Competent Care: Culturally. language. and across. language assistance. services.

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1 Programs to address diabetes disparities: The following are programs that address diabetes disparities. Women In Government will continue to update information on programs that address diabetes disparities. Feel free to contactt us if you have a program you would like to include in this list.

2 CULTURAL COMPETENCE PROGRAMS National Standards on Culturally and Linguistically Appropriate Services (CLAS) The CLAS standards are 14 standards encompassing principles and activities towards cultural and linguistically appropriate healthh services. The Office off Minority Health (OMH) suggests CLAS recommendations be implemented by healthcare organizations. According to OMH, the 14 standards are organized byy themes: Culturally Competent Care (Standards 1-3), Language Access Services (Standards 4-7), and Organizational Supports for Cultural Competence (Standards 8-14). Source: Department of Health and Human Services. //minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=15 Culturally Competent Care: Standard 1: Healthcare organizations should ensure that patients/consumers receive from all staff member' 's effective, understandab ble, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language. Standard 2: Healthcare organizations should implement strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area. Standard 3: Healthcare organizations should ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery. Language Access Services Standard 4: Healthcare organizations must offerr and provide language assistance services, ncluding bilingual staff and interpreter services, att no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation. Standard 5: Healthcare organizations must provide to patients/consumers in their preferred language both verbal offers and written notices nforming them of their right to receive language assistance services.

3 Standard 6: Healthcare organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/cons sumer). Standard 7: Healthcare organizations must makee available easily understood patient- groups and/or groups represented in the service area. related materials and post signage in the languages of the commonly encountered Organizational Supports for Cultural Competence Standard 8: Healthcare organizations should develop, implement, and promote a written strategic plan that outlines clear goals, policies, operational plans, and management accountability/oversight mechanisms to provide culturally and linguistically appropriate services. Standard 9: Healthcare organizations should conduct initial and ongoingg organizational self-assessments of CLAS-relatedd activities and are encouraged to integrate cultural and linguistic competence-related measures into their internal audits, performance improvement programs, patient satisfaction assessments, and outcomes-based evaluations. Standard 10: Healthcaree organizations should ensure that data on the individual patient's/consumer's race, ethnicity, and spokenn and written language are collected in health records, integrated into the organization's management information systems, and periodically updated. Standard 11: Healthcaree organizations should maintain a current demographic, cultural, and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristic cs of the service area. Standard 12: Healthcaree organizations should develop participatory, collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient/consumer r involvement in designing and implementing CLAS-related activities. Standard 13: Healthcaree organizations should ensure that conflict and grievance resolution processes are culturally and linguistically sensitivee and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients/consumers.

4 Standard 14: Healthcaree organizations are encouraged to regularly make available to the public informationn about their progress andd successful innovations in implementing the CLAS standards and to provide public notice in their communities about the availability of this information. PROGRAMS & RESOURCES: For a full CLAS report visit: //minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdff For a CLAS executive summary visit: //minorityhealth.hhs.gov/assets/pdf/checked/executive.pdf National Action Plan to Improve Health Literacy Health literacy is the degree to which people are able too obtain, process, and understand basic health information needed to make health decisions. Withoutt easily-understood resources to make informed decisions, patients may miss out on helpful treatments that can save their lives. A better informed public also raises health awareness and can positively affect health behaviors. The National Action Plan to Improve Health Literacy is a multi-sector effort to engage organizations, professionals, policymakers, and communities towards a delivery system which provides services that are understandable and beneficial to health and quality of life. To Access the National Action Plan to Improve Healthh Literacy visit: // pdf According to the action plan, there are seven goals thatt will improve health literacy. The plan suggests strategiess for achieving them: 1. Develop and disseminate health and safety information that is accurate, accessible, and actionable. 2. Promote changes in the healthcare system that improve health information, communication, informed decision-making, and access to health services. 3. Incorporate accurate, standards-based, and curricula in child care and education through the and developmentally appropriate health and science information university level.

5 4. Support and expand local efforts to provide adult education, English language instruction, and culturally and linguistically appropriate health information services in the community. 5. Build partnerships, develop guidance, and change policies. 6. Increasee basic research and the development t, implementation, and evaluation of practices and interventions to improve health literacy. 7. Increasee the dissemination and use of evidence-based health literacy practices and interventions. PROGRAMS & RESOURCES: Centers for Disease Control and Prevention (CDC): Health Literacy Programs by State: The CDC provides resources that include state and local collaborations, academic, government, and non-profit organizations focused on health literacy. The programs are inline with the National Action Plan to Improve Health Literacy. To check for Health Literacy Programs in your state visit: http: :// Center for Disease Control and Preventionn (CDC): Health Literacy Training Modules: The CDC lists materials and modules for Health Literacy Training. To access the comprehensive list of health literacy resources visit: // For specific health literacy training programs from the CDC website visit: Health Literacy for Public Health Professionals: U.S. Centers for Disease Control and Prevention: // A Physician's Practical Guide to Culturally Competent Care: HHS Office of Minority Health: Unified Health Communication Course: Health Resources and Services Administration: // University of Minnesota School of Public Health: Culture and Health Literacy Modules: //cpheo1.sph.umn.edu/healthlit/#a

6 Community Programs Shared Medical Appointments (Group Medical Visits) Shared Medical Appointments (SMA), often knownn as group medical appointments, allows a group of patients to see a provider at the same time. The provider can address diabetes and give verbal instruction to the group, as a whole, instead of individual patient visits. In order to participate, patients must sign a confidentiality waiver and HIPPA disclosure form. SMA s have been shown to provide quality care and reduce costs. PROGRAMS Veteran Affairs (VA) Shared Medical Appointments for Patients with Diabetes This manual compiles the VA s processes to facilitate Diabetes Shared Medical Appointments s. It includes challenges and solutionss for conducting group sessions. Additionally provided in the manual are handouts about Diabetes Care ABC s to Better Health and a Diabetes Action Plan. Source: Department of Veteran Affairs /shared-med-appt.pdf in an Ethnically Diverse Clinic Resident-Driven n Group Medical Visits for Diabetes Mellitus Population In this study, a family medicine resident physician initiated group medical visits for diabetes mellitus at a family medicine residency clinic with the cooperative health care clinic format. Patients were ethnically diverse; mostly of Asian or Pacific Islander ancestry. A registered dietician was present at mostt group visits, and topics discussed were patient driven. Source: Hawaii Medical Journal. gov/pmc/articles/pmc / RESOURCE: American Association of Diabetes Educators SMA Fact Sheet // dical Appts_PRACTICE_ADVISORY.pdf

7 Community Pharmacies The Role of Community Pharmacies in Diabetes Care: Eightt Case Studies Katherine Knapp, Max Ray, Anandi Law, Mark Okamoto, and Peter Chang This report describes eight pharmacy-based diabetes care programs. They are diverse geographically and serve a wide variety of patients: richh and poor, rural and urban, Englishare not speaking and primarily non-english speaking. Althoughh programs of this type common, there is increasing interest in matching the professional skills. Source: California Healthcare Foundation // diabetes-care-eight-case-studies The Asheville Project: Long-Term Clinical and Economic Outcomes of a Community Pharmacy Diabetes Care Program Carole W. Cranor, Barry A. Bunting, and Dale B. Christensenn The City of Asheville, North Carolina, began efforts too provide education and health services for employees with chronic conditions, such as diabetes. Employees were given education throughh the Mission-St. Joseph s Diabetes and Health Education Center and weree then teamed with community pharmacists to ensure medications were taken correctly. Pharmacists developed thriving healthcare services which let to participant s improved A1C levels, total healthh care costs, and fewer sick days. Source: American Pharmacists Association Foundation //

8 School-based Programs NEEMA: A School-Based Diabetes Risk Prevention Program Designed for African-American Children NEEMA is a school-based diabetes prevention program for African-American children. NEEMA is implemented via four social networks classroom (Health and Physical Education Class), after school (Health Club), home (Family Fun Fair) and school cafeteriaa (Food Service Program). Sample teacher and student manuals for a NEEMA program can be found on the Social and Health Research Center s Website. It includes curriculum, manuals, and activities for: first grade through eighth grade; cafeteriaa manual; physical education games and activities; and family programs. Source: Social and Health Research Center For access to materials: Diabetes Education in Tribal Schools (DETS) Diabetes in Tribal Schools Program is designed to increase American Indian and Alaska Native students understanding of health, diabetes, and maintaining life in balance. The DETS Project is part of a national effort to decrease the incidence and improve the care of type 2 diabetes among American Indian and Alaska Natives (AI/AN). Using a multiunits that disciplinary approach, the DETS Project is a K - 12 curriculum that consists of incorporate National Science Education Standards, Inquiry-Learning (5E model), and AI/AN cultural and community knowledge. Source: Diabetes Education in Tribal Schools, National Institute of Diabetes Digestive and Kidney Diseases //www3.niddk.nih.gov/fund/other/dets/index.htm To access the DETS Curriculum: //www3.niddk.nih.gov/fund/other/dets/currsupplements.htmm

9 diabetes Support Programs Patients with diabetes are tasked with the challenge of managing insulin, medications, nutrition choices, and physical activity. Sharing the experience with others can make diseasee management less difficult. By interacting with peers, diabetics can exchange knowledge and provide support through understanding and empathy. The following are sample programs whichh can provide peer support for those with diabetes. Project POWER Project POWER is a faith-based program targeting the African American community. Project POWER provides churches with a foundation for integrating diabetes awareness messages and healthy living tips into the life of the family and church. It engages the church in a variety of year-round activities that provide lessons which improve the health of church members living with diabetes, their families and the greater community as well. Source: Project Power programs/project-power.html DiabetesSisters DiabetesSisters is a national 501(c)(3) non-profit health organization whose mission is to improve the health and quality of life of women with, and those at risk of developing diabetes and to advocate on their behalf. The organization s key initiatives include the orange: will campaign, SisterMatch Program, sistertalk Blogs, the Women s Forum, Ask the Experts Column, locall Meetups and the Annual Weekend for Women Conference. Source: DiabetesSisters