Capella University Lunch and Learn Presentation

COM-20189-XA036 HC Cultural ?
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Competency
In this project, you will demonstrate your mastery of the following competency:
Apply cultural knowledge to enhance communica!on within a healthcare organiza!on
Scenario
Crystal Creek is a long-term care facility that provides rehabilita!ve, restora!ve, and ongoing skilled nursing care to
pa!ents in need of assistance with ac!vi!es of daily living, such as bathing, ea!ng, and walking. Crystal Creek has a
small administra!ve team of senior-level managers that establish healthcare standards, make strategic policy
decisions, and oversee personnel in support of the facility?s vision for long-term care. As a member of this team, you
have a dual mission. You must ensure that residents are provided high-quality medical and personal care, and that
opera!ons, finances, and personnel are managed e?ec!vely.
On a daily basis, you and your sta? at Crystal Creek interact with culturally diverse clients and their families. It is a
mul!cultural workplace. To ensure that your residents con!nue to receive high-quality care that exemplifies cultural
humility, and that coworkers interact respec#ully, you?ve decided to plan a 30-minute lunch and learn, a seminar
with free lunch for the sta?.
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Direc!ons
As a healthcare administrator at Crystal Creek, you want your sta? to communicate with diverse popula!ons and
establish rapport with their clients and coworkers. To ensure that your sta? communicates e?ec!vely, you will host a
30-minute lunch and learn on how cultural knowledge enhances communica!on within healthcare facili!es. During
the ini!al 20 minutes, you will talk about how cultural knowledge enhances communica!on, care, and popula!on
health outcomes. During the last 10 minutes, you will answer ques!ons from the crowd.
Your presenta!on (10?15 slides, with comprehensive speaker notes totaling 1,000?1,500 words) should teach
par!cipants about cultural awareness and healthcare. First, you will describe the key concepts and principles of
providing culturally relevant healthcare. Then, you will discuss how to apply cultural knowledge to facilitate
communica!on with pa!ents and coworkers. Your discussion will include a scenario to examine with the group.
Finally, you will explain how healthcare organiza!ons apply cultural knowledge to improve popula!on health
outcomes. In your presenta!on, include slides that encompass the following:
Descrip!ons of key concepts related to the applica!on of cultural knowledge in a healthcare environment (2?
4 slides)
What is cultural knowledge (cultural competence, cultural humility, cultural skills, and cultural awareness)?
How would you explain these terms in your own words?
What are the key elements or principles of each?
An analysis of how cultural knowledge facilitates communica!on with pa!ents and coworkers (2?4 slides)
How can cultural knowledge impact how you communicate with your pa!ents and coworkers?
How does your own culture a?ect how you communicate and interact with others verbally and
nonverbally?
What assump!ons do you make about interac!ons with pa!ents and coworkers in a healthcare
environment?
How can you demonstrate mutual respect and cultural humility with pa!ents and coworkers?
How can you ensure that your own personal beliefs do not interfere with your ability to provide
culturally relevant care?
A brief role-play scenario about how to apply cultural knowledge to an interac!on with a pa!ent or coworker
(2?3 slides)
Write a brief role scenario (about three to five sentences) describing an instance when cultural knowledge
could be applied to enhance communica!on in healthcare. Your scenario should have at least two people.
It should describe a realis!c interac!on. You should situate each person in the scenario by describing them
and specifying the topic of the conversa!on. Explain the cultural characteris!cs of each person.
In another slide, explain how you could use cultural knowledge to foster communica!on in your scenario.
A discussion of how healthcare organiza!ons foster cultural awareness among their sta? and local
communi!es (1?2 slides)
How do healthcare organiza!ons raise cultural awareness among their sta? and local communi!es?
Provide at least two specific examples.
A discussion of how healthcare organiza!ons apply cultural awareness to improve popula!on health outcomes
(1?2 slides)
How does cultural knowledge impact popula!on health outcomes? Include at least one specific example to
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support your asser!ons.
What are popula!on health, health dispari!es, and socioeconomic and non-socioeconomic factors?
What are popula!on health, health dispari!es, and socioeconomic and non-socioeconomic factors?
Describe these terms as an aspect of your response.
What to Submit
Every project has a deliverable or deliverables, which are the files that must be submi$ed before your project can be
assessed. For this project, you must submit the following:
Lunch and Learn Presenta!on (10?15 slides with comprehensive speaker notes totaling 1,000?1,500 words)
Create a presenta!on for a 30-minute lunch and learn or informa!onal seminar for your employees. Focus your 20minute presenta!on (allowing 10 addi!onal minutes for ques!ons) on how cultural knowledge enhances
communica!on in the healthcare field. You must describe evolving terminology, apply cultural knowledge to
interac!ons with pa!ents and coworkers, and discuss how the applica!on of cultural knowledge impacts popula!on
health outcomes. You will submit your slides with comprehensive speaker notes. Your speaker notes should reflect
what you would say in an audio or in-person presenta!on.
Suppor!ng Materials
The following resource(s) may help support your work on the project:
Cita!on Help
Need help ci!ng your sources? Use the CfA Cita!on Guide and Cita!on Maker.
Informa!on about Long-Term Care Facili!es
Website: Caregiver Resources & Long-Term Care
In this web resource for caregivers from the U.S. Department of Health and Human services, you will find a
repository of informa!on about the components of long-term care in the United States.
Website: Na!onal Study of Long-Term Care Providers
This web resource created by the Centers for Disease Control and Preven!on includes reports, na!onal and state
es!mates, journal ar!cles, and presenta!ons about long-term care providers in the United States.
Informa!on about Lunch and Learns
Explore these websites to learn more about the purposes and func!ons of lunch and learns.
Reading: Lunch and Learn Benefits
Reading: Lunch and Learn: A Voluntary Training Session That Combines the Pleasure of Ea!ng and Learning During
Lunch Break
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Communities in Action: Pathways to Health Equity
Date: Jan. 13, 2017
From: Plus Company Updates
Publisher: Right Vision Media
Document Type: Article
Length: 593 words
Full Text:
Princeton, NJ: Robert Wood Johnson Foundation has issued the following news release:
Americans today live shorter, sicker lives than people in other developed countries, and, across the nation, health varies by income,
education, race and ethnicity, and geography. Warning that the United States will pay the high price in lost lives, wasted potential and
squandered potential resources until these gaps are closed, a comprehensive report from the National Academies of Sciences,
Engineering, and Medicine (NASEM) calls for leaders across sectors to make health equity a priority for the nation.
Communities in Action: Pathways to Health Equity is the result of a year-long analysis by a 19-member committee of national experts
in public health, health care, civil rights, social science, education, research and business. The Robert Wood Johnson Foundation
(RWJF) commissioned the report as part of a $10 million, five-year grant to NASEM to examine solutions to promote health equity, a
key element in a Culture of Health.
Top Takeaways
Health equity is crucial to the well-being and vibrancy of communities.
Social inequities matter more than health care in shaping health disparities.
Health equity holds benefits for the entire nation, from economic vitality to national security.
Communities have the power to take steps toward health equity.
Why Does Health Equity Matter?
When health equity is achieved, “everyone has the opportunity to attain full health potential, and no one is disadvantaged from
achieving this potential because of social position or any other socially defined circumstance,” the report says. And ensuring that
opportunity is crucial not just for individuals, but also for the nation’s economic and growth prospects, for its national security and for
its communities’ well-being and vibrancy.
Data show the costs of current health inequities: The report estimates that racial health disparities alone are projected to cost health
insurers $337 billion between 2009 and 2018. The impact on national security is also high, with some 26 million young adults
unqualified to serve in the U.S. military because of persistent health problems, or because they are poorly educated or have been
convicted of a felony.
The report calls on leaders from education, transportation, housing, planning, public health, business and others to prioritize health
equity. It offers specific recommendations–ranging from research priorities to guidance for public and private policies and multisector
partnerships–along with tools for communities to use.
Key Facts
The Cost of Inequality
In 2015, the percentage of low-birthweight infants in the U.S. rose for the first time in seven years.
Racial health disparities alone are projected to cost health insurers $337 billion between 2009 and 2018.
Health care spending accounted for 17.5 percent of GDP in 2014.
In 2014, VA-enrolled veterans accounted for 17.9 percent of suicide deaths among U.S. adults.
People with disabilities are more than twice as likely not to receive medical care because of cost.
Health equity means we all have the basics to be as healthy as possible. However, across the nation, many communities have
experienced generations of isolation from opportunity. Some neighborhoods have more liquor stores than grocery stores, lack safe
and affordable housing, or have poor-quality schools.
Acknowledging that the root causes of health inequities are “diverse, complex, evolving and interdependent,” the Panel calls for
greater investment and collaboration across sectors to address the multiple factors that influence health, and to change the types of
policies, practices and systems that have kept inequity in place.
The report also highlights nine communities across the United States that are taking steps to address health inequities.
In case of any query regarding this article or other content needs please contact: [email protected]
Copyright: COPYRIGHT 2017 Right Vision Media
Source Citation ()
Gale Document Number: GALE|A477863423
May 2018 | Issue Brief
Beyond Health Care: The Role of Social Determinants in
Promoting Health and Health Equity
Samantha Artiga and Elizabeth Hinton
Key Findings
Social determinants of health are the conditions in which people are born, grow, live, work and age that
shape health. This brief provides an overview of social determinants of health and emerging initiatives to
address them. It shows:
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Social determinants of health include factors like socioeconomic status, education,
neighborhood and physical environment, employment, and social support networks, as well
as access to health care. Addressing social determinants of health is important for improving
health and reducing longstanding disparities in health and health care.
?
There are a growing number of initiatives to address social determinants of health within
and outside of the health care system. Outside of the health care system, initiatives seek to
shape policies and practices in non-health sectors in ways that promote health and health equity.
Within the health care system, there are multi-payer federal and state initiatives as well as
Medicaid-specific initiatives focused on addressing social needs. These include models under the
Center for Medicare and Medicaid Innovation, Medicaid delivery system and payment reform
initiatives, and options under Medicaid. Managed care plans and providers also are engaged in
activities to identify and address social needs. For example, 19 states required Medicaid managed
care plans to screen for and/or provide referrals for social needs in 2017, and a recent survey of
Medicaid managed care plans found that almost all (91%) responding plans reported activities to
address social determinants of health.
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Many challenges remain to address social determinants of health, and new directions
pursued by the Trump Administration could limit resources and initiatives focused on these
efforts. The Trump Administration is pursuing a range of new policies and policy changes, including
enforcing and expanding work requirements associated with public programs and reducing funding
for prevention and public health. These changes may limit individuals? access to assistance
programs to address health and other needs and reduce resources available to address social
determinants of health.
Introduction
Efforts to improve health in the U.S. have traditionally looked to the health care system as the key driver
of health and health outcomes. However, there has been increased recognition that improving health and
achieving health equity will require broader approaches that address social, economic, and environmental
factors that influence health. This brief provides an overview of these social determinants of health and
discusses emerging initiatives to address them.
What are Social Determinants of Health?
Social determinants of health are the
conditions in which people are born,
grow, live, work and age.1 They include
factors like socioeconomic status,
education, neighborhood and physical
environment, employment, and social
support networks, as well as access to
health care (Figure 1).
Addressing social determinants of
health is important for improving health
and reducing health disparities.2 Though
health care is essential to health, it is a
relatively weak health determinant.3
Research shows that health outcomes are driven by an array of factors, including underlying genetics,
health behaviors, social and environmental factors, and health care. While there is currently no
consensus in the research on the magnitude of the relative contributions of each of these factors to
health, studies suggest that health behaviors, such as smoking, diet, and exercise, and social and
economic factors are the primary drivers of health outcomes, and social and economic factors can shape
individuals? health behaviors. For example, children born to parents who have not completed high school
are more likely to live in an environment that poses barriers to health such as lack of safety, exposed
garbage, and substandard housing. They also are less likely to have access to sidewalks, parks or
playgrounds, recreation centers, or a library.4 Further, evidence shows that stress negatively affects
health across the lifespan5 and that environmental factors may have multi-generational impacts.6
Addressing social determinants of health is not only important for improving overall health, but also for
reducing health disparities that are often rooted in social and economic disadvantages.
Initiatives to Address Social Determinants of Health
A growing number of initiatives are emerging to address social determinants of health. Some of these
initiatives seek to increase the focus on health in non-health sectors, while others focus on having the
health care system address broader social and environmental factors that influence health.
Focus on Health in Non-Health Sectors
Policies and practices in non-health sectors have impacts on health and health equity. For
example, the availability and accessibility of public transportation affects access to employment,
affordable healthy foods, health care, and other important drivers of health and wellness. Nutrition
programs and policies can also promote health, for example, by supporting healthier corner stores in lowincome communities,7 farm to school programs8 and community and school gardens, and through
Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity
2
broader efforts to support the production and consumption of healthy foods.9 The provision of early
childhood education to children in low-income families and communities of color helps to reduce
achievement gaps, improve the health of low-income students, and promote health equity.10
?Health in All Policies? is an approach that incorporates health considerations into decision
making across sectors and policy areas.11 A Health in All Policies approach identifies the ways in
which decisions in multiple sectors affect health, and how improved health can support the goals of these
multiple sectors. It engages diverse partners and stakeholders to work together to promote health, equity,
and sustainability, and simultaneously advance other goals such as promoting job creation and economic
stability, transportation access and mobility, a strong agricultural system, and improved educational
attainment. States and localities are utilizing the Health in All Policies approach through task forces and
workgroups focused on bringing together leaders across agencies and the community to collaborate and
prioritize a focus on health and health equity.12 At the federal level, the Affordable Care Act (ACA)
established the National Prevention Council, which brings together senior leadership from 20 federal
departments, agencies, and offices, who worked with the Prevention Advisory Group, stakeholders, and
the pubic to develop the National Prevention Strategy.
Place-based initiatives focus on implementing cross-sector strategies to improve health in
neighborhoods or communities with poor health outcomes. There continues to be growing
recognition of the relationship between neighborhoods and health, with zip code understood to be a
stronger predictor of a person?s health than their genetic code.13 A number of initiatives focus on
implementing coordinated strategies across different sectors in neighborhoods with social, economic, and
environmental barriers that lead to poor health outcomes and health disparities. For example, the Harlem
Children?s Zone (HCZ) project focuses on children within a 100-block area in Central Harlem that had
chronic disease and infant mortality rates that exceeded rates for many other sections of the city as well
as high rates of poverty and unemployment. HCZ seeks to improve the educational, economic, and health
outcomes of the community through a broad range of family-based, social service, and health programs.
Addressing Social Determinants in the Health Care System
In addition to the growing movement to incorporate health impact/outcome considerations into non-health
policy areas, there are also emerging efforts to address non-medical, social determinants of health within
the context of the health care delivery system. These include multi-payer federal and state initiatives,
Medicaid initiatives led by states or by health plans, as well as provider-level activities focused on
identifying and addressing the non-medical, social needs of their patients.
FEDERAL AND STATE INITIATIVES
In 2016, Center for Medicare and Medicaid Innovation (CMMI), which was established by the ACA,
announced a new ?Accountable Health Communities? model focused on connecting Medicare and
Medicaid beneficiaries with community services to address health-related social needs. The model
provides funding to test whether systematically identifying and addressing the health-related social needs
Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity
3
of Medicare and Medicaid beneficiaries through screening, referral, and community navigation services
will affect health costs and reduce inpatient and outpatient utilization. In 2017, CMMI awarded 32 grants
to organizations to participate in the model over a five-year period. Twelve awardees will provide
navigation services to assist high-risk beneficiaries with accessing community services and 20 awardees
will encourage partner alignment to ensure that community services are available and responsive to the
needs of enrollees.14
Through the CMMI State Innovation Models Initiative (SIM), a number of states are engaged in
multi-payer delivery and payment reforms that include a focus on population health and recognize
the role of social determinants. SIM is a CMMI initiative that provides financial and technical support to
states for the development and testing of state-led, multi-payer health care payment and service delivery
models that aim to improve health system performance, increase quality of care, and decrease costs. To
date, the SIM initiative has awarded nearly $950 million in grants to over half of states to design and/or
test innovative payment and delivery models. As part of the second round of SIM grant awards, states are
required to develop a statewide plan to improve population health. States that received Round 2 grants
are pursuing a variety of approaches to identify and prioritize population health needs; link clinical, public
health, and community-based resources; and address social determinants of health.
?
All 11 states that received Round 2 SIM testing grants plan to establish links between primary
care and community-based organizations and social services.15 For example, Ohio is using SIM
funds, in part, to support a comprehensive primary care (CPC) program in which primary care
providers connect patients with needed social services and community-based prevention programs.
As of December 2017, 96 practices were participating in the CPC program. Connecticut?s SIM model
seeks to promote an Advanced Medical Home model that will address the wide array of individuals?
needs, including environmental and socioeconomic factors that contribute to their ongoing health.
?
A number of the states with Round 2 testing grants are creating local or regional entities to
identify and address population health needs and establish links to community services. For
example, Washington State established nine regional ?Accountable Communities of Health,? which
will bring together local stakeholders from multiple sectors to determine priorities for and implement
regional health improvement projects.16 Delaware plans to implement ten ?Healthy Neighborhoods?
across the state that will focus on priorities such as healthy lifestyles, maternal and child health,
mental health and addiction, and chronic disease prevention and management.17 Idaho is creating
seven ?Regional Health Collaboratives? through the state?s public health districts that will support local
primary care practices in Patient-Centered Medical Home transformation and create formal referral
and feedback protocols to link medical and social services providers.18
?
The Round 2 testing grant states also are pursuing a range of other activities focused on
population health and social determinants. Some of these activities include using population
health measures to qualify practices as medical homes or determine incentive payments,
incorporating use of community health workers in care teams, and expanding data collection and
analysis infrastructure focused on population health and social determinants of health.19
Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity
4
MEDICAID INITIATIVES
Delivery System and Payment Reform
A number of delivery and payment reform initiatives within Medicaid include a focus on linking
health care and social needs. In many cases, these efforts are part of the larger multi-payer SIM models
noted above and may be part of Section 1115 Medicaid demonstration waivers.20 For example, Colorado
and Oregon are implementing Medicaid payment and delivery models that provide care through regional
entities that focus on integration of physical, behavioral, and social services as well as community
engagement and collaboration.
?
In Oregon, each Coordinated Care Organization (or ?CCO?) is required to establish a community
advisory council and develop a community health needs assessment.21 CCOs receive a global
payment for each enrollee, providing flexibility for CCOs to offer ?health-related services? ? which
supplement traditional covered Medicaid benefits and may target the social determinants of health.22
Early experiences suggest that CCOs are connecting with community partners and beginning to
address social factors that influence health through a range of projects. For example, one CCO has
funded a community health worker to help link pregnant or parenting teens to health services and
address other needs, such as housing, food, and income.23 Another CCO worked with providers and
the local Meals on Wheels program to deliver meals to Medicaid enrollees discharged from the
hospital who need food assistance as part of their recovery.24 An evaluation conducted by the Oregon
Health & Science University’s Center for Health Systems Effectiveness released in 2017 found CCOs
were associated with reductions in spending growth and improvement in some quality domains.25
According to the evaluation, most CCOs believed health-related flexible services were effective at
improving outcomes and reducing costs.26
?
Similarly, in Colorado, the Regional Collaborative Organizations (RCCOs), which are paid a per
member per month payment for enrollees, help connect individuals to community services through
referral systems as well as through targeted programs designed to address specific needs identified
within the community.27 A study published in 2017 comparing Oregon?s CCO program to Colorado?s
RCCO program found that Colorado?s RCCO program generated comparable reductions in
expenditures and inpatient care days.28
Several other state Medicaid programs have launched Accountable Care Organization (ACO) models that
often include population-based payments or total cost of care formulas, which may provide incentives for
providers to address the broad needs of Medicaid beneficiaries, including the social determinants of
health.29
Some state Medicaid programs are supporting providers? focus on social determinants of health
through ?Delivery System Reform Incentive Payment? (DSRIP) initiatives. DSRIP initiatives emerged
under the Obama Administration as part of Section 1115 Medicaid demonstration waivers. DSRIP
initiatives link Medicaid funding for eligible providers to process and performance metrics, which may
involve addressing social needs and factors. For example, in New York, provider systems may implement
Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity
5
DSRIP projects aimed at ensuring that people have supportive housing. The state also has invested
significant state dollars outside of its DSRIP waiver in housing stock to ensure that a better supply of
appropriate housing is available.30 In Texas, some providers have used DSRIP funds to install
refrigerators in homeless shelters to improve individuals? access to insulin.31 The California DSRIP waiver
has increased the extent to which the public hospital systems focus on coordination with social services
agencies and county-level welfare offices.32 To date, data on the results of DSRIP programs are limited,
but a final federal evaluation report is scheduled to for 2019.33
Medicaid programs also are providing broader services to support health through the health
homes option established by the ACA. Under this option, states can establish health homes to
coordinate care for people who have chronic conditions. Health home services include comprehensive
care management, care coordination, health promotion, comprehensive transitional care, patient and
family support, as well as referrals to community and social support services. Health home providers can
be a designated provider, a team of health professionals linked to a designated provider, or a community
health team. A total of 21 states report that health homes were in place in fiscal year 2017.34 A federallyfunded evaluation of the health homes model found that most providers reported significant growth in
their ability to connect patients to nonclinical social services and supports under the model, but that lack
of stable housing and transportation were common problems for many enrollees that were difficult for
providers to address with insufficient affordable housing and rent support resources.35
Housing and Employment Supports
Some states are providing housing support to Medicaid enrollees through a range of optional
state plan and waiver authorities. While states cannot use Medicaid funds to pay for room and board,
Medicaid funds can support a range of housing-related activities, including referral, support services, and
case management services that help connect and retain individuals in stable housing.36 For example, the
Louisiana Department of Health formed a partnership w