1. The Welcome Back Initiative: Improving diversity in the health workforce ®

2. Who We Are Started as a project of the SF and LA RHORCs, then added the Central Valley and San Diego RHORCs. Our mission is to build a bridge between the need for more culturally and linguistically diverse health professionals and the untapped resource of immigrants trained in a field of health in their country of origin who are living in the US. Our mission is to build a bridge between the need for more culturally and linguistically diverse health professionals and the untapped resource of immigrants trained in a field of health in their country of origin who are living in the US. The Welcome Back Initiative currently includes centers in San Francisco, Los Angeles, San Diego, Boston, Rhode Island and Puget Sound.

3. Why? “The lack of minority health professionals is compounding the nation’s persistent racial and ethnic health disparities.” (Sullivan Commission, Sept. 04)

4. Current Composition of Selected Health Professions in California by Race, Ethnicity Source: 2005 American Community Survey, Public Use Microdata Sample for California: California Medical Board Re-licensing Survey; Board of Registered Nursing 2006 * Data Source: HRSA, US Census 2000 Profession White(%)Latino(%)Asian(%) African Am. (%) Native Am. (%) US Population * 72.011.03.811.20.7 California Population 43.335.512.25.90.5 Physicians/Surgeons61.75.226.43.20.6 Registered Nurses 64.35.722.54.50.3 Dentists61.4--29.2---- Pharmacists47.8--44.5---- Psychologists84.07.6------ Social Workers 67.813.58.48.1-- RespiratoryTherapists 58.0-------- Diagnostic-related Technologists & Technicians 56.722.912.6---- Healthcare Support Occupations 34.134.817.59.8--

5. Validating the Model There are large numbers of Internationally Trained Health Professionals (ITHPs) in California not working in the health sector. Of 7,339 WBI participants 4,696 (64%) were not working in the health sector at their point of entry into the program. Of 7,339 WBI participants 4,696 (64%) were not working in the health sector at their point of entry into the program. Of the ITHPs that are working in the health sector, many are underemployed. Most of the WBI physicians and nurses who are employed in the health sector were working as CNAs and dentists were working as dental assistants. Most of the WBI physicians and nurses who are employed in the health sector were working as CNAs and dentists were working as dental assistants.

6. ITHPs will have better opportunities to re-enter the health care sector with increased English proficiency. Eighty-six percent (86%) of the WBI participants that have obtained jobs in the health sector self- reported an English level of five or higher on a scale from one to ten. Eighty-six percent (86%) of the WBI participants that have obtained jobs in the health sector self- reported an English level of five or higher on a scale from one to ten. Public and private health sector employers will hire the WBI participants. Over 978 (11%) participants have been newly employed in public and private health settings across the state. Over 978 (11%) participants have been newly employed in public and private health settings across the state.

7. Cross-Cutting Themes English Language Proficiency Participants, educators, and employers alike identified lack of fluency in English as a fundamental obstacle for ITHPs entering the health workforce. Loss of Professional Identity Immigrant health professionals often faced the loss of professional identity and associated social standing and the challenge of redefining themselves in a new societal context. Immigrant health professionals often faced the loss of professional identity and associated social standing and the challenge of redefining themselves in a new societal context.

8. Lack of Familiarity with the US Health System Different roles and professions exist in the US; also, there are inherent differences in the US health workplace culture, rules, and regulations. Economic Issues Lack of financial resources and time to attend classes were consistently identified as barriers to participation in the WBI. Individuals often did not have the time to go to school because they held two or three jobs in order to support their families. Lack of financial resources and time to attend classes were consistently identified as barriers to participation in the WBI. Individuals often did not have the time to go to school because they held two or three jobs in order to support their families.

9. Replicating the Welcome Back Model: Lessons Learned Understanding the context The characteristics of the existent regional health workforce; urban or rural geographical settings; density and size of service area; ethnic composition of the community; and overall economic characteristics of the region will shape individual programs. The characteristics of the existent regional health workforce; urban or rural geographical settings; density and size of service area; ethnic composition of the community; and overall economic characteristics of the region will shape individual programs.

10. Developing employer partnerships Employers are direct beneficiaries of the WBI. For this reason, WBCs should include potential employers early on in the development of the project. Employers can be involved in several different ways: serving on advisory committees, funding educational programs, providing training slots or volunteer opportunities, making in-kind contributions (e.g. space), or as policy partners. Employers are direct beneficiaries of the WBI. For this reason, WBCs should include potential employers early on in the development of the project. Employers can be involved in several different ways: serving on advisory committees, funding educational programs, providing training slots or volunteer opportunities, making in-kind contributions (e.g. space), or as policy partners. Selecting educational institutions The leadership of the selected educational institutions should work together to ensure the viability of the program. The leadership of the selected educational institutions should work together to ensure the viability of the program.

11. Structuring the program elements It is important to conduct an assessment with potential program participants prior to structuring all elements of the program related to curricula, time, location, duration of interventions, and intensity of case management required. The Initiative’s approach to developing a career strategy with the participants started by understanding where the participant was in the spectrum of options available to him/her. It is important to conduct an assessment with potential program participants prior to structuring all elements of the program related to curricula, time, location, duration of interventions, and intensity of case management required. The Initiative’s approach to developing a career strategy with the participants started by understanding where the participant was in the spectrum of options available to him/her. Outreaching to and identifying participants The program needs staff that can speak more than one language and/or have access to interpreters. As well, an understanding of multiple cultural norms supports the configuration of appropriate services. The program needs staff that can speak more than one language and/or have access to interpreters. As well, an understanding of multiple cultural norms supports the configuration of appropriate services.

12. Building the program The WBCs should take into account participants’ needs and interests along with regional employment opportunities, political and economic conditions, and availability of committed academic partners. The WBCs should take into account participants’ needs and interests along with regional employment opportunities, political and economic conditions, and availability of committed academic partners. Monitoring and evaluation Monitoring and evaluation A comprehensive evaluation strategy that can provide “hard data” validating the program’s work is imperative for demonstrating the project’s credibility, developing sustainability strategies, and supporting continuous quality improvement throughout implementation. Mechanisms for interpreting and communicating the data to key stakeholders on an ongoing basis are also important. A comprehensive evaluation strategy that can provide “hard data” validating the program’s work is imperative for demonstrating the project’s credibility, developing sustainability strategies, and supporting continuous quality improvement throughout implementation. Mechanisms for interpreting and communicating the data to key stakeholders on an ongoing basis are also important.

13. Creating a supportive policy environment Moving a policy agenda forward while implementing the program will open or create channels for ITHPs to enter the health workforce. Moving a policy agenda forward while implementing the program will open or create channels for ITHPs to enter the health workforce. Sustaining the program Flexible, non-categorical funding streams to address emerging issues. Flexible, non-categorical funding streams to address emerging issues. Diversified, ongoing funding base that includes private and public entities Diversified, ongoing funding base that includes private and public entities Modular sponsorship: sponsors of one element of the program. Modular sponsorship: sponsors of one element of the program. Contracts by program staff to provide trainings to employers or community organizations. Contracts by program staff to provide trainings to employers or community organizations. Fee-for-service. Fee-for-service. Contributions and support from alumni. Contributions and support from alumni.

14. Professions - All Centers Other includes: psychologists, speech therapists, pharmacists, midwives, physical therapists, social workers. Total Participants: N= 8,492 as of December 2008.

15. Working In Health? - All Centers N= 8,492 as of December 2008

16. Time in the US N= 8,492 as of December 2008

17. Heard about the program? N= 8,492 as of December 2008

18. Gender

19. Professions – By Center Welcome Back Center -Los Angeles Welcome Back Center –San Francisco Welcome Back Center –San Diego

20. Professions – By Center Welcome Back Center – Boston Welcome Back Center – Rhode Island Welcome Back Center – Puget Sound

21. Country Of Origin CA Welcome Back Centers Mexico21% El Salvador10% Peru 9% Philippines 8% China 4% Colombia 2% Other Countries Include: Afghanistan, Algeria, Argentina, Bolivia, Bosnia, Brazil, Bulgaria, Burma, Chile, Costa Rica, Cuba, Dominican Republic, Ecuador, Egypt, Ethiopia, France, Germany, Greece, Guatemala, Haiti, Honduras, Indonesia, Iran, Iraq, Israel, Japan, Kazakhstan, Kenya, Korea, Latvia, Lebanon, Libya, Morocco, Nigeria, Pakistan, Palestine, Panama, Romania, Russia, Somalia, Spain, Sri Lanka, Saudi Arabia, Switzerland, Syria, Taiwan, Trinidad, Turkmenistan, Tunisia, Turkey, Ukraine, USA, Uruguay, Venezuela, Vietnam. Total Participants in CA: N= 7,782 as of December 2008.

22. Country Of Origin Boston Welcome Back Center Haiti20% Brazil 7% China 6% Nigeria4% Philippines3% Other Countries Include: Albania, Antigua, Bulgaria, Cameroon, Cape Verde, Colombia, Congo, Czech Republic, Dominican Republic, El Salvador, Ethiopia, Ghana, Honduras, India, Japan, Korea, Lebanon, Liberia, Moldova, Mongolia, Nepal, Nigeria, Peru, Philippines, Poland, Puerto Rico, Sierra Leone, South Africa, South Korea, Taiwan, Tanzania, Turkey, Uganda, United Kingdom, Zambia Total Participants: N= 547 as of December 2008.

23. Country Of Origin Rhode Island Welcome Back Center Dominican Republic 33% Colombia 20% Nigeria 11% Puerto Rico11% Mexico 9% Other Countries Include: Brazil, Haiti, and Venezuela. Total Participants: N= 80 as of December 2008.

24. Country Of Origin Puget Sound Welcome Back Center Ethiopia 12% Kenya 7% Ukraine 7% India 7% Iraq 6% Mexico 6% Other Countries Include: Afghanistan, Bolivia, Bosnia and Herzegovina, Brazil, Burkina Faso, Cambodia, Colombia, El Salvador, Estonia, Guatemala, Guinea, Japan, Moldova, Nigeria, Peru, Philippines, Russia, Vietnam. Total Participants: N= 83 as of December 2008.

25. ENGLISH HEALTH TRAIN CURRICULUM COURSE ACOURSE B COURSE C MODULE 1 Exploring Career Goals in Health Care MODULE 2 Communicating with Patients and Families MODULE 3 Communicating with Other Health Professionals MODULE 4 Exploring Critical Issues in Health Care MODULE 5 Intercultural Communication in Health Care UNIT 1 Health Care Professions and Career Paths The Patient-Health Professional Relationship Interaction among Health Care Workers Understanding Health Care Systems Culture and Communication in Health Care UNIT 2 Requirements for Entry in Health Field Gathering Patient Information Using Medical Terminology Appropriately Understanding Health Care Cultures Beliefs and Traditions about Health and Illness UNIT 3 Job Search Skills The Patient-Centered Interview Assertive Communication with Co-Workers Critical Health Issues in the U.S. Cultural Diversity in Health Care UNIT 4 Job Application Process Examining and Monitoring Patients Professional and Social Communication Healthy Lifestyles and Behaviors Serving Multicultural Patients UNIT 5 Job Interview Skills Developing a Treatment Plan Working Effectively on a Team Alternative Health Perspectives and Practices Working with Multicultural Health Professionals UNIT 6 Professional Behavior & Workplace Expectations Medical Charting and Reporting Supervising and Instructing other Health Professionals Health Care for an Aging Population Cultural Disparities in Health Care UNIT 7 Work & Safety Issues for Health Professionals Patients with Special Needs Electronic Communication Legal & Ethical Issues in Health Care Analyzing Needs of Cultural Communities UNIT 8 Career and Professional Development in Health Care Handling Challenging Situations with Patients Handling Challenging Situations with Co- Workers Future Directions for Health and Health Professionals Serving Our Own Cultural Communities

26. Welcome Back Technical Assistance Tool Kit Educational Case Management Starting a Welcome Back Center Orientation to Health Care in the U.S. English for Health Professionals Considerations in Starting a Center Data Collection & Evaluation Strategic Planning Workshop Types of Participant Services Provided Guidelines for Managing a Center Implementing the Welcome Back Model Overview of Program Evaluation Data Collection & Data Entry Data Analysis & Report Generation Sample Evaluation Tools & Reports The Case Management Process Career & Employment Options Evaluation of Healthcare Credentials Professional Licensing Processes Types of Courses & Group Activities Health Professions & Practice Course Organization of Health Services Course Public Health & Safety Course Planning & Assessing English Courses Training of Trainers: Five Components Module 3: Co- Worker Communication Skills Module 1: Exploring Career Goals in Health Module 2: Patient Communication Skills Job Readiness Skills Residency Training for IMGs Course Course Planning & Implementation Tools Module 4: Critical Issues in Health Care Module 5: Intercultural Communication

27. Outcomes (through December 2008) 1,735 Validated their Credentials 1,104 Passed Licensing Exams 978 Obtained Employment in the US Health Sector for the First Time 649 Obtained Advancement in Health Career 417 Obtained License in their Original Professions 60 MDs Accepted into Residency Programs

28. Welcome Back Initiative WBI SFWBC Los Angeles WBC San Diego WBC Boston WBC Rhode Island WBC Puget Sound WBC Montgomery County, MD New York? Texas?

29. Welcome Back Centers San Francisco, CA(415) 561-1833 Hosted by City College of San Francisco Los Angeles, CA(909) 594-5611 x6102 Hosted by Mt. San Antonio College San Diego, CA(619) 409-6417 Hosted by Grossmont College Boston, MA(617) 228-4226 Hosted by Bunker Hill Community College Providence, RI ( 401) 273-8866 ext 155 Hosted by Dorcas Place Puget Sound, WA(206) 878-3710 ext 3345 Hosted by Highline Community College www.welcomebackinitiative.org