The Welcome Back Initiative: Improving diversity in the health workforce ®

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


Heard about the program?Heard about the program?

54%

15%

11%

3%

17%

Word of Mouth

TV

Newspaper

Flyer/Brochure

Other


GenderGender

30%

70%

Male

Female


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.


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.


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

Documents

The Welcome Back Initiative: Improving diversity in the health workforce ®