1. Taraqi Dehendai Sehat:
Addressing Health Disparities in
the Afghan Community
Presented by:
Raymond Grimm, Ph.D.
Human Services Department
City of Fremont, CA
November 15, 2017

2. A brief Introduction to Afghan Refugees
War affected for past 40 years
2.7 million refugees and immigrants traumatically displaced
Over 1 million lives lost, many sons, daughters, husbands and wives of residents living in the U.S.
12,000 reside in Fremont and the San Francisco Bay Area

3. Identified Needs High utilization of emergency rooms
“Doctor shopping” and collection of multiple medications
High rates of multiple chronic conditions, both health (chronic pain, diabetes, hypertension, arthritis) and mental health (e.g., 75 % of women affected by PTSS, anxiety, depression, insomnia)
Due to language and economic barriers, inability to access health, social and other community services resulting in significant health disparities
Social isolation, especially among women

4. Afghan Elderly Association (AEA) – A brief history
Early 90’s Najia Hamid, assists in documenting needs of Afghan elders.
1995 Najia Hamid, establishes AEA and becomes AEA Executive Director
1998 AEA receives non-profit status; grows from 8 women to over 500 participants by
2000 receives funding to launch weekly Healthy Aging Program, includes socialization, exercise, health education and a healthy meal.
2006 with funding from Alameda Area Agency on Aging and Alameda County Public Health, AEA in partnership with COF public health nurse launches the Taraqi Dehendai Sehat (TDS) program.

5. AEA Early Successes
Health Promotion (HP) training developed, 5 Afghans recruited and receive 100 hours of training.
HPs provide accesses to social services, promote fall prevention, provide health education, chronic disease and medication assistance.
Results were 18% increase in exercise, 25% reduction in falls, 21% decrease in ER usage, 14% increase in Medi-Cal access and 81% of clients obtained health care services.

6. AEA programs Healthy Aging Program
Mission: Implement a culture-based chronic condition self- management and care management program that utilizes peers to promote health, wellness and community access to older refugees and immigrants.
Healthy Aging Program
Tarqi Dehandai Sehat (TDS) Four components:
The Happy, Healthy Me Program: utilizes The
Flinders Program©
Linkages
Medication Assistance
Community Health Education
AEA’s TDS (Health Promotion) Program has four components
The Happy, Healthy Me Program: utilizes The Flinders Program© and Partners –in-Health assessment. Health promoters (HP) and participants collaboratively identify and prioritize health goals used in the development of a personalized wellness plan.
Linkages: HPs assist participants to accessing health, social service, housing and other community resources.
Medication Assistance: HPs and nursing students provide medication review and education, falls awareness and home safety education.
Community Health Education: TDS offers Matter of Balance and Tai Chi for Falls Prevention and the Stanford Chronic Disease Self-Management Program programs in Dari.

7. Why Flinders?
Federal mandate that all federally funded programs must be ‘evidence-based’
Best fit for Afghan community through the use of modified use of My Health Story program
Incorporates outcome and and change measures.
Use of Motivational Interviewing and
Structured Problem-Solving.

8. Flinders Implementation - Challenges
Federal approval of Flinders as an ‘evidence-based’ program.
Formalized use of program format (questionnaires, measures, forms) not previously utilized in Afghan community or by health promoters.
Need to translate Partners-In-Health scale
Health Promoters (HP) not previously trained in either Motivational Interviewing or Structured Problem-Solving. Used to telling clients what needed to be done.
Other cultural factors:
Religion – life is written before birth; current health is God’s wish
Priority on services, not health
Assessment is viewed as unnecessary
“You are the professional, tell me what I should do” client expectations

9. Movement 2015-16: 2016-2017: Health Promoters trained in Flinders
Translation of PIH and inclusion of Afghan images (approved by Flinders). :
Implementation of Results-Based Accountability includes Flinders scales
Gaps in HPs use of scales and wellness plans identified
Need to integrate HHM program and Linkages program for funding and accountability

10. Movement
2017:
National Council on Aging approves Flinders as an evidenced- based model
Development of Chronic
Conditions Self-Management
Strategies Wheel as summary
of PIH scales
Clients and HPs found this
useful as a tool used for a
holistic overview of their
health and decision-making
tool.
Development of HP
supplementary manuals
Chronic conditions outcomes
Measurement Wellness Plan – Revised for Flinders
Peer Case Management Outcome Measures

11. Supplementary Manuals
Chronic conditions outcomes measurement wellness plan – Revised for Flinders – 12 Domains
1. Knowledge of Condition(s)
5. Accessing Services
9. Managing Impact of Condition(s) on Personal Care and Physical Activity
2. Knowledge of Medications and Treatment
6. Attending Appointments
10. Managing Impact of Condition(s) on Emotional Well-being
3. Medications and Treatment Management
7. Chronic Condition Self-Management
11. Managing Impact of Condition(s) on Social Aspects of Life
4. Empowered Decision Making (Sharing in Decisions)
8. Symptom Monitoring, Response and Management
12. Living a Healthy Lifestyle

12. Supplementary Manuals

13. Supplementary Manuals
Peer Case Management Outcome Measures – 19 Domains
1. Activities of Daily Living (ADL)/ Independent Activities of Daily Living (IADL)
8. Sensory Deficits
14. Health Insurance
2. Nutrition
9. Cognitive Status
15. Legal Issues
3. Fall Prevention
10. Psychological Status
16. Abuse/Exploitation
4. Medical/Health
11. Housing
17. Immigration
5. Medication Management
12. Transportation
18. Family/Caregiver
6. Pain Management
13. Finances
19. Socialization
7.Language Barriers

14. Supplementary Manuals

15. Sample of 2016-2017 Outcomes 161 immigrant/refugee clients served
84 clients received medication education
45 clients developed wellness goals
132 clients assisted with accessing services
58 clients participated in health education
Outcomes
Outcomes and Satisfaction

16. Future Directions Ongoing training for HPs in
development of Wellness Plans, MI,
problem-solving, self-management
of chronic conditions
Utilization of electronic data base
Refinement of supplementary manuals
Improve outcomes
Expansion of program to
other ethnic communities
(next up is our Mandarin-
speaking community).

17. Questions
Contact Information
Raymond Grimm, Ph.D.
Senior Project Coordinator
Aging and Family Services Division, Human Services Department
City of Fremont, CA, USA
(510)