Holy Cross Hospital: A Minority Outreach Network with an Adaptable Community Infrastructure Wendy W. Friar, RN, MS Vice President, Community Health October 21, 2010 Minority Outreach and Technical Assistance (MOTA) Maryland Commission on Indian Affairs

Cigarette Restitution Fund Program (CFRP)  The State of Maryland became a signatory party to the Master Tobacco Settlement reached in litigation filed by multiple states against the tobacco industry to recover Medicaid costs associated with smoking.  As a signatory party to the Tobacco Settlement, Maryland received funds to enable it to make extraordinary strides in education, health and agriculture, to transform Maryland into an anti-cancer State.  The plan was to assemble leading minds, practitioners and concerned community activists for the most effective distribution of Tobacco Settlement monies targeted for programs to end smoking and conquer cancer in Maryland.

Cigarette Restitution Fund Program (CFRP) continued  The Maryland Department of Health and Mental Hygiene has administrative oversight on the distribution of health related funds  The Maryland CFRP’s primary goals are to: -Reduce smoking -Reduce the incidence of cancer -Reduce minority health disparities associated with cancer and tobacco product use

Cigarette Restitution Fund Program (CFRP) continued With funds from the CRFP, the overall strategy to meet these goals, is the development of a network of community-based, minority-serving organizations that will:  Increase awareness about cancer prevention and tobacco-use cessation.  Ensure that ethnic/racial minorities benefit from the tobacco settlement fund programs.

Overview - Minority Outreach &Technical Assistance (MOTA)  Maryland established the Minority Outreach & Technical Assistance Program (MOTA) to ensure the involvement of minorities in the CRFP throughout the State.  With CRFP funds, MOTA provides 24 jurisdictions with funding to: -Partner with the local health department around cancer and tobacco product control -Attend local CRFP cancer and tobacco coalition meetings -Collaborate with multiple minority groups -Reach out to faith-based groups -Empower local minority communities to act decisively and effectively around: Prevention & early detection  health and wellness

Minority Outreach &Technical Assistance (MOTA) con’t  Targeted minority outreach efforts may be through community leadership and networks: MOTA encourages the establishment of community-based collaborations that target racial and ethnic minority groups (e.g., community and faith-based organization’s, minority health initiatives, coalitions, and hospitals):  Collaborations provide the opportunity to recognize and respect diversity to ensure cultural competency and linguistic sensitivity.

MOTA Empowerment Strategies Community-based collaborations:  Enhance the educators’ knowledge of health disparities that affect minority communities through community and organizational capacity building.  Engage and empower community members through T/A training: To encourage health screenings, early detection, and healthy behaviors and lifestyles among minorities.  Refer community members to the local health department for health screenings and treatment.

MOTA Empowerment Strategies (continued)  Community development is a process that connects people, ideas and resources in a culturally appropriate way to improve the health of the community.  Engage and empower local minority communities to act decisively and effectively  Capacity building creates relationships and an exchange of knowledge across cultures to bring people together and strengthen communities around the elimination of health disparities.  MOTA grantees are collectively diverse entities that offer leadership, time, knowledge, creativity, compassion, and hard work to community partnerships for collaboration around health to eliminate health disparities.

Two (2) Key Components – The Building of an Infrastructure 1. Organizational Capacity Building  Technical assistance (T/A) training (health promotion): - Early detection and screening - Education and empowerment - Referral services - Shared knowledge  Community Activism: - Leadership training that impacts cancer, tobacco abuse and chronic and emergent health conditions, and healthcare decision making 2. Community Capacity Building  Community education and empowerment  Self-advocacy for sustainability

Minority Communities Empowerment Project (MCEP) 2005 – Holy Cross Hospital became the only hospital-based partner and lead entity for the Minority Communities Empowerment Project (MCEP): A multi-organization collaborative to reduce health disparities in cancer morbidity and mortality and chronic and emergent health conditions. MCEP targets racial and ethnic communities. Montgomery County Demographics: Total: 950,680 Non-Hispanic White: 519,847 Minority Population: 430, % African American: 165,899 Asian/Pacific Islander: 135,175 American Indian: 4,823 Hispanic:140,657 Source: Maryland Vital Statistics Annual Report 2008

Minority Communities Empowerment Project (MCEP) continued  Target populations may have low English proficiency; are low- income, uninsured, under-insured, medially underserved; racial and ethnic communities in Montgomery County. Communities with low-resources.  Racial and ethnic groups targeted for outreach are: – African Americans – Blacks of the Caribbean and Africa – Asian Americans – Latino Americans – Native Americans

Minority Communities Empowerment Project: Partnerships Participating fiscal year 2011 partners:  Holy Cross Hospital – lead entity (July 2004)  Asian American Health Initiative (2004)  African American Heath Program (2004)  Community Ministries of Rockville (2004)  Maryland Commission on Indian Affairs (2007) Historically:  CASA de Maryland (2004 – 2010)  Latino Health Initiative (2004)  African Women’s Cancer Awareness Association (2009)

Minority Communities Empowerment Project: Collaboration 1. Contributes – Researches and gathers information, shares information 2. Takes Responsibility – Duties as assigned, shares equally 3. Value Other ’ s Viewpoints – Listens to and cooperates with teammates, helps team reach a fair decision From:

Minority Communities Empowerment Project (MCEP) continued  Raises awareness about the importance of early cancer detection and prevention, tobacco-related illness, chronic disease self-management and emergent conditions.  Links community members with local medical screening opportunities.  Three (3) points of access: 1. Financial 2. Cultural 3. Geographical  Implantation through the Sustainable Minority Outreach Technical Assistance (SMOTA) model.

Sustainable Minority Outreach & Technical Assistance (SMOTA) SMOTA model:

Minority Communities Empowerment Project (MCEP) continued Multiple venues provide culturally competent and linguistically sensitive outreach and education:  Community centers  Faith-based institutions  Day Laborer sites  Barbershops  Beauty salons  Metro stations  Ethnic grocery stores  Health fairs  Individual meetings and community gatherings

Ethnic Health Promoters Holy Cross is committed to reducing health disparities Established an ethnic health promoter program. Ethnic health promoters:  Reach out to racial and ethnic minority populations who have reduced access to health care  Medically vulnerable and underserved populations with: - Limited English proficiency - Financial constraints - Geographical constraints - Varying cultural practices - Lack of knowledge of the U.S. healthcare system

Ethnic Health Promoters (continued) Ethnic Health Promoters (multi-ethnic health educators): 80 collectively  Live in the communities where they provide outreach  Speak foreign languages  Establish trust  Raise awareness about early disease detection  Link to care, treatment and immunization  Provide education  Offer support during screening, diagnosis and treatment

Strategies for Success The MCEP is a multi-organizational collaborative that works harmoniously and collectively based upon:  Equitable delegation of roles and responsibilities.  Respectful value other’s knowledge and opinions.  Shared knowledge -- best and promising practices based on the literature, evidence-based practice, experience, observation and learning's from the community.  Promotion on the grassroots level.  Joint responsibility for the success of an activity (outcomes).

Challenge: Hard to Reach Populations Limited English proficient (LEP) individuals.  The LEP individuals are often socially isolated, making them a hard to reach population.  May experience communication barriers in everyday activities.  Barriers can threaten individual health, safety and access to public services.  The County’s foreign-born population has nearly doubled from 140,000 in1990 to more than 270,000 in 2007.

Challenge: Hard to Reach Populations (continued)  % of Latino households spoke a language other than English, 30% spoke little to no English.  Montgomery County’s LEP population was higher than the national and state average.  Asian Americans in Montgomery County had the highest linguistic isolation with a rate of 40% when compared to other minorities.  Culturally competent and linguistically sensitive ethnic health promoters are able to reduce the barriers to communication.

Outcomes for Fiscal Year 2010 Health education encounters (FY 2010):  African Health Program - 2,193  Asian American Health Initiative  CASA de Maryland - 1,319  Community Ministries of Rockville - 5,507  Holy Cross Hospital - 7,530 MCEP Total: 17,429

Outcomes for Fiscal Year 2010 (continued) Referrals for cancer screenings:  African Health Program - 8  Asian American Health Initiative - 45  CASA de Maryland  Community Ministries of Rockville  Holy Cross Hospital provided – 12 MCEP Total: 787

Program Replication  2009 & 2010 – MOTA was asked to draw upon its network’s statewide infrastructure to reach minority communities not adequately reached through mainstream prevention efforts.  Holy Cross Hospital (HCH) provided a demonstration of an adaptable community infrastructure to address chronic disease and emergent health conditions: - To promote and encourage self-management of chronic diseases - To disseminate H1N1 prevention messages and vaccinations  Replication of HCH’s cancer prevention activities (MCEP), created the necessary infrastructure to provide effective H1N1 outreach in the targeted minority communities.

Target groups were ethnic and racial minorities facing cultural, linguistic and geographical barriers to H1N1 prevention information and vaccination in Montgomery County. Populations at-risk for H1N1 included:  Pregnant women  Children under four years of age  Non-elderly adults with chronic disease  School aged students Program Replication for Emergent Health Conditions (con’t)

Program Replication The MCEP model is amenable to multiple chronic and emergent and disease prevention activities:  Cancer (e.g., colorectal, prostate, cervical, oral)  Tobacco product cessation  Breast cancer (Komen for Cure)  H1N1  Expanding to chronic disease-self management

During fiscal year 2010 the infrastructure of the MCEP model was adapted to a culturally competent H1N1 information and immunization program. Key elements: 1. Culturally competent outreach 2. Education through empowerment 3. Immunization navigation with links to the health department and hospitals 4. Collaborative with the Montgomery County Department of Health and Human Services. Replication of Emergent Health Conditions

Culturally competent and linguistically sensitive outreach and education was provided at multiple venues: One-to-one encounters, health fair participation and group presentations were provided in a variety of community venues including: Faith-based organizations Beauty salons Grocery store Public Schools Child day care sites Day laborer sites Community centers Skilled care facilities (for staff) Program Replication for Emergent Health Conditions (con’t)

November 2009 – July 2010:  Participated in 544 outreach events/educational sessions  Provided H1N1 health education to approximately 19,700 low-income and uninsured community members  Approximately 3,500 community members were referred to free H1N1 vaccination clinics in Montgomery County. Program Replication for Emergent Health Conditions (con’t)

January Holy Cross Hospital hosted a “quiet” flu clinic in collaboration with the Dennis Avenue Health Center, Disease Control Center (MCHHS)  The outreach workers and HCH staff provided information to approximately 300 community members.  H1N1 vaccinations were administered to 275 community members.  A special area was set-up to be inviting and “friendly” for children.  The target population was Holy Cross Hospital staff, volunteers, physicians and family members. Program Replication for Emergent Health Conditions (con’t)

We can achieve sustainable positive outcomes when all segments of the community work together -- to make the vision of healthy communities in Maryland a reality. (anonymous adapted)

Thank You