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Cultural Connection
Mental Health Services Act (MHSA) update
Bonnie Birnbaum. DrPH
Quality Management
During FY 2007/08, Health Care Agency Behavioral Health Services has continued providing MHSA-funded Community Services and Supports (CSS) while planning for the use of funding for other MHSA components, including: Workforce Education and Training (WET), Capital Facilities and Technological Needs (CFTN), and Prevention and Early Intervention (PEI).
Community Services and Supports
Funding for CSS programs continues to grow. The California Department of Mental Health (DMH) has notified Orange County that it will be eligible for about $52.2 million for 2008/09. This may be compared to the $36.3 million allocated to OC in FY 2007/08. Below is a brief summary of the number of people served in CSS-funded programs in FY 2007/08.
People Served by CSS Funds FY 2007/08
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Full Service Partnerships: 1,201
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General Systems Development: 3,276
(Except for Education and Training)
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Education and Training: 7,073
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Outreach and Engagement: 777
Total: 12,327 (not unduplicated)
For CSS, Full Service Partnerships (FSPs) provide the most intensive level of services available. Services include linkage to, or provision of, all needed services and benefits as defined by the client and family in consultation with the Personal Services Coordinator, including help with school, employment, physical health and co-occurring disorders, and housing. The number of individuals enrolled in Full Service Partnerships in Orange County has increased steadily over the past two years. At the end of FY 2007/08, over 1200 clients were enrolled in FSPs.
Workforce Education and Training (WET)
The Plan for the WET component was approved by the California Department of Mental Health Services on August 14, 2008. Now that the WET Plan has been approved, implementation will begin. The approved Plan includes 19 programs that fall into the following five categories:
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Workforce Staffing Support
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Training and Technical Assistance
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Mental Health Career Pathways
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Residencies and Internships
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Financial Incentives
The California Department of Mental Health has notified Orange County that additional WET funding has been identified, bringing the county’s WET total funding to about $17.2 million. Decisions made in the original WET planning process will be used to guide the allocation of the new WET funding.
Capital Facilities and Technological Needs
The CFTN component plan was submitted in July and as of September 3, 2008 is still under review. The Component Proposal includes Capital Facilities funding for three new facilities to be constructed at 401 S. Tustin St., Orange. The three facilities are expected to house programs that have been previously approved by DMH. These programs are a Wellness/Peer Support Center, an Adult Crisis Residential Program, and a Vocational Training Program.
The overall goal for use of the Technological Needs funding is to create an integrated information systems infrastructure through the implementation of an Electronic Health Record (EHR). Implementation of an EHR will provide secure, real-time, point of service information to service providers.
Additional CFTN has become available, and a planning process will be conducted for the use of those funds. The total amount available to Orange County for CFTN is about $37.2 million.
Prevention and Early Intervention
Input gathering for the PEI planning process is now drawing to a close. A comprehensive, community-based PEI planning process began in January 2008. During the PEI planning process, 75 community focus groups were held, including groups conducted in Spanish, Vietnamese, Farsi, Korean, Arabic, and American Sign Language. In addition, two surveys, one for community-based organizations and one for community members (provided in the threshold languages of Spanish, Vietnamese, and English) were conducted. Eight project-specific workgroups were also held. A sub-committee of the MHSA Steering Committee assisted in the decision making process and developed recommendations to ultimately be presented to the Steering Committee by HCA staff.
 Housing
In addition to the Housing provided through a county’s CSS Plan, DMH decided to set up a special CSS Housing Program. CalHFA administers the program for the counties. Orange County was allocated a total of $33,158,300 to be used for MHSA Housing. Of this, $11,052,800 may be used for operating subsidies, and the remainder must be used for permanent supportive housing. Developers must partner with County Health Care Agencies to submit an application. Several potential local projects are currently under consideration.
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Costs and solutions to low health literacy
Rachel Bressi, Intern
Cultural Competency
Ever wonder if biannually means twice per year or once every other year? Actually, it means both. So when your prescription says to take your medicine “BID,” does that mean to take it twice a day or once every other day? How are you even supposed to know that “BID” stands for bi-daily? How many of us with adequate literacy have felt overwhelmed by a doctor’s explanation and treatment instructions? Now imagine how hard it would be to figure out if you had trouble getting through the morning paper. The difference is that not understanding the newspaper won’t kill you (or stop you from getting better!).
Low health literacy costs at least $73 billion per year in unnecessary costs (Low Health, 1998), but beyond the financial issues, people with limited literacy skills report lower overall health, are less likely to utilize screening, seek medical attention at later stages of their disease, are more likely to be hospitalized, and have lower rates of treatment success (Villaire, 2008).
To understand how bad the problem really is, consider these facts:
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Informed consent forms are generally written at the 13th grade reading level or higher.
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Medication package inserts are written at between the 10th and 12th grade reading level.
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Emergency department discharge instructions are written at the 7th to 16th grade reading level.
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The average Medicaid recipient reads at a 5th grade level.
60% of Medicaid recipients have basic or below basic literacy skills (Rudd, 1999).
 If you didn’t know the problem was this extensive, consider that 40% of patients with low literacy admit to feeling shame, 53% have never told their children of their difficulties, and 67% have never told their spouse (Villaire, 2008). Not only does this mean that the chance of a provider recognizing that a patient has low literacy is very low, but also that it is hard for the patient to even seek help from his or her own family to understand medical information.
With a clearer picture of how widespread the problem is, we can now learn how to fix it. Short of implementing a huge new literacy program, there are small and easy changes we can make to improve patients’ understanding.
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Use plain language in both writing and speaking; instead of saying “bi-daily,” say “two times everyday” or “one with breakfast and one with dinner.” Instead of using the word “vomit” say “throw up.”
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Use simple and direct sentences, not complicated structures.
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Consider culture: take into account the patient’s culture and how it might help or hinder his or her medical habits. Things like family relationships, gender roles, spiritual values and habits, and view of the healthcare system can make or break a patient’s treatment.
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Use visual aids; act something out or use pictures to indicate what your patient may not understand through written or verbal communication.
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Take it slow; explaining things too fast might intimidate or discourage a patient from asking for clarification. If you don’t take the time to explain something in full, then how will you even be able to perceive that your patient may have low literacy skills?
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Convey the few most important concepts or facts and keep them simple to make sure your patient at least understands these things.
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Ask the patient to explain back to you what you have told them.
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If you have access to them, use tools like booklets with short sentences accompanied by easy to understand “action” pictures. If you can’t find any or don’t like what you do find, consider producing your own picture guides. With these guides, your patient can access the information they need at home in a way that’s easy for them to understand. Make sure to offer this guide in the languages your patients speak (Villaire 2008).
Implementing these simple measures can make a big difference in the healthcare of people with low literacy. Even people who can read at a 16th grade level may not know what all the medical verbage you’re telling them means, so consider applying these tips to all patients or suggesting them to your physician!
References:
Low Health Literacy Skills Increase Annual Health Care Expenditures by $73 Billion, 1998.
www.agingsociety.org/agingsociety/publications/fact/fact_low.html
Rudd, R.E., 1999. Health and Literacy: A Review of Medical and Public Health Literature (Cited in Villaire, Micael. “Health Literacy 101: An Introduction to the Field.”
Villaire, Micael. “Health Literacy 101: An Introduction to the Field.”
The Institute for Healthcare Advancement 7th Annual Health Literacy Conference, May 1-2, 2008.
Cultural Events Calendar
October
October 14, 15, 16, 2008
Orange County Immersion Training
744 N. Eckoff (in auditorium)
Orange, CA 92612
Registration: Free
For more info, contact Zanetta Moloi at (714) 667-5620
October 17, 2008
Consortium on Asian American Mental Health Training
Spirituality and Mental Health: Compatibility & Conflicts
Marriott Hotel
4700 Airport Plaza Dr.
Long Beach, CA
Registration: By 9/28 $90.00 – after 9/28 $110.00
For more info, contact Freda Cheung at (310) 222-4266
or email: fcheung@labiomed.org
Thursday, October 23, 2008 - Friday, October 24, 2008
Rose Jenkins Conference
Revisiting Systems of Care in the Changing Landscape: The Mental Health Services Act, Evidence Based Practices and Fiscal Challenges
Double Tree Hotel Sacramento
2001 Point West Way
Sacramento, CA 95815
Registration: $285.00 before 9/30 – after 9/30 $310.00
For more info, contact CIMH at (916) 379-5329
or register online at www.cimh.ORG
November
November 18th – 19th,
Cultural Competency Symposium:
Recent Developments In the Treatment of Culturally Diverse Populations
Bower’s Museum of Cultural Art
2002 Main St.
Santa Ana, CA
Registration: Free. Space is Limited for this MHSA funded event
For more info, contact Christy Castiglione to register at (714) 796-0188
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What is the Promotora Model and why is it successful?
Rachel Bressi, Intern
Cultural Competency
The basic idea of the Promotora Model is to train community members to provide health advice and information to their own community. The reason why we think these promotores, also called community health workers, are so effective is because they understand the nuances of their own cultural community and provide a more familiar setting for members to get help. Not only do promotores speak the same language as the people they serve, but they are also active and accepted members of the community, not outsiders who come to impose their ways. Many minority populations in Orange County do not seek the health care they need from traditional providers until a condition is very serious, if at all. But with the involvement of a promotora, they have easier and more comfortable access to health information and advice.
The OCHCA is currently conducting a study to gauge the promotora model’s effectiveness in helping chronically mentally ill Spanish speaking Latino adults manage diabetes II. Consumers from Orange County’s Behavioral Health Services system are participating in the study with those in the “intervention” group meeting with trained promotores to participate in a 12-week program teaching diabetes self-management. Participants continue to receive medical and mental health support for six months after their 12-week program ends. Even though all of the results are not in yet, the study is looking promising.
 In 2001, the National Heart, Lung, and Blood Institute and the National Council of La Raza targeted the Latino-American community in their own programs aimed at reducing the consequences of cardiovascular disease among Latinos called Salud Para Su Corazón (Health for Your Heart). Through this program they not only sought to alleviate the burden of cardiovascular disease on Latinos, but also to evaluate the effectiveness of promotores in increasing “heart-healthy behaviors” in Latino families. The program found that the involvement of promotores did increase “heart-healthy behaviors” within Latino families (Balcázar, 2005).
Currently, a few communities throughout Orange County are implementing promotores to help their members identify and seek help with health problems. Both the Latino and Korean American communities are using promotores to improve the mental health of their populations.
Beyond Orange County, organizations like Planned Parenthood have been training promotores as liaisons between Planned Parenthood and Latino communities. The key with the promotora model is peer education and trust and Planned Parenthood suggests that Latinas are generally more comfortable discussing their sexual health with other Latinas in an informal setting rather than with a male doctor in a formal setting. Building on this cultural practice, Planned Parenthood seeks to provide Latinas with an informed friend with whom to discuss their sex-related problems and questions. Since these women don’t have to worry about going to a doctor or a Planned Parenthood office for information and advice, they can get the information faster and seek medical assistance if needed in a timelier manner. Planned Parenthood has found that the use of the Promotora Model results in increased cultural competency and the ability to reach and serve certain populations more effectively (Kohn, 2004).
There are some possible difficulties with this model as well. It may be hard to find enough promotores to serve your target population, and it may also be difficult to ensure promotores are fulfilling their assignments, since monitoring can be tricky. These hurdles can usually be overcome with an active recruitment effort and involved and frequent trainings and ultimately the advantages to the Promotora Model greatly outweigh the difficulties associated with it (Kohn, 2004).
References:
Balcázar H, Alvarado M, Hollen ML, Gonzalez-Cruz Y, Pedregón V. 2005. Evaluation of Salud Para Su Corazón (Health for Your Heart), National Council of La Raza Promotora outreach program.
www.cdc.gov/pcd/issues/2005/jul/04_0130.htm.
Kohn, Julia. “A Guide to Promotora Programs.” Planned Parenthood, 2004.
www.plannedparenthood.org/files/PPFA/programs-promotoras-guide.pdf.
Cultural Competency Spotlight on Excellence
March Honoree
The “Spotlight on Excellence Award” was given to Zanetta Moloi, Program Supervisor for Behavioral Health Services Mental Health Services Act (MHSA) Training Program. Zanetta has been a County employee for 19 years and is noted by her peers as being highly productive, customer and community focused. She treats everyone with respect and is helpful to consumers and to staff equally. Zanetta is also courteous of everyone’s unique ethnic and cultural differences and needs and is seen as a resource for both staff and the community. Prior to her current position as Program Supervisor, Zanetta served as an Office Tech and Staff Specialist for HCA Children and Youth Services (CYS) Quality Review and Training (QRT) program.
(Pictured in photo, Ronnie Kelley (Cultural Competency), Zanetta Moloi and
Rafael Canul(Cultural Competency)
January Honoree
Behavioral Health’s Cultural Competency Program named John Kane of Older Adult Mental Health Recovery Services as the recipient of the January 2008 Spotlight on Excellence Award.John currently serves as a Mental Health Specialist for Older Adult Services (OAS)and is recognized for his commitment and dedication to clients and co-workers alike. He often takes on extra work assignments each month in order to relieve his peers from their extra workload and is known for following the mantra of “it’s never too late.” John is also recognized for going the extra mile for patients under his care. Prior to joining the County, John worked for the LA Times for 41 years. After retiring, he attended Saddleback College where he studied to become a certified Addiction Treatment Counselor. He then joined the OAS Substance Abuse Resources Team (START) Program as a Drug and Alcohol Counselor. During this time, he attended Cal State Fullerton and received a BS in Human Services and a MS in Gerontology.
(Pictured in photo, Ronnie Keley ( Cultural Competency) John Kane, Dan Conditt ( Older Adult Services) Rafael Canul (Cultural
Competency)
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The Cultural Connection is published quarterly by
the Cultural Competency Program of the County of Orange/Health
Care Agency. If you would like to contribute an article, or have comments,
ideas, or suggestions for newsletter improvement, please write to us at:
County of Orange/Health Care Agency
405 W. 5th Street, Suite 400
Santa Ana, CA 92701
Telephone: (714) 796-0188
FAX: (714) 796-0194
Web:
ochealthinfo.com/behavioral/cultural
Editor:
Veronica A. Kelley, LCSW
Ethnic Services Coordinator/Service Chief I
Cultural Competency
Contributing Staff:
Bonnie Birnbaum, DrPH
Rachel Bressi
Production Staff:
Christy Castiglione County of Orange/Health Care Agency
405 W. 5th Street, Suite 400
Santa Ana, CA 92701
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