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Cultural Humility & Health Equity
May 23, 2018: 2 PM ET
The Promise of Community Action
Community Action changes people’s lives, embodies the spirit of hope, improves communities, and
makes America a better place to live.
We care about the entire community and we are dedicated to helping people
help themselves and each other.
AgendaMay 23, 2018
• Learning Community Information
• Introductions
• Cultural Humility & Health Equity
• Question & Answer Session – type your questions in the chat box at anytime throughout the
webinar!
• Meeting Schedule & Wrap Up
Purpose: The purpose of the LCRC is to analyze Community Action outcomes and identify effective,
promising, and innovative practice models that alleviate the causes and conditions of poverty.
BUILD CAA CAPACITY TO FIGHT POVERTY!
Open LCGs
• Health Intersections• Decreasing Family Homelessness• Results at the Community Level• Cultivating Data Centered Organizations
Intensive LCGs• Integrated Services to Improve Impact• Financial Empowerment for Families• Whole Family Approaches for Economic Mobility from Poverty 1.0
Communities of Practice • Rural Integration Model for Parents and Children to Thrive (IMPACT)• Whole Family Approaches for Economic Mobility from Poverty 2.0
THE LEARNING COMMUNITY
FRAMEWORK COMPONENTS:
“Learning communities provide a space and a structure for people to align around a shared goal. Effective communities are both aspirational and practical. They connect people, organizations, and systems that are eager to learn and work across boundaries, all the while holding members accountable to a common agenda, metrics, and outcomes. These communities enable participants to share results and learn from each other, thereby improving their ability to achieve rapid yet significant progress.”
- Harvard Center on the Developing Child
A DEFINITION
THE LEARNING COMMUNITY
RURAL
URBAN
CULTURALLY DIVERSE
FIELD LEADERS
407 Counties
Total individuals served: 1,640,775
LCRC TEAM
Charity Frankowski, VISTA Lead, Rural IMPACT
Tiffney MarleyProject Director, LCRC
Jeannie ChaffinConsultant
Subject Matter Experts
Dr. Dayna LongDepartment for Community Health and Engagement (DCHE)UCSF Benioff Children's Hospital - Oakland, CA
Leanna Lewis, LCSWDepartment for Community Health and Engagement (DCHE)UCSF Benioff Children's Hospital - Oakland, CA
Cultural Humility and Health Equity
Leanna W. Lewis, MSW, LCSWManager, Cultural Humility Initiatives
Objectives
Learn the principles of cultural humility
Define Health Equity
Understand the relationship between Cultural Humility and Health Equity
Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.
- Martin Luther King, Jr.
http://www.orthodoxytoday.org/view/alveda-king-how-can-blacks-survive-if-we-murder-our-children
Cultural Humility is…
not a discreet endpoint, but a commitment and active engagement in a lifelong
process that individuals enter into on an ongoing basis with
participants, communities, colleagues, and with
themselves.- Leland Brown, 1994
Adapted from Dr. Melanie Tervalon
“ “
A lifelong process of critical self-reflection and self-critique
Redressing the power imbalances in the patient-provider dynamic
Developing mutually beneficial partnerships with communities on behalf of individuals and defined populations
Advocating for and maintaining institutional accountability
Tervalon M, Murray-Garcia J: “Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education, “Journal of Health Care for the Poor and Underserved 1998; 9(2):117-124
Cultural HumilityDeveloped by Drs. Melanie Tervalon and Jann Murray-Garcia, cultural humility is…
Adapted from Dr. Melanie Tervalon
• Know your own identity and what you are bringing to an interaction.
• In what ways are you bringing your identity, power and privilege to the work?
Critical Self-Reflection and Life Long Learning:
Patient and provider in dynamic, reciprocal partnership
Provider as rich expert
Patient/Clientas rich expert
Redressing Power Imbalance
Adapted from Dr. Melanie Tervalon
Partnership with Community
Institutional Accountability
Acknowledgment and assumption of responsibility for actions, products, decisions, and policies including the administration, governance, and implementation within the institution
Equity means just and fair inclusion. An equitable society is one in which all can participate and prosper. The goal of equity must be to create conditions that allow all to reach their full potential. In short, equity creates a path from hope to change.
- PolicyLink
23
What is Equity?
Adapted from Melanie Tervalon, MD, MPH, Do Not Copy Without Permission 2018
Unequal Opportunity
https://www.rwjf.org/content/dam/images/unrestricted-use/infographics/RWJF_bikes_equality_equity_PURPLE.jpg
Adapted from https://everydayfeminism.com/2014/09/equality-is-not-enough/
Equity = Fairness
Access to Same Opportunities -> We
must first ensure equity before we
can enjoy equality
Equality = Sameness
Giving everyone the same thing ->
it only works if everyone starts
from the same place
Adapted from https://www.storybasedstrategy.org/the4thbox/
Health equity means that everyone
has a fair and just
opportunity
to be as healthy as possible.
Braveman P, Arkin E, Orleans T, Proctor D, and Plough A. What Is Health Equity? And What Difference Does a Definition Make? Princeton, NJ: Robert Wood Johnson Foundation, 2017. Brennan Ramirez LK, Baker EA, Metzler M. Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.
Figure adapted from Anderson et al, 2003; Marmoetal, 1999; and Wilkinson et al, 2003.39–41
What is Health Equity?
Now what?!
Photo Source: http://1.bp.blogspot.com/-XR1cP35ch7M/TxmYZoq6jgI/AAAAAAAAA9k/pWzy9kaq5SM/s1600/what+can+i+do.gif
1.Address Underlying Social Inequities
1.Systematically Targeted Interventions
Equitable Measurement
• Institutional Accountability
• Redress Power Imbalances
• Meaningful Community Partnership
• Eliminating Disparity for Most Disadvantaged
• Critical Self-Reflection
Achieving Health Equity Requires
Braveman P, Arkin E, Orleans T, Proctor D, and Plough A. What Is Health Equity? And What Difference Does a Definition Make? Princeton, NJ: Robert Wood Johnson Foundation, 2017.
Address Underlying Social Inequities: Institutional Accountability
• Demonstrate cultural humility in organizational strategies and practices
• Acknowledgment and assumption of responsibility for actions, products, decisions, and policies including the administration, governance, and implementation within the institution
Eligible patients/clients
Referral to Social Work, Medical Legal Partnership, Developmental and Mental Health Services, Home Visiting, early intervention services
Help with utilities, food,
afterschool activities, food
etc
Universal social and
environmental needs
screening
Patients with
basic resource
needs
Patients with
complex needs
What is a Help Desk?
Warm Hand-offs&
Culturally Responsive Care
Slide Adapted from Dr. Laura Gottlieb, MD, MPH
Systematically Targeted Interventions
Social Determinants of Health Interventions -Help Desk Models
Equitable Measurement: Critical Self-Reflection
Consider a public review of the client experience
Dialogue with the community and hear their input as expert - in the community venue of choice
Distributing the knowledge and decision making often and freely
Create “Communities of Dialogue” to work with community members, and clients, and each other on tough issues
A lifelong process of critical self-reflection and self-critique
Redressing the power imbalances in the patient-provider dynamic
Developing mutually beneficial partnerships with communities on behalf of individuals and defined populations
Advocating for and maintaining institutional accountability
Tervalon M, Murray-Garcia J: “Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education, “Journal of Health Care for the Poor and Underserved 1998; 9(2):117-124
Cultural HumilityDeveloped by Doctors Melanie Tervalon and Jann Murray-Garcia, cultural humility is…
How Can We Achieve Health Equity?
Equitable Community-Centered Measurement
1.Systematically Targeted Interventions
1.Address Underlying Social Inequities
Utilize Cultural Humility Framework
Closing Reflection
In what ways did this session challenge you to do/think/approach your
work differently?
What will you do differently tomorrow based on what you learned today?
Thank you! Please look for an evaluation in your email
Image credit: http://az616578.vo.msecnd.net/files/2015/12/21/6358626217332020101255530005_thankyou.jpg
Questions?
References
Adams, M., Bell, L, & Griffin, P. (1997). Teaching for diversity and social justice: A sourcebook. (appendix 6B). Retrieved fromhttp://books.google.ca/books?id=V-BEnvaodCoC&pg=PA108
Brennan Ramirez LK, Baker EA, Metzler M. Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.
Braveman P, Arkin E, Orleans T, Proctor D, and Plough A. What Is Health Equity? And What Difference Does a Definition Make? Princeton, NJ: Robert Wood Johnson Foundation, 2017.
McIntosh, P. (1988) White Privilege and Male Privilege: A Personal Account of Coming To See Correspondences through Work in Women's Studies. Wellesley College Center for Research on Women, Wellesley, MA.
Tervalon, M. & Murray-García, J. (1998) Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education. Journal of Health Care for the Poor and Underserved, 9 (2) 117-125
Wijeyesinghe, C. L., Griffin, P., & Love, B. (1997). Racism curriculum design. In M. Adams, L. Bell, & P. Griffin (Eds), Teaching for diversity and social justice: A sourcebook (pp. 82-107). New York: Routledge
Open Chat and Questions
Webinar Wednesdays!
https://www.communityactionpartnership.com/menus/webinars.html
Stay ConnectedContinue Learning
Join the online Community Action Academy!
Health Intersections
Free, online learning hub for the Community Action Network
1. Go to https://moodle.communityactionpartnership.com & create an account.2. Once the account confirmation is complete (via email), login.3. In the Course Categories box to the right of the screen, click Learning Communities.4. Choose Open Learning Community Groups, then Health Intersections.
Engage through online discussion, accessing resources, and agency resource sharing!
Meeting Schedule
February 21, 2018 at 2 pm ET
February 28, 2018 at 2 pm ET
April 4, 2018 at 2pm ET
April 25, 2018 at 2pm ET
May 23, 2018 at 2pm ET
June 27, 2018 at 2pm ET (Register)
Impact and Evaluation for Social Determinants of Health
Wednesday, June 27 at 2:00pm ET
Join the Health Intersections Learning Community to explore the data and evaluation processes related to the social determinants of health. Dr. Dayna Long, Pediatrician at UCSF Benioff Children's Hospital Oakland, will lead a knowledge building session on identifying health indicators for measurement of impact on the social determinants of health.
Upcoming Webinar Wednesdays• May 30 at 2:00pm ET: Racial
Equity In Financial Empowerment Program Design (Register)– Prosperity NOW
• June 6 at 2:00pm ET: A Family Centered Coaching Approach to Service Integration (Register)– The Prosperity Agenda
• June 13 at 2:00pm ET: Becoming Data Centric Using a Whole Agency Data Approach (Register)– Paige Teegarden and Barbara
Mooney
2018 National Community Action Partnership Annual Convention
Early Bird Registration Ends April 30th –Register, Advertise, Sponsor Today!
#CAPCON18Click here to learn more.
LCRC Staff Contact Info:Tiffney Marley, Project Director, LCRC
Jarle Crocker, Director of Training and Technical Assistance (T/TA)[email protected]
Courtney Kohler, Senior Associate, T/[email protected]
Hyacinth (Xandy) McKinley, Program Associate, [email protected]
Liza Poris, Program Associate, T/[email protected]
Charity Frankowski, VISTA [email protected]
Jeannie Chaffin, Consultant for CA Economic Mobility [email protected]
This presentation was created by the National Association of Community Action Agencies – Community Action Partnership, in the performance of the U.S. Department
of Health and Human Services, Administration for Children and Families, Office of Community Services Grant Number, 90ET0466. Any opinion, findings, and
conclusions, or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the U.S. Department of Health and
Human Services, Administration for Children and Families.
