SAHRA NOOR, CEO

KEYNOTE PRESENTATION:

CHALLENGES AND BEST PRACTICES FOR LLD POPULATIONS

JUNE 6, 2015

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

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

Refugee Arrivals to MN by Region of World 1979-2014

0

1000

2000

3000

4000

5000

6000

7000

80001979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

Nu

mb

er

of

arr

ivals

Southeast Asia Sub-Saharan Africa Eastern EuropeFSU Middle East/North Africa Other

Source: Refugee Health Program, Minnesota Department of Health

“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

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

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

Imagine!

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

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?

Challenges: Code of Ethics

In small, emerging communities, lines get blurred.

Professionalism

Boundaries

Respect Vs. Advocacy

Confidentiality

Autonomy

Community “expert” Vs. neutral/impartial role

Challenges: Workforce

Limited access to bilingual or qualified interpreters

Limited job opportunities (mostly freelance)

Complex system to navigate

Changing workforce dynamics, shortages

Reputation

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

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.

Best Practices: Professional role

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

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.

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

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.

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.

All about the Triple Aim

Thank you!

Contact:

Sahra Noor

Email: noors@peoples-center.org

Tel: 612-332-4973

Website: www.peoples-center.org