturally competent provider  Federally qualified/funded to serve uninsured  Certified patient-centered health care home  10,000 patients, 36,000 visits annually  Celebrating 45 year anniversary
  3. 3. Diversity in Minnesota  According to Census 2010, Minnesota is becoming increasingly diverse  Home to largest Somali, Tibetan and Hmong population in North America  Large Russian, Korean, Vietnamese and Cambodian community  Growing Karin population
  4. 4. Refugee Arrivals to MN by Region of World 1979-2014 0 1000 2000 3000 4000 5000 6000 7000 8000 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 Numberofarrivals Southeast Asia Sub-Saharan Africa Eastern Europe FSU Middle East/North Africa Other Source: Refugee Health Program, Minnesota Department of Health
  5. 5. “Other” includes Afghanistan, Belarus, Cambodia, Cameroon, Cuba, DR Congo, Ecuador, El Salvador, Eritrea, the Gambia, Honduras, Iran, Kenya, Liberia, Moldova, Nepal, Russia, Rwanda, Sierra Leone, Sri Lanka, Sudan, Tanzania, Ukraine, and West Bank Source: Refugee Health Program, Minnesota Department of Health Somalia, 1130 (46%) Burma, 838 (34%) Iraq, 191 (8%) Bhutan, 77 (3%) Ethiopia, 59 (2%) All Others*, 171 (7%) Primary Refugee Arrivals 2014
  6. 6. Country of Origin by County of Resettlement, 2014 0 100 200 300 400 Hennepin Somalia Iraq Bhutan Ethiopia Other 0 100 200 300 400 500 600 700 800 900 Ramsey Burma Somalia Bhutan Iraq Ethiopia Other 0 50 100 150 200 250 Stearns Somalia Iraq Kenya 0 20 40 60 80 100 Anoka Iraq Somalia Afghanistan Other N=451 N=1,272 N=275 N=155 Refugee Health Program, Minnesota Department of Health Source: Refugee Health Program, Minnesota Department of Health
  7. 7. Secondary Refugee Arrival Notifications to Minnesota 2014 Somalia, 789 (94%) Iraq, 26 (3%) Burma, 13 (1%) All Others, 13 (2%) N=841 Source: Refugee Health Program, Minnesota Department of Health
  8. 8. Imagine!
  9. 9. What we know  Language barriers contribute to health disparities  Poor access to care  Poor adherence to treatment and follow up  Increased prevalence of chronic disease  Poor interpretation has severe consequences  Under or over diagnoses  Misdiagnoses  Poor use of limited health resource  Life threatening surgical and medical errors  Legal risk to provider, healthcare organization  Loss of trust
  10. 10. Challenges: “Meaningful Access”  Title VI of the Civil Rights Act of 1964 prohibits discrimination based on race, color, or national origin by any entity that receives federal financial assistance.  Focus is on “meaningful access” and federal programs  How is it defined and by whom?  Person receives and understands program information?  Person can effectively communicate with service provider?
  11. 11. Challenges: Code of Ethics  In small, emerging communities, lines get blurred.  Professionalism  Boundaries  Respect Vs. Advocacy  Confidentiality  Autonomy  Community “expert” Vs. neutral/impartial role
  12. 12. Challenges: Workforce  Limited access to bilingual or qualified interpreters  Limited job opportunities (mostly freelance)  Complex system to navigate  Changing workforce dynamics, shortages  Reputation
  13. 13. Challenges: Reimbursement District of Columbia and 13 states) are providing reimbursement. • Hawaii • Iowa • Idaho • Kansas • Maine • Minnesota • Montana • New Hampshire • Utah • Vermont • Virginia • Washington • Wyoming
  14. 14. Challenges: Training/Mentoring  Limited language training programs exist in many states  Interpreter training programs have grown over the past years nationally.  Over 70 programs advertise program including major universities, but not any offering languages spoken by the new African, Asian, Eastern European refugees and immigrants.  Very few prepare graduates for health related interpreting  Limited formal peer to peer mentoring or support for new medical interpreters.
  15. 15. Best Practices: Professional role
  16. 16. Best Practices: Cultural Brokering  Most effective interpreters are those who not only interpret language but cultural context and meaning.  Visuals  Metaphors  Community-Healthcare Connections  Explain cultural/ geographical norms  Nonverbal cues
  17. 17. Best Practices: Grow Talent  Focus on Human Capital  There will always be limited number of individuals in the community who have the “gift” and willing to do the hard work of being a medical interpreter.  We need to retain and grow the talent we already have while encouraging another generation to pursue it as a career, not a job.  Appeal to heart, not the head or pocket  Best interpreters are those who have the compassion, yet have the skills required to do the job  While it may not always be paid job, medical interpreting can be a rewarding, challenging job.
  18. 18. Best Practices: Technology  Leverage Technology to:  Educate patients  Increase access  Reduce impact of talent gap  Reduce Cost  Emerging tools:  Smart Phone Apps  Mobile VRI  Phone interpreting devices  Translation software
  19. 19. Best Practices: Hybrid Roles  We need to think outside the box.  Emerging models:  CHW/Interpreter  Transport/Interpreter  Care Coordinator/Interpreter  Educator/Interpreter  Utilize the skills of a medical interpreter and combine it with other critical roles in health care.  That way we can ensure patients and families receive affordable high quality care.
  20. 20. Policy Change  Payment Reform  Sustained legislative advocacy for payment reform so all states can provide reimbursement  Expand reimbursement to non-governmental insurance  National Certification/Registry  There is momentum. Let’s capitalize on it.  Let’s raise the standards, together  Accountability/Consumer Protection  There has to be consequences for poor access to language services and poor interpreter conduct besides losing a job.
  21. 21. All about the Triple Aim
  22. 22. Thank you!  Contact: Sahra Noor Email: noors@peoples-center.org Tel: 612-332-4973 Website: www.peoples-center.org

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