the welcome back initiative: improving diversity in the health workforce ®
TRANSCRIPT
The Welcome Back Initiative:The Welcome Back Initiative:Improving diversity in the health workforceImproving diversity in the health workforce
®
Who We AreWho We AreStarted as a project of the SF and LA RHORCs, then Started as a project of the SF and LA RHORCs, then added the Central Valley and San Diego RHORCs.added the Central Valley and San Diego RHORCs.
Our mission is to build a bridge between the need for Our mission is to build a bridge between the need for more culturally and linguistically diverse health more culturally and linguistically diverse health professionals and the untapped resource of immigrants professionals and the untapped resource of immigrants trained in a field of health in their country of origin who trained in a field of health in their country of origin who are living in the US. are living in the US.
The Welcome Back Initiative currently includes centers The Welcome Back Initiative currently includes centers in San Francisco, Los Angeles, San Diego, Boston, in San Francisco, Los Angeles, San Diego, Boston, Rhode Island and Puget Sound.Rhode Island and Puget Sound.
Why?Why?
““The lack of minority health The lack of minority health professionals is compounding the professionals is compounding the nation’s persistent racial and ethnic nation’s persistent racial and ethnic health disparities.”health disparities.”
(Sullivan Commission, Sept. 04)(Sullivan Commission, Sept. 04)
Current Composition of Selected Health Professions in California by Current Composition of Selected Health Professions in California by Race, EthnicityRace, 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
ProfessionProfession WhiteWhite(%)(%)
LatinoLatino(%)(%)
AsianAsian(%)(%)
African Am.African Am.(%)(%)
Native Am.Native Am.(%)(%)
US Population *US Population * 72.072.0 11.011.0 3.83.8 11.211.2 0.70.7
California PopulationCalifornia Population 43.343.3 35.535.5 12.212.2 5.95.9 0.50.5
Physicians/SurgeonsPhysicians/Surgeons 61.761.7 5.25.2 26.426.4 3.23.2 0.60.6
Registered NursesRegistered Nurses 64.364.3 5.75.7 22.522.5 4.54.5 0.30.3
DentistsDentists 61.461.4 ---- 29.229.2 ---- ----
PharmacistsPharmacists 47.847.8 ---- 44.544.5 ---- ----
PsychologistsPsychologists 84.084.0 7.67.6 ---- ---- ----
Social WorkersSocial Workers 67.867.8 13.513.5 8.48.4 8.18.1 ----
Respiratory Respiratory TherapistsTherapists 58.058.0 ---- ---- ---- ----
Diagnostic-related Technologists Diagnostic-related Technologists & Technicians& Technicians 56.756.7 22.922.9 12.612.6 ---- ----
Healthcare Support OccupationsHealthcare Support Occupations 34.134.1 34.834.8 17.517.5 9.89.8 ----
Validating the ModelValidating the ModelThere are large numbers of Internationally Trained Health There are large numbers of Internationally Trained Health Professionals (ITHPs) in California not working in the Professionals (ITHPs) in California not working in the health sector.health sector.
Of 7,339 WBI participants 4,696 (64%) were not working Of 7,339 WBI participants 4,696 (64%) were not working in the health sector at their point of entry into the in the health sector at their point of entry into the program.program.
Of the ITHPs that are working in the health sector, many Of the ITHPs that are working in the health sector, many are underemployed.are underemployed.
Most of the WBI physicians and nurses who are employed Most of the WBI physicians and nurses who are employed in the health sector were working as CNAs and dentists in the health sector were working as CNAs and dentists were working as dental assistants.were working as dental assistants.
ITHPs will have better opportunities to re-enter ITHPs will have better opportunities to re-enter the health care sector with increased English the health care sector with increased English proficiency.proficiency.
Eighty-six percent (86%) of the WBI participants Eighty-six percent (86%) of the WBI participants that have obtained jobs in the health sector self-that have obtained jobs in the health sector self-reported an English level of five or higher on a reported an English level of five or higher on a scale from one to ten.scale from one to ten.
Public and private health sector employers will Public and private health sector employers will hire the WBI participants.hire the WBI participants.
Over 978 (11%) participants have been newly Over 978 (11%) participants have been newly employed in public and private health settings employed in public and private health settings across the state.across the state.
Cross-Cutting ThemesCross-Cutting Themes
English Language ProficiencyEnglish Language Proficiency
Participants, educators, and employers alike Participants, educators, and employers alike identified lack of fluency in English as a fundamental identified lack of fluency in English as a fundamental obstacle for ITHPs entering the health workforce.obstacle for ITHPs entering the health workforce.
Loss of Professional IdentityLoss of Professional Identity
Immigrant health professionals often faced the loss of Immigrant health professionals often faced the loss of professional identity and associated social standing professional identity and associated social standing and the challenge of redefining themselves in a new and the challenge of redefining themselves in a new societal context.societal context.
Lack of Familiarity with the US Health SystemLack of Familiarity with the US Health System
Different roles and professions exist in the US; also, Different roles and professions exist in the US; also, there are inherent differences in the US health there are inherent differences in the US health workplace culture, rules, and regulationsworkplace culture, rules, and regulations..
Economic IssuesEconomic Issues
Lack of financial resources and time to attend classes Lack of financial resources and time to attend classes were consistently identified as barriers to participation in were consistently identified as barriers to participation in the WBI. Individuals often did not have the time to go to the WBI. Individuals often did not have the time to go to school because they held two or three jobs in order to school because they held two or three jobs in order to support their families.support their families.
Replicating the Welcome Back Replicating the Welcome Back Model: Lessons LearnedModel: Lessons Learned
Understanding the contextUnderstanding the context
The characteristics of the existent regional health The characteristics of the existent regional health workforce; urban or rural geographical settings; workforce; urban or rural geographical settings; density and size of service area; ethnic composition of density and size of service area; ethnic composition of the community; and overall economic characteristics the community; and overall economic characteristics of the region will shape individual programs.of the region will shape individual programs.
Developing employer partnershipsDeveloping employer partnerships
Employers are direct beneficiaries of the WBI. For this Employers are direct beneficiaries of the WBI. For this reason, WBCs should include potential employers early reason, WBCs should include potential employers early on in the development of the project. Employers can be on in the development of the project. Employers can be involved in several different ways: serving on advisory involved in several different ways: serving on advisory committees, funding educational programs, providing committees, funding educational programs, providing training slots or volunteer opportunities, making in-kind training slots or volunteer opportunities, making in-kind contributions (e.g. space), or as policy partnerscontributions (e.g. space), or as policy partners..
Selecting educational institutionsSelecting educational institutions
The leadership of the selected educational institutions The leadership of the selected educational institutions should work together to ensure the viability of the should work together to ensure the viability of the program. program.
Structuring the program elementsStructuring the program elements
It is important to conduct an assessment with potential It is important to conduct an assessment with potential program participants prior to structuring all elements of program participants prior to structuring all elements of the program related to curricula, time, location, duration the program related to curricula, time, location, duration of interventions, and intensity of case management of interventions, and intensity of case management required. The Initiative’s approach to developing a required. The Initiative’s approach to developing a career strategy with the participants started by career strategy with the participants started by understanding where the participant was in the spectrum understanding where the participant was in the spectrum of options available to him/her.of options available to him/her.
Outreaching to and identifying participantsOutreaching to and identifying participants
The program needs staff that can speak more than one The program needs staff that can speak more than one language and/or have access to interpreters. As well, an language and/or have access to interpreters. As well, an understanding of multiple cultural norms supports the understanding of multiple cultural norms supports the configuration of appropriate services. configuration of appropriate services.
Building the programBuilding the program
The WBCs should take into account participants’ needs and The WBCs should take into account participants’ needs and interests along with regional employment opportunities, interests along with regional employment opportunities, political and economic conditions, and availability of political and economic conditions, and availability of committed academic partners.committed academic partners.
Monitoring and evaluationMonitoring and evaluation
A comprehensive evaluation strategy that can provide “hard A comprehensive evaluation strategy that can provide “hard data” validating the program’s work is imperative for data” validating the program’s work is imperative for demonstrating the project’s credibility, developing demonstrating the project’s credibility, developing sustainability strategies, and supporting continuous quality sustainability strategies, and supporting continuous quality improvement throughout implementation. Mechanisms for improvement throughout implementation. Mechanisms for interpreting and communicating the data to key stakeholders interpreting and communicating the data to key stakeholders on an ongoing basis are also important.on an ongoing basis are also important.
Creating a supportive policy environmentCreating a supportive policy environment
Moving a policy agenda forward while implementing the Moving a policy agenda forward while implementing the program will open or create channels for ITHPs to enter program will open or create channels for ITHPs to enter the health workforce.the health workforce.
Sustaining the programSustaining the program
Flexible, non-categorical funding streams to address Flexible, non-categorical funding streams to address emerging issues.emerging issues.
Diversified, ongoing funding base that includes private Diversified, ongoing funding base that includes private and public entitiesand public entities
Modular sponsorship: sponsors of one element of the Modular sponsorship: sponsors of one element of the program.program.
Contracts by program staff to provide trainings to Contracts by program staff to provide trainings to employers or community organizations.employers or community organizations.
Fee-for-service.Fee-for-service. Contributions and support from alumni. Contributions and support from alumni.
Professions - All CentersProfessions - All Centers
Other includes: psychologists, speech therapists, pharmacists, midwives, physical Other includes: psychologists, speech therapists, pharmacists, midwives, physical therapists, social workers. Total Participants: N= 8,492 as of December 2008.therapists, social workers. Total Participants: N= 8,492 as of December 2008.
12.0%
10.4%
38.4%
39.2%
MD
Nurse
DDS
Other
Working In Health? - All CentersWorking In Health? - All Centers
N= 8,492 as of December 2008N= 8,492 as of December 2008
66%
34%
Yes
No
Time in the USTime in the US
20%
28%
28%
9%
15%
<12 months
1-3 years
4-6 years
7-9 years
10 + years
N= 8,492 as of December 2008N= 8,492 as of December 2008
Heard about the program?Heard about the program?
54%
15%
11%
3%
17%
Word of Mouth
TV
Newspaper
Flyer/Brochure
Other
N= 8,492 as of December 2008N= 8,492 as of December 2008
Professions – By CenterProfessions – By Center
47%
14%
11%28%
MD
Nurse
DDS
Other
Welcome Back Center -Los AngelesWelcome Back Center -Los AngelesWelcome Back Center –San FranciscoWelcome Back Center –San Francisco
Welcome Back Center –San DiegoWelcome Back Center –San Diego
9%11%
39%
41%
MDNurseDDSOther
40%
10%13%
37%
MDNurseDDSOther
Professions – By CenterProfessions – By CenterNurse
54%35%
0%
11%
MDNurseDDSOther
Welcome Back Center – BostonWelcome Back Center – Boston Welcome Back Center – Rhode Island
Welcome Back Center – Puget SoundWelcome Back Center – Puget Sound
28%
54%
5%13%
MD
Nurse
DDS
Other
Country Of OriginCountry Of OriginCA Welcome Back CentersCA Welcome Back Centers
MexicoMexico 21%21%
El SalvadorEl Salvador 10% 10%
PeruPeru 9% 9%
PhilippinesPhilippines 8% 8%
ChinaChina 4% 4%
ColombiaColombia 2% 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 Total Participants in CACA: N= 7,782 as of December 2008.: N= 7,782 as of December 2008.
Country Of OriginCountry Of OriginBoston Welcome Back CenterBoston Welcome Back Center
HaitiHaiti 20%20%
Brazil Brazil 7%7%
China China 6% 6%
NigeriaNigeria 4%4%
PhilippinesPhilippines 3%3%
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.Total Participants: N= 547 as of December 2008.
Country Of OriginCountry Of OriginRhode Island Welcome Back Rhode Island Welcome Back
CenterCenter
Dominican Republic Dominican Republic 33%33%
Colombia Colombia 20%20%
NigeriaNigeria 11% 11%
Puerto RicoPuerto Rico 11%11%
MexicoMexico 9% 9%
Other Countries Include:
Brazil, Haiti, and Venezuela.
Total Participants: N= 80 as of December 2008.Total Participants: N= 80 as of December 2008.
Country Of OriginCountry Of OriginPuget Sound Welcome Back Puget Sound Welcome Back
CenterCenter
Ethiopia Ethiopia 12%12%KenyaKenya 7% 7%Ukraine 7%Ukraine 7%India 7%India 7%Iraq Iraq 6% 6%MexicoMexico 6% 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.Total Participants: N= 83 as of December 2008.
ENGLISH HEALTH TRAINCURRICULUM
COURSE A COURSE B COURSE C
MODULE 1MODULE 1Exploring Career Exploring Career
Goals in Health CareGoals in Health Care
MODULE 2MODULE 2Communicating with Communicating with Patients and FamiliesPatients and Families
MODULE 3MODULE 3Communicating with Communicating with
Other Health Other Health ProfessionalsProfessionals
MODULE 4MODULE 4Exploring Critical Exploring Critical
Issues in Health CareIssues in Health Care
MODULE 5MODULE 5Intercultural Intercultural
Communication in Communication in Health CareHealth Care
UNIT UNIT 11
Health Care Professions Health Care Professions and Career Pathsand Career Paths
The Patient-Health The Patient-Health Professional Professional RelationshipRelationship
Interaction among Interaction among Health Care WorkersHealth Care Workers
Understanding Health Understanding Health Care SystemsCare Systems
Culture and Culture and Communication in Communication in Health CareHealth Care
UNIT UNIT 22
Requirements for Entry Requirements for Entry in Health Fieldin Health Field
Gathering Patient Gathering Patient Information Information
Using Medical Using Medical Terminology Terminology AppropriatelyAppropriately
Understanding Health Understanding Health Care Cultures Care Cultures
Beliefs and Traditions Beliefs and Traditions about Health and Illnessabout Health and Illness
UNIT UNIT 33
Job Search SkillsJob Search Skills The Patient-Centered The Patient-Centered InterviewInterview
Assertive Assertive Communication with Communication with Co-WorkersCo-Workers
Critical Health Issues in Critical Health Issues in the U.S.the U.S.
Cultural Diversity in Cultural Diversity in Health CareHealth Care
UNIT UNIT 44
Job Application ProcessJob Application Process Examining and Examining and Monitoring PatientsMonitoring Patients
Professional and Social Professional and Social CommunicationCommunication
Healthy Lifestyles and Healthy Lifestyles and BehaviorsBehaviors
Serving Multicultural Serving Multicultural PatientsPatients
UNIT UNIT 55
Job Interview SkillsJob Interview Skills Developing a Treatment Developing a Treatment PlanPlan
Working Effectively on Working Effectively on a Teama Team
Alternative Health Alternative Health Perspectives and Perspectives and PracticesPractices
Working with Working with Multicultural Health Multicultural Health ProfessionalsProfessionals
UNIT UNIT 66
Professional Behavior Professional Behavior & Workplace & Workplace ExpectationsExpectations
Medical Charting and Medical Charting and ReportingReporting
Supervising and Supervising and Instructing other Health Instructing other Health ProfessionalsProfessionals
Health Care for an Health Care for an Aging PopulationAging Population
Cultural Disparities in Cultural Disparities in Health CareHealth Care
UNIT UNIT 77
Work & Safety Issues Work & Safety Issues for Health Professionalsfor Health Professionals
Patients with Special Patients with Special NeedsNeeds
Electronic Electronic CommunicationCommunication
Legal & Ethical Issues Legal & Ethical Issues in Health Carein Health Care
Analyzing Needs of Analyzing Needs of Cultural CommunitiesCultural Communities
UNIT UNIT 88
Career and Professional Career and Professional Development in Health Development in Health CareCare
Handling Challenging Handling Challenging Situations with PatientsSituations with Patients
Handling Challenging Handling Challenging Situations with Co-Situations with Co-WorkersWorkers
Future Directions for Future Directions for Health and Health Health and Health ProfessionalsProfessionals
Serving Our Own Serving Our Own Cultural CommunitiesCultural Communities
Welcome BackTechnical 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
Outcomes Outcomes (through December 2008)(through December 2008)
1,735 Validated their Credentials1,735 Validated their Credentials
1,104 Passed Licensing Exams1,104 Passed Licensing Exams
978 Obtained Employment in the US Health 978 Obtained Employment in the US Health Sector for the First Time Sector for the First Time
649 Obtained Advancement in Health Career 649 Obtained Advancement in Health Career
417 Obtained License in their Original Professions417 Obtained License in their Original Professions
60 MDs Accepted into Residency Programs 60 MDs Accepted into Residency Programs
Welcome Back InitiativeWelcome Back Initiative
Texas?
New York?
Montgomery County, MD
Puget SoundWBC
Rhode Island WBC
Boston WBC
San Diego WBC
Los Angeles WBC
WBISFWBC
Welcome Back CentersWelcome Back CentersSan Francisco, CASan Francisco, CA (415) 561-1833(415) 561-1833
Hosted by City College of San FranciscoHosted by City College of San Francisco
Los Angeles, CALos Angeles, CA (909) 594-5611 x6102(909) 594-5611 x6102Hosted by Mt. San Antonio CollegeHosted by Mt. San Antonio College
San Diego, CASan Diego, CA (619) 409-6417(619) 409-6417Hosted by Grossmont CollegeHosted by Grossmont College
Boston, MABoston, MA (617) 228-4226(617) 228-4226Hosted by Bunker Hill Community CollegeHosted by Bunker Hill Community College
Providence, RIProvidence, RI ((401) 273-8866 ext 155401) 273-8866 ext 155Hosted by Dorcas PlaceHosted by Dorcas Place
Puget Sound, WAPuget Sound, WA (206) 878-3710 ext 3345(206) 878-3710 ext 3345
Hosted by Highline Community CollegeHosted by Highline Community College
www.welcomebackinitiative.orgwww.welcomebackinitiative.org