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Geraldine Oliva, M.D.,MPH 1 Jennifer Rienks, MS, Ph.d (c) 1 Virginia Smyly, MPH, CHES 2

Geraldine Oliva, M.D.,MPH 1 Jennifer Rienks, MS, Ph.d (c) 1 Virginia Smyly, MPH, CHES 2 Linda Mack Burch, MPH 1 Judith Hager Belfiori, MA, MPH,.

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Geraldine Oliva, M.D.,MPH 1 Jennifer Rienks, MS, Ph.d (c) 1 Virginia Smyly, MPH, CHES 2

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  1. Geraldine Oliva, M.D.,MPH1 Jennifer Rienks, MS, Ph.d (c) 1 Virginia Smyly, MPH, CHES 2 Linda Mack Burch, MPH 1 Judith Hager Belfiori, MA, MPH, The Role of Cultural Competency Training in Eliminating Infant Mortality Disparities: Impact on Knowledge and Practice of Health and Social Service Providers SevenPrinciples for African American Infant Survival and Community Unity * • University of California, San Francisco, Family Health Outcomes Project, 3333 California Street, Suite 365, San Francisco, CA 94118 • San Francisco Department of Public Health

  2. Infant Mortality in San Francisco • In 2000 the SF African American infant mortality rate for was 9.2 almost three times the rate for whites and double that for other race/ethnic groups • This disparity has persisted for over 15 years • The preterm birth and low birthweight rates remained twice that of whites over the same time period UCSF Family Health Outcome ProjectAPHA 2005

  3. SevenPrinciples Project Description Goal:To eliminate disparities in African American infant mortality rates in San Francisco and improve infant survival and the health of families and communities through increasing community protective factors and educating and supporting community members Philosophy:Project values and strategies derived from Karenga’s seven principles of Kwanza (Nguzo Saba) Funding:Centers for Disease Control REACH 2010 Initiative. UCSF Family Health Outcome ProjectAPHA 2005

  4. Impetus for Cultural Competency Training • In 1999 as part of a planning year for a CDC REACH 2010 funded project the San Francisco DPH conducted a community assessment to identify issues and strategies • Community discussion groups and the project coalition identified lack of cultural sensitivity and racism in health and social service providers as barriers to care for African Americans in SF. UCSF Family Health Outcome ProjectAPHA 2005

  5. Project Partners • San Francisco Dept of Public Health • Booker T. Washington Center • UC San Francisco Family Health Outcomes Project • Jelani House • Black Coalition on AIDS • Homeless Prenatal Program • Parents Who Care • Blue Cross UCSF Family Health Outcome ProjectAPHA 2005

  6. SevenPrinciples Project Approach • Project partners identified Dr. Melanie Tervalon and Robin Tucker as curriculum developers and instructors • Provider workgroup that included major OB-GYN providers for target population and project partners was convened • Collaborative development of training objectives and content UCSF Family Health Outcome ProjectAPHA 2005

  7. Training Components Didactic session on disparities Didactic session on cultural humility: Small group exercises on cultural awareness List of resources for continuing information and education on cultural issues Packet of client education materials and local referral resources for clients Article on components of culture for medical students education UCSF Family Health Outcome ProjectAPHA 2005

  8. Study Objectives 1) To evaluate the satisfaction with and quality of the training as expressed by participants 2) To assess longer term impact on participant practices in the workplace UCSF Family Health Outcome ProjectAPHA 2005

  9. Evaluation Methods • Pre and Post test of knowledge and attitudes on cultural competency • Participant survey on evaluation of the training • Baseline, 3 and 6 month self-assessment questionnaires on use of culturally competent practices in the workplace • Report of attendance by agency • Comments by participants on follow up questionnaires and meetings UCSF Family Health Outcome ProjectAPHA 2005

  10. Results • 153 participants attended one of 4 trainings over a 10 month period overlapping 2004 and 2005 • Participants included: M.D.s 9.2 %, N.P.s 3.9%, R.Ns and PHNs 24.2%, social workers 26.1%, health educators 14.7 % and smaller #s of mental health workers, clinic assts., clinic and health plan administrators • Of the 112 who completed the training evaluation survey, 90% rated the training as good to excellent and 85% said they were very to use the tools presented. UCSF Family Health Outcome ProjectAPHA 2005

  11. Results: Pre-Post Test UCSF Family Health Outcome ProjectAPHA 2005

  12. Results: Pre-Post Test The following highly significant changes in participants’ level of confidence were found: • 73.7% expressed increased ability to identify resources for cultural competency • 56.3% expressed increased ability to describe how the health provider bias can negatively impact the patient encounter • 66.9% expressed increased ability to use communication tools taught in the workshop in clinical encounters with African Americans • 66.9% expressed increased ability to describe the elements of culturally competent health care • 64.3% expressed increased ability to describe the social conditions that impact rates of African American infant mortality UCSF Family Health Outcome ProjectAPHA 2005

  13. UCSF Family Health Outcome ProjectAPHA 2005

  14. Results: Snowball Effect UCSF Family Health Outcome ProjectAPHA 2005

  15. Participant Feedback: Examples • “The Cultural Competency training has helped our staff. We have discussions about our upbringing and share stories and we encourage staff not to make assumptions about our clients.” • “As the director of a Family Resource Center, after attending the Cultural Competency Training, I required that my entire staff attend the training.” • “I’m the director of a Primary Care Residency Program and would like to request a special training for all of the residents in my program” UCSF Family Health Outcome ProjectAPHA 2005

  16. Key Lessons Learned • Personal contacts are necessary to outreach to health and social service agencies • Continuing education credit must be offered to get M.D.s and nurses to attend • Concrete action messages and resources to assist in these actions should be provided • Adequate time must be allotted for small group process UCSF Family Health Outcome ProjectAPHA 2005

  17. Conclusions • A provider training designed to promote cultural humility in health and social service providers was effective in increasing the knowledge and confidence of participants • The training was well accepted by the participants • Participants took specific action to make their workplace more culturally sensitive UCSF Family Health Outcome ProjectAPHA 2005

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