1. Center for Diversity and Health Equity Ali Adem Patient Navigator Seattle Children’s Center for Diversity and Health Equity The Patient's Perspective of Patient Navigation

2. Center for Diversity and Health Equity At the end of this talk, you will able to identify: How refugee families experience care in a pediatric hospital. How language barriers, cultural background and mistrust can impact a family’s ability to access care. How a family’s beliefs about health and expectations about how healthcare should be delivered impact care outcomes. How a patient navigator can remove those barriers. Today’s objectives

3. Center for Diversity and Health Equity One family’s story 10 year old Somali child 5 years at Seattle Children’s before receiving patient navigation Extremely complex diagnosis Care provided in 8 clinics by multiple providers High no-show rate

4. Center for Diversity and Health Equity The family Ten children, including the patient One driver in the family (the father) Experiencing housing insecurity, resulting in frequent moves Both parents pre-literate.

5. Center for Diversity and Health Equity Unmet expectations Dad’s expectation: “The doctors will find out what is wrong on the first visit and then they will cure my son.” The care team’s expectations: “This is a medically complex child. It will take a while to evaluate all his difficulties and to create a treatment plan.” “He will need to be seen in many clinics by multiple specialists. Improvement will be slow.”

6. Center for Diversity and Health Equity Language barriers How do you find linguistic equivalents in Somali for: speech therapy? video fluoroscopic swallowing study? pH probe? bilateral myringotomy? tube placement?

7. Center for Diversity and Health Equity The family’s perspective of the hospital staff “They don’t want to help us”. “They give us bad care because we are poor.” “What if they are using my son for experiments?”

8. Center for Diversity and Health Equity Patient Navigator interventions Assessed the family's logistical needs Helped the family obtain low income housing Helped the father schedule clinic visits according to his availability Taught the family how to schedule transportation and to obtain a gas card from WA State’s DSHS.

9. Center for Diversity and Health Equity Listened to the father’s concerns and frustrations. Explained the roles of the different clinics and providers. Encouraged the father to ask questions and modeled how to do that. Patient Navigator interventions

10. Center for Diversity and Health Equity Interpreted or assured a qualified interpreter. Convinced providers to re-explain diagnoses and procedures Followed up after every clinic visit to guarantee understanding and participation in the care plan. Patient Navigator interventions

11. Center for Diversity and Health Equity Patient Navigator interventions Reassured the father about the providers’ commitment to his son’s well being. Coached the father how to be patient when he didn’t like what providers were saying. Explained that yelling and using certain hand gestures were signs of aggression in this country

12. Center for Diversity and Health Equity Outcomes The father understood for the first time his son’s medical complexities. The father become proactive in scheduling clinic appointments. The father learned how to ask his questions in a calm manner. The father participated in the developing the care plan. The father consented to a long-delayed cataract procedure.

13. Center for Diversity and Health Equity Outcomes The father reports that his son has stopped vomiting and is eating better then ever before. The school reports that the patient can see and read text much better than before. The father is applying his new skills to get healthcare for the rest of the family.

14. Center for Diversity and Health Equity You will able to identify: How refugee families experience care in a pediatric hospital. How language barriers, cultural background and mistrust can impact a family’s ability to access care How a family’s beliefs about health and expectations about how healthcare should be delivered impact care outcomes How a patient navigator can remove culturally-relevant barriers. Today’s objectives

15. Center for Diversity and Health Equity Sarah Rafton, MSW Cynthia Roat, MPH Zuraya Aziz Seattle Children’s Hospital Pacific Hospital Preservation and Development Authority Seattle Children’s Center for Diversity & Health Equity Acknowledgements

16. Center for Diversity and Health Equity Please contact The Center for Diversity and Health Equity at Seattle Children’s Hospital 206-987-3506 For more information

17. Center for Diversity and Health Equity