Disparities in health are common among ethnic and racial minority groups. For example, African Americans have 77% higher rates of diabetes than whites and in 2014 African Americans were almost three times more likely to die from asthma related causes than the white population. To address health disparities, the United States Centers for Disease Control and Prevention (US CDC) funds the Racial and Ethnic Approaches to Community Health (REACH) grant program. These grants support community efforts to plan and carryout strategies to address local health issues.
In Maine, Healthy Androscoggin, part of Central Maine Health Corporation, was awarded a four-year REACH grant to help local healthcare and wellness providers improve their cultural competency and increase access to care for adult African New Americans. These initiatives were intended to assist communities of immigrants and refugees from East and Central African countries living in the cities of Lewiston and Auburn, Maine; accounting for about 11% of the population.
Healthy Androscoggin brought together eight health and wellness providers in the REACH Partnership to increase cultural competency through agency wide trainings, workforce development, Culturally and Linguistically Appropriate Services (CLAS) assessments, community outreach, data collection, culturally competent video education materials, and translated medical and informational documents. In addition to the high-level system changes that were implemented, REACH also worked directly with each of the eight partners to target individual programming within their organizations.
Healthy Androscoggin contracted with our partner, Hart Consulting, Inc., and the Market Decisions team to develop required and voluntary evaluation plans to meet US CDC expectations. Market Decisions joined the team to support program data collection and performance monitoring needs. This included developing data collection tools and methods, tracking progress of overall grant activities and partner level implementation, facilitating trainings, federal reporting, and information gathering from the communities of focus.
Actual Use: United Ambulance
Healthy Androscoggin was required to select one area of the REACH project to focus on for an Actual Use Evaluation to track interventions aimed at reducing health disparities in specific sub-populations. United Ambulance was selected for the Actual Use Evaluation.
United Ambulance is one of the eight partners working on the REACH grant to improve their cultural and linguistic competencies to help New American populations manage chronic disease. The agency is owned jointly by the two area health care systems and is an accredited ground ambulance service. The service of interest for the use assessment is the home visiting service, which provides adults the opportunity for a regular visit with a Community Paramedic at no cost. They provide the basic tools and resources needed for improved self-awareness of medical problems and management of chronic diseases.
Healthy Androscoggin’s intervention included the delivery of cultural competency trainings and technical assistance for agency leaders and staff, updating data collection systems, translating materials, and conducting a CLAS assessment. Data collection systems were updated to include required fields for race, ethnicity, country of origin, and preferred language.
The overall evaluation design measured actual use of the United Ambulance’s home visiting services. We tracked the number of people that used the service during the baseline compared to post-intervention. We worked directly with United Ambulance to determine frequency of the data collection and reporting needs, including collecting and disseminating success stories.
This is a longitudinal study looking at baseline and post intervention data on the same patients as well as policy and systems changes at United Ambulance. We used satisfaction surveys with patients to understand changes in service levels and reach. The evaluation also tracked United Ambulance staff participation in cultural competency trainings, numbers of tools translated, interpreter services implemented, number of CLAS standards met, and data collection improvement.
Culturally and Linguistically Appropriate Service (CLAS) Assessment
As part of the REACH project, eight health and wellness agencies had the opportunity to complete a self-assessment of cultural competency to identify strengths and gaps in health and wellness services for adult African immigrant and refugee populations. The structured process used a federally recognized Culturally and Linguistically Appropriate Services assessment tool focused on the 15 National CLAS Standards to help partners gauge how culturally diverse and underserved communities are receiving their services. The REACH evaluation team worked with each agency to complete the assessment and develop an action plan to take steps towards improvement in various areas of cultural competency.
The REACH evaluation team selected a well-known and federally recognized CLAS assessment tool from Georgetown University, the Cultural and Linguistic Competence Policy Assessment (CLCPA). Using the CLCPA assessment results, the team developed a scoring system to allow partners to see how well their agency met each of the 15 National CLAS standards.
This pilot process tracked eight REACH partners as they moved along a continuum, or rating scale, showing changes over a one-year period. After a baseline assessment was completed in spring 2016, the results were used to develop an action plan that included training and resources to support change over one year of the grant period (2016-2017). A post assessment using the same tools was completed by all eight partners in spring 2017. Final reports and results were disseminated to all partners and stakeholders, and results were also presented at state and national conferences. Overall results can be found below.
Objective: Each of the 8 REACH Partners will improve in least 1 CLAS Standard.
Outcome: All 8 of the REACH Partners far exceeded those expectations.
Out of the 15 National CLAS Standards, REACH Partners:
Increased scores on an average of 11 Standards
Improved ratings on an average of 8 Standards
Are “Partially or Mostly Meeting” an average of 9 Standards