Idaho Refugee Maternal/Child Health Program: Input and Inspiration from our Communities

Margie Widener, MSN,CNMSaint Alphonsus Women’s Health

Marla Lipscomb, MSW,LCSWCARE Maternal/Child Health ProgramFamily Medicine Residency of Idaho

Eunice Njiraini, Senior Health AdvisorCARE Maternal/Child Health Program

Judith Hobbs, RN, BSNManagerSaint Alphonsus Family CenterCARE Maternal/Child Health Program

Idaho Refugee Resettlement Program

Boise, Idaho 91% Caucasian

Goals of CARE ClinicAddress and decrease health disparities

Provide quality prenatal and postpartum care to linguistically and culturally diverse populations

Create a model of care that adapts to the needs and strengths ofour patients

Create a safe, supportive, empowering environment for women and their babies

Influence the greater system of care at Saint Alphonsus by strengthening provider’s cultural awareness and sensitivity

Strengthen advocacy for patients in overall healthcare system

CARE Maternal/Child Prenatal Clinic

C – CulturallyA – AppropriateR – ResourcesE – Education

Interpreter and Health Advisor –A New ParadigmInterpreter – serves as a voice for provider and the patient repeating what each of them says without adding additional information.Health Advisor - Provides case coordination to increase access to maternal/child health and family services, assist in increasing healthcare providers’ capacity to deliver culturally appropriate care and assist in improving the health status of refugee mothers and infants

Our Health Advisors(Arabic, Burmese, Farsi, French, Kirundi, Kizigua, Maay Maay,

Nepali, Russian, Somali, Swahili, Uzbek)

Health Advisors – Provide insight into the communities

Help to identify strengths, needs, and concerns within their communities

At the table for curriculum development and decision making

Help pregnant refugee women “navigate” through the American Healthcare System

Reduce barriers to access and a Medical Home – “One-Stop Shop”

Health Advisor Role ContinuedKnowledge of both provider and patient culturesImprove cultural competence of providersHelp the providers understand the diversity of skin color, language, culture, religion, class, skill level, knowledge, life experiences, and personality

RefugeeIdentified

Needs

DEVELOPPROGRAM

ASSESS

Is thisprogram

being practiced?

YES

NO

ASCERTAIN ROOT CAUSE

ADDRESS ROOT CAUSE WITH HEALTH

ADVISORREASSESS

Focus Group: Physician Offices

Focus Group: Refugee Community

Community Assessment Survey

Program EvaluationHow do we know they know?

Presenting Culturally Sensitive Educational Topics

Actively engaging in the contentBuilding on their own experienceLearning new techniques and contentApplying the new content for immediate learning and relevance.Taking away new knowledge and using for skill buildingHealth Advisors – curriculum consultantsExchange of knowledge between providers and clients

AnchorAddApplyAway

Building on their experiences How does your body tell you when it is time to do something?

Building on their experiences How does your body tell you when it is time to do something?Signs of LaborWhen is it time to go to the hospital?We know they know because they get to the hospital in time!

CARE Program Design: Creating Safe, Supportive, Empowering Environment

Pre-Appointment VideoKnow what to expectDecrease anxiety about prenatal examWhy are you taking all my blood?

CARE Program Design: Creating Safe, Supportive, Empowering Environment

Group Model of Care and Education

Group education – multiple languages in each groupMedical interpreters present for each language groupEstablishing group ground rules, and confidentialityConfidential interviews regarding specific concerns

CARE Program Design: Creating Safe, Supportive, Empowering Environment

Individual concerns shared during prenatal examOften report shared concerns of other group membersPatient is asked permission for provider to anonymously share concern/question with group

Safe, Supportive, Empowering Environment

Consistency: Know what to expectFemale Interpreters and Health AdvisorsStrengths Based approach to careRestoration of Dignity and Respect

Safe, Supportive, Empowering Environment

Providers take time to listen and learn from patients Genuine provider compassion can be felt despite language barriers

Shared sense of community within CARE Clinic

“ I feel important about myself because the teacher asks if I have any special recipes to share with the rest of the class. I feel that each culture has something to share”.

Desire to work with refugees – not enough

Get them on the bus!

Job Requirement:CompassionFriendly faceHelp Me Understand…Willingness to listen

“To be culturally competent doesn’t mean you

are an authority in the values and beliefs of

every culture. What it means is that you hold

a deep respect for cultural differences and

are eager to learn, and willing to accept, that

there are many ways of viewing the world.”

- Okokon O. Udo PhD

Lessons Learned by ProvidersCaution: Seeing their knowledge as a deficit rather than seeing strength of knowledge

Limited understanding of healthcare system does not mean limited knowledge or ability

A little “cultural competence” can be more dangerous than none at all

Impact of Provider assumptions on care providedMay stereotype individual vs. seeing their unique strengths and needs

Lessons Learned by ProvidersProviders have realized that it is “US” that needed to adapt

System and provider need to adapt to provide quality care

Recognizing need for providers to be aware of personal bias

Ethnocentric ways of thinkingBelief that Western Medicine is superior

Manar’s Thank You