National Center for Cultural Competence
Georgetown University Child Development Center
University Centers for Excellence in Developmental Disabilities
Topical Conference Call 4
Infusing Cultural and Linguistic Competence into the
Six Core Outcomes for Children with Special Health Care Needs:
Success Stories
Thursday, May 23, 2002
2:00 p.m. - 3:30 p.m. EDT
Tawara D. Goode: I would like to say good afternoon to everyone. My name is Tawara Goode. I'm Director at the National Center for Cultural Competence. Welcome to everyone who is participating on the call today, Infusing Cultural and Linguistic Competence into the Six Core Outcomes for Children with Special Health Care Needs. And we are going to have the opportunity to look at success stories from various areas across the country. And I'm going to turn things over now to Suzanne Bronheim, who is a member of our faculty here at the National Center for Cultural Competence, and also to Diana Denboba, who is our Federal Project Officer with Maternal Child Health Bureau.
Suzanne Bronheim: Thank you, Tawara. This is Suzanne and good afternoon. And we are delighted that so many of you are with us this afternoon. Those of you who have been on our other conference calls maybe have gotten used to our format and we are going to depart a little bit today because you're going to be hearing probably more voices speaking than you have on some of the other calls. I think that really reflects the fact that when we begin talking about working towards these Six Core Outcomes for Children with Special Health Care Needs it's very collaborative work and it's very difficult to speak about the work with just one voice. So instead I'm going to go through briefly and let you know who you'll be hearing from. And as they speak you will learn more about them and the work that they're doing.
We're going to be hearing from folks in Hawaii today about implementing the medical home outcome with cultural and linguistic competence. And we'll be hearing from Sharon Taba who is the Project Director of the Hawaii Medical Home Implementation Project and is the co-author of the new book that we gave you the website to look at, The Medical Home, Reaching the Next Level. And actually her co-author, Dr. Lynn Wilson who is a cultural anthropologist will be on the line to answer questions if necessary.
We'll also be hearing from Harry Brown who is the father of Kahiau Brown who is a 6-year old with cerebral palsy. And he and his wife Donna are founders of a grassroots family group, Partners - Na Hulu Mamo, for families with children with special health care needs and Ko'olauloa, on the island of Oahu.
We are also going to be hearing from Dr. May Okihiro who is also from Oahu. She is a pediatrician who's been in practice for over 11 years in Hawaii, also in the Pacific Islands.
Then to talk about the goals related to making services easy for families to use, we are going to hear from Yakima Washington. Yakima is actually a winner of the Community Can! Communities of Excellence Award for doing an exceptional job of integrating services for young children with families. We will hear about their efforts in relation to that goal and particularly how they are infusing cultural and linguistic competence into those goal-related activities.
We will hear from Jackie McPhee who is the Program Coordinator for Child Health Services at Children's Village, Yakima, WA. They will explain to you how that helps them meet this particular goal or outcome with Yakima Valley Memorial Hospital.
JoAnne Jennings, who is a nurse and Specialty Clinic Coordinator at Children's Village and the Yakima Valley Farm Workers Clinic, which is an integral part of this integrated set of services. Deon Jefferson is the Client and Intake Services Coordinator from Children's Village.
And Jackie is there one other person with you?
Jackie McPhee: Yes, actually we do. We have the Director of Children's Village, Betty Ingham and Christy Albertson.
Suzanne Bronheim: Great. Thank you so much. So you can see we've got a lot of expertise on this phone call and we'll be hearing the variety of voices that it takes to do this work.
And now Diana, do you want to get us started with our discussion?
Diana Denboba: Sure. We'll be talking, first of all, about one of our Healthy People 2010 goals about children with special health care needs receiving coordinated, ongoing comprehensive care within a medical home. And I'd like to address Sharon Taba first. Sharon, could you just tell the audience because we have such a diverse audience from new and current grantees, friends, hospitals, youth, schools, could you tell everyone what a medical home is and how the concept relates to cultural and linguistic competence? Sharon?
Diana Denboba: Sharon? Donna? I think we lost Hawaii?
Harry Brown: This is Harry. I'm here.
Suzanne Bronheim: Oh, you're there.
Diana Denboba: Sharon Taba there?
Suzanne Bronheim: No. All right. We're going to have someone check back with the conference operator to see what's happened and we may have to shuffle some things around a little bit.
Suzanne Bronheim: This is, this is the conference operator. How can I help you?
Female Voice: We don't have a person on the line, Sharon Taba.
Suzanne Bronheim: Okay. I'll see what I can do. One moment.
Female Voice: Thank you.
Diana Denboba: Okay. Why don't we then move on, Suzanne, and maybe you can have a conversation with Donna and Harry and we'll get back to Sharon.
Suzanne Bronheim: Okay. And Donna is Harry's wife. She was going to be on the call but she is doing something very important today. There is a school trip and I would certainly vote for that over being on the call. So we have the opportunity to hear from Harry and it's nice always to hear a father's perspective. Harry, could you tell us a little bit about the area where you live and the families who are served, and, what are the challenges for getting services for families on your part of Oahu?
Harry Brown: Okay. Thank you. Aloha from Hawaii. We live in a community that's far removed from the main center or where most of the services are. So even though we are a small state in terms of miles, we are still a great distance away. And that presents sometimes a problem in the ability to, first of all, if we have a child that is of special needs, the travelling time can be a problem.
And secondly because my wife can't just take her, my son by himself, by herself, I'm sorry, it requires for me to take time off of work and it's a long travelling time to and from. So that's, a big part of my day that's taken away from my work. And so that's kind of, presents a problem. And I think because we live in a country area it's, the services seem to, people might feel that we are small in community and therefore the needs are not as great. But it's not a true statement because we actually have quite a lot of children out here with special needs. That's why we formed, my wife and I formed our own parent advocacy group.
Conference Operator: Excuse me, this is the conference operator. Sharon Taba is now on the line.
Sharon Taba: Hi, this is Sharon.
NCCC: Hi, Sharon. Harry was telling us a little bit about where he lives and then maybe we'll come back to you to talk about what Medical Home is about.
Sharon Taba: That would be great. Go ahead Harry, hi.
Harry Brown: Thank you, good morning. And, in Ko'olauloa which is an area that includes several communities we are a community that's quite close knit and also is a makeup of predominantly various Polynesian groups and also a lot of immigrant type of groups. We have Philippinos. We have Samoans. We have Chinese. We have Hawaiians. We have Japanese. So our group is predominantly made up in our community or in our local, as we call that, a lot of immigrant groups. And therein lies the cultural part, through our community of diverse Asian & Pacific Islanders communities these communities that would makeup our Ko'olauloa area.
Again, the distance of being able to get from one place to the other is a drawback and for a lot of times because of the makeup of the community and the makeup of types of families it's not easy to get to and from one area. And having to adjust your work schedules, and also our families are fairly large and it creates additional problems. So we are at somewhat of a disadvantage being out in the far reaches of the island.
Suzanne: Harry, what you were discussing really applies to a lot of rural environments, some with migrant, some with other kinds of immigrants. And we'd like to know, you were talking about specifically what some of the challenges were for you to access in Medical Home. Let's go back, Sharon, just, could you tell us what a medical home is and just link the concept of cultural and linguistic competence to it?
Sharon Taba: Sure. Medical Home actually found its way from the American Academy of Pediatrics. And the physicians are looking at Medical Home as a partnership approach. A partnership with families to be able to provide the best quality health care for their children and Medical Home implies care that is accessible, that is family centered, continuous, comprehensive, coordinated with other services, and, lastly, culturally effective. And culturally effective as it relates to cultural and linguistic competence means that the physician has the capacity, the knowledge to learn about customs and the other ethnic beliefs that families have. A monograph that we had developed talks about culture but also it goes beyond ethnicity. It goes on to socio-economic. It goes to faith, different diverse faiths. It also goes to diverse, you know, social groups. You know in terms of how physicians approach providing quality medical care.
Female Voice: Thank you, Sharon. And we know particularly in rural areas or areas that really have a shortage of pediatricians that some families look to other sources of primary health care other than pediatricians. Nurse practitioners, family practice docs, so that, you know, all providers of primary health care really relate this cultural and linguistic competence . . .
Sharon Taba: Absolutely.
NCCC: Principals to their practice.
Sharon Taba: Absolutely. And our Medical Home, Reaching the Next Level monograph, really looks at what this partnership is all about and extending into the community. If some partnership with the family extended to social workers, nurse practitioners, to the therapist, to the specialist, to the community leaders who support families in their communities. It is the handholding together in communities that we are talking about and what the Medical Home is doing in terms of reaching that next level. Partnerships to networks.
Suzanne: Thank you. And Harry from your perspective of parent with a child with special health care needs, how has your child's medical home supported you and your family and your cultural needs or values?
Harry Brown: I think, first of all, because we grow up in a particular type of culture here in Hawaii which is, very Hawaiian, a very Polynesian, they've been inbred with certain types of things & thinking pertaining to medical. A majority of that has to do with doing things in more of a natural way, herbal, or anything they can do aside from the so-called Western medicine. For the most part, that's how we grew up. But in our case, particularly now out here, we were able to partner up with Kahiau's pediatrician, Dr. Sutherland. And what's been advantageous in this particular situation is that Dr. Sutherland, with all of his knowledge as a professional and a doctor, was able to not only give us his perspective of things in the healing process or in the caring process of our son. But he also listened to us. Because we, we had very strong feelings that came from a cultural side. And we're very afraid of certain types of medical, you know, situations. But we work together. And Dr. Sutherland is very, very open to that.
We were looking for the best natural way to do things, while at the same time implementing, you know, some of the medical things that we are not familiar with that he has a lot of expertise in. So that part for us has been a partnership that has worked real well. And that's how he's been advantageous to us because he's helped Kahiau to be complete. I kind of look at this as, you know, if I want to eat a pie, the pie can be cut into pieces. And I'm going to have something that's going to be delicious, you know, a piece of the pie. But when you partner it's not just one piece, it's a complete whole.
At least I feel that. And my wife does. So we are very comfortable with Dr. Sutherland, the pediatrician for Kahiau and his ability to integrate our feelings, our beliefs, our cultural upbringing and mix it in with so-called quote, unquote, Western medicine.
Diana Denboba: And Harry could you just give us an example of, maybe a different spiritual perspective?
Harry Brown: Yes, I could. For instance, one of the things that Kahiau has to do with his nervous system. And although there are medications that when we took him in to the hospitals, they, some of the ways to try and solve that problem was to do some surgery, some major surgeries, many of them. And we were somewhat hesitant and afraid and somewhat against it because it was cutting up our son. So we talked to Dr. Sutherland and we told him, that's not what we want to do.
What we want to do is first, let's try our way and let's see if this would work and he was very open to it because we talked about doing the natural Lomi Lomi or the natural massage is what we call. And it's more than just a massage. But it's actually, people get trained in it (Lomi Lomi) here in Hawaii from a spiritual side. It is not just the physical part but it's the connection, between the patient and the persons that actually get involved in preparation before touching our son. And he was very supportive of that.
So we have been taking him because he has a curvature of the spine. We did not want to go in and cut and try to correct that. We wanted to see if we could help him from a natural way to correct that. And so far it has, it has done that with the Hawaiian practice of lomi lomi and the spiritual connection from the person that is doing it. It is not just somebody, anybody that can lay their hands on them, it's really an art and quite an involved process. And it's repetitive and it's ongoing and for a long period of time.
But I've seen, we have seen, the benefits of what's happened and yet we've been able to accomplish our goals while trying to help him. So, you know, it's worked. And so that's been a real positive for us in terms of that spiritual connection from a cultural side.
Suzanne: Thank you.
NCCC: Maybe we should go on now and speak with May, with Dr. Okihiro. Did you want to start?
Suzanne: Sure. Hello, again.
May Okihiro: Hello.
Female Voice: Could you tell us a little bit about the cultural and linguistic groups that you're serving in your medical home?
Ma Okihiro: Okay. I work at a health center in Waianae, Hawaii, which is on the west end of Oahu. It's also a rural community that our health clinic serves mostly a large group of native Hawaiians plus a mixture of Pacific Islanders, including Micronesians and Polynesians, Samoans and Philippinos.
Diana: Excuse me, so what sorts of challenges do you find trying to provide care in a medical home with such a diverse group of families?
May Okihiro: One I think is just the poverty. There's a lot of poverty with the patients we work with. That's one issue. The second is just, you know, lack of resources from the patients themselves. And then it is a, quite a diverse culture. We have new immigrants, kind of similar to what Harry's been talking about. But we also have a local population of native Hawaiians who, of course, have a little bit of a different culture.
Diana Denboba: Thank you. A key aspect of any medical home is connecting with other community-based resources. How do you use partnering and networking with other services to make the medical home culturally and linguistically competent or effective?
May Okihiro: Well, we are lucky in that our health center has been around for about 30 years now. And has been very attuned to the needs of the community and has established a group of community health workers that are part of our health center. And they go and visit the patients at their homes, especially patients who have complicated medical problems or who are having problems accessing the health care system. And working with those community health workers are social workers and some nurse practitioners.