Culturally Engaged Health Care in Buffalo, NY

Kim Rook, Outreach Coordinator, MPH CoordinatorPavani Ram, Director, Office of Global Health Initiatives, Associate

Professor Jessica Scates, Coordinator, Office of Global Health Initiatives

Paul Wietig, Vice President, Interprofessional Education University at Buffalo School of Public Health and Health Professions

June 19, 2014

Data extracted from the Worldwide Refugee Admissions Processing System (WRAPS)

Arrivals by State for the Reporting Period of 1-October-2013 through 30-April-2014Data

Texas 3888

California 3237

New York 2256

Refugees resettled in New York State

*Federal Fiscal Year 2013 New York State Bureau of Refugee and Immigrant Assistance

Total: 3829

Sites of Refugee Resettlement in NY

*Federal Fiscal Year 2013 New York State Bureau of Refugee and Immigrant Assistance

Erie County welcomes 36% of

refugees in New York State!

Background and Objectives

• Refugee health in Buffalo• UB/Community engagement• Refugee Health Summit

Refugee

County department

of health

State departme

nt of health

Primary care

providersCommunity organizatio

ns

Insurers

Funding organizatio

ns

Medicaid

State bureau of refugee and immigrant assistance

Medical specialists

Resettlement agency

Refugee leaders

University

Health Needs & Gaps

Lead poisoningTrauma and tortureSTIs/STDsTuberculosis

DiabetesCancerMental illness – depressionSuicideOther chronic conditions

Health needs to address

EducationBuffalo Public Schools

Refugee Community SupportBurmese Community

Support CenterH.E.A.L. International

Resettlement AgenciesCatholic Charities of BuffaloJewish Family Service of

Buffalo & Erie CountyJourney’s End Refugee

Services, Inc.International Institute of

BuffaloPrimary Care Provision and Health Assessments

Community Health Center of Buffalo

Jericho Road Community Health Center

Neighborhood Health Center

Planning Committee Members

Health DepartmentNew York State Department

of HealthUniversity at Buffalo

Global Health Initiative GSAOffice of Global Health

InitiativesOffice of Interprofessional

EducationOffice of Public Health

PracticeSchool of Dental MedicineSchool of ManagementSchool of Medicine &

Biomedical SciencesSchool of NursingSchool of Pharmacy and

Pharmaceutical SciencesSchool of Public Health &

Health ProfessionsSchool of Social Work

Refugee Health Summit

Goal: Examine barriers and explore solutions to culturally engaged health care provision for refugees in Buffalo  Objectives:• Describe existing barriers of culturally engaged health

care provision for stakeholder groups in WNY• Learn about successful models to providing engaged

health care for refugees in Buffalo and beyond• Identify potential linkages and spark collaborations to

adapt and implement solutions to expand culturally engaged health care for refugees in Buffalo

Summit Program

12:30-1:00 Introduction1:00-2:00 Panel2:00-3:00 Share Fair3:00-4:00 Informational talks4:00-4:30 Next steps4:45-5:00 Dinner 5:30-6:30 Breakout groups6:30-7:15 Large group reporting and discussion7:15-7:30 Closing

Panelists

Bishnu Adhikari

Employment Specialist, Journey’s End Refugee Services, Inc.

Denise Phillips Beehag

Director of Refugee and Employment Services, International Institute of Buffalo

Cheryl Brown

Refugee Health Program, Public Health Representative II, New York State Department of Health, Western Region

Oma Chapagain

Bhutanese Nepali Community Member

Dianne M. Loomis

Associate Clinical Professor, School of Nursing, Department of Family Medicine, University at Buffalo

Chan Myae Thu

Client Services Coordinator, Burmese Community Support Center

RefugeesResettlement agencies

ProvidersState

Culture TrustLangua

ge

Religion

Gender

Definitions of good and poor

health

Health as a priority

Preventive health vs. curative

Interpretation

Accessing personal health

information

Accessing preventive care

Accessing knowledge

about prevention

Translating medical terms

Non-verbal language

Mental health

History of trauma

The doctor and other ‘authority’

figures

Power within the family

Many other issues as well…

• Access to medical care (primary care)• Cultural unfamiliarity among providers• Grouping refugees into one generalizable

group• Health insurance • Language• Mental health and screening

Barriers to Healthcare

Dr. Myron Glick Dr. Kim Griswold Jim Sutton, RPA-C

Informational Talks

• Rochester Model RSMI – Remote Simultaneous Medical Interpreting Empowered oversight committee Coordinated providers and care

Jericho Road Community Health Care Model Hire a diverse staff, encourage diversity Invest in community relationships Built walk-ins into the system

Models for Community Engagement & Care

• Mental Health Provision• Train bi-lingual / bi-cultural mental health care providers• Adjust screening methods• Increase mental health value among refugees

• Ethnic community support groups Burmese Community Support Center Others:

BhutaneseIraqi

Models for Community Engagement & Care

• Coordination of stakeholders• Mentorship of providers• Mobilizing human capital / leadership among

refugee community• Interpretation• Improving linkages of care, addressing gaps

in care

Breakouts to Address Barriers

• Coordination of stakeholders- Day-to-day agency partnerships through

agreements- Community-based steering committee or council- Annual summit to reassess- Culturally engaged healthcare assessment available

online

• Provider mentorship, education- Referral / map app and web based resources- Hiring of bilingual health providers and front office

staff- Relocate specialists to primary care locations- Culturally engaged health care grand rounds

Solutions to Barriers

• Refugee mentorship, education, leadership- Platform for ethnic community-based support

organizations- Identify leaders in the community for continued

education training

• Interpreter services- RSMI (UN-like headsets)- Interpretation phone apps - Hire local community members and bi-lingual

employees- Web-based portal with language resources- Educate providers in second languages

Solutions to Barriers

• Improving linkages of care, addressing gaps- Health-e-Link health assessment- Mental health providers in community health

centers- Mapping system addressing transportation

issues- Referral / map app- Agency partnerships- Health education – preventive care

Solutions to Barriers

• 110 registrants, 130 participants• 30 agencies and University Schools• Collaborations among agencies and refugee

maximizes resources• Meaningful interagency relationships• Task forces and action plans created• UB will be leader in steering committee,

exploration of interpretation models, among other areas

Takeaways

• Improving Linkages of Care (10)• Mentorship of Providers (15)• Coordination of Stakeholders (7)• Mobilizing of Human Capital (4)• Interpretation (5)

Takeaways

• Dissemination of Refugee Health Summit Report• Exploratory meeting with Refugee Advocates

(June)• Task force development• Health for Refugee Populations Course

Next Steps

• Solidify University at Buffalo’s role moving forward• School of Pharmacy continuing education• School of Social Work build capacity and linkages• School of Public Health provide field placement• IT involvement• Recruitment of talent from the refugee community• Best practice research and assessments

Next Steps

Acknowledgements:

Office of Global Health InitiativesDr. Pavani RamJessica ScatesDr. Arthur Goshin

School of Public Health and Health Professions

UB Office of Interprofessional EducationDr. Paul Wietig

Community Agencies

Thank You