Diversity Advisory Council for Health Equity

State: MO Type: Promising Practice Year: 2016

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The Diversity Advisory Council on Health Equity was created with the purpose of providing a forum to diverse communities in the Clay County and the Kansas City metro area, where their voices and needs can be heard in a non-judgmental way on health care issues, more specifically on access to care. To better serve all community members, sharing of experiences, issues, and proposed solutions, needs to occur. Through the Diversity Advisory Council on Health Equity, Clay County Public Health Center and the local public health system (LPHS) are actively learning how to engage and support diverse communities in improving access to care issues and health equity.

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Clay County Public Health Center
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Diversity Advisory Council for Health Equity
The health department is located in Liberty, Missouri and serving around 225,000 people that live in Clay County, which consists of urban, suburban, and rural communities. Health inequities are becoming more apparent as access to accurate and timely data of populations becomes available. These inequities are often present among minority, disabled, or hard to reach populations. In order to serve our communities, it is crucial that public health understands and implements a focus on equitable health for all. To do so requires health departments to understand the diverse communities in the population they serve, the existing inequities, and targeted community outreach and inclusion. Therefore, Clay County Public Health Center created the Diversity Advisory Council for Health Equity. In the year since the Diversity Advisory Council for Health Equity was formed, the group completed several processes to create a mission and vision, as well as goals and objectives. The mission of the Diversity Advisory Council for Health Equity is to facilitate the access to equitable health and to provide culturally competent tools and information to members of the local public health system, so that all residents feel safe and have access to health where they work, play, live, and worship. The vision is Healthy people in ALL communities. Using the mission and vision, the Diversity Advisory Council for Health Equity has two goals; one is to reach out to diverse communities and use their expertise in helping Clay County Public Health Center, and other public health agencies, in their public health emergency, cultural competency, and workforce development plans. The second is to share the information learned from the council membership with the local public health system to improve health for all communities. The specific objectives in 2015 are:• Complete one tabletop exercise to better prepare our emergency operations plans to serve access and functional needs populations. • Bring together members from diverse communities and public health to initiate a dialogue on issues/barriers impacting health and health outcomes The council was formed in October 2014 and meetings have continued monthly since then. Emails, phone calls, and personal visits are used to reach out to the diverse populations that exist in the community. They are asked to join the council as well as be a guest speaker to share their experience with health and access to health in their community, specifically addressing any barriers or challenges to accessing health. The objectives for the Diversity Advisory Council for Health Equity have been ongoing for the first year of its existence. Due to its growing membership, fluid and ongoing objectives allow for flexibility when working with the community. The first successful outcome was the development of a mission and vision statement. The main objective in year one was to learn from diverse communities on how to advocate for health equity. The group has learned about barriers for accessing care from over a dozen communities and this information has been shared via social media, meeting minutes, Clay County’s Community Health Assessment, Clay County Epidemiology Bulletin, and a Diversity Advisory Council Report. The second main objective was to learn from diverse communities to inform emergency plans. The group completed a tabletop exercise in 2015 to discuss communication with access and functional needs populations. From this council, the local public health system has learned numerous barriers to care from a variety of groups. This group has been successful for several reasons. First, it is a safe and open place for community members to share their experiences. Second, it directly asks a community what issues they face and a place for the community members themselves to provide solutions. Lastly, there are diverse representation from the community but also within the system, utilizing groups such as Parks and Recreation, Federally Qualified Health Centers, city council members, area hospitals, and many others. This council provides the local public health system specific ways to reduces health inequities in the community. Some solutions are “low-hanging fruit” and allow organizations to take immediate action while others require the group strategically work together to address changes. Both will have an impact on the diverse populations in the community and build lasting partnerships between diverse communities and the local public health system.
Health inequities exist in communities all across the United States. Clay County is no different. Clay County Public Health Center’s Data sets show inequities exist in the community, particularly as it relates to access to care. We know many of our vulnerable populations have less access to care, poorer health outcomes, and a shorter life expectancy. To truly understand how this issue will continue to be prominent in the future, it is important to understand what diverse groups exist and continue to grow in our community so we can be more aware in addressing their needs. As our diverse population is projected to only grow in the future, it is important to increase our agency’s cultural competency. To do this, Clay County Public Health Center created the Diversity Advisory Council for Health Equity. This council allows our organization to fully understand the needs of the community by listening to them directly and making them partners in the process. From there, we can work together to create both dialogue and action to make the local public health system more equitable for all. The targeted population in Clay County is any community or group of people who face an increased burden of health inequities due to factors such as but not limited to race, religion, cultural or language identifiers, gender identity, sexual orientation, or disability. The county has increased in diversity from 7.5% non-whites in the 2000 U.S. Census to 13.3% in 2014. Another 11% experience disability and 14.1% of the population in Clay County experience language isolation. But many continue to be invisible in their community and there is little data to show the diversity of the community unrelated to race and ethnicity. For the Diversity Advisory Council for Health Equity, this meant reaching out to and inviting as many groups as possible that make up the diverse communities or the local public health system. From this council, we have expanded our definition of Diversity to include groups such as LGBT, foster children, immigrants and refugees, or homeless. This has given us a better understanding of the issues faced by our community members. Very little data currently exists for the diverse populations of Clay County. The non-white population in Clay County is at 13.3%, 11% of the population experiences a disability, and 14.1% experience language isolation. However, there are many more groups we do not have data for that are included in our definition of diversity , In the first year, it has been the goal of the Diversity Advisory Council to understand existing health inequities from a big-picture perspective. Future years will dig into data collection of population size and health inequity metrics. With a lack of metrics determining diverse community population size beyond race/ethnicity, disability, and language, Clay County Public Health Center used number of organizations/communities participating to determine the possible depths of our reach. In the first 13 months of establishing the Diversity Advisory Council for Health Equity, the council has grown to include 38 different organizations or communities. New members are consistently joining each month and include a wide range sectors. We have also listened to around 10 communities so far on the health inequities they face in Clay County and the Kansas City region. In the past, Clay County Public Health Center has done very little to address the health inequities in our community, specifically as it relates to cultural competency. Previous cultural competency initiatives include such projects as a language line, translated materials, and hosting a Posada, a cultural event for Hispanic members of our community. While these are beneficial to our community, they do not bring true cultural competency to our organization, or address the current inequities that exist. They also are activities done for the community instead of with the community. This makes a huge difference to our community members who are seeking to be understood and provided the needed resources. The Diversity Advisory Council for Health Equity was established as an effort to increase our organizations cultural competency and reduce health inequities within the local public health system. The Diversity Advisory Council for Health Equity is more successful at addressing the needs of diverse populations because it involves the community. Instead of directing the community on systems’ change, the community is telling the local public health system what problems exist and how to address them. This creates trust, community buy-in, and long-lasting partnerships that will bring about change for years to come. Each meeting is a time in which community members can feel comfortable discussing barriers to care and lack of resources in a non-judgmental forum. The meetings also host many partners in the local public health system, so they too can hear the issues for themselves and address these changes within their own organization. This practice is combining current practices of cultural competency and participatory research to create direct partnerships between communities and the local public health system. It is bringing together a wide range of partners to address access to health and emergency preparedness. It is innovative in the way it builds direct trust and relationships. Solutions are also more innovate because they come directly from the community, increase collaboration among the system, and create buy-in to the process early on. This also gives community members a platform to share their experiences and allows others to engage with their experiences, sharing how it is similar or different. This also creates dialogue for the local public health system to address barriers to care and break down silos among partners. We have been using a participatory model or participatory research (a collaborative process in which the partners work together to create interventions that facilitate individual and cultural change), building community empowerment through the process. While this model is often used for stakeholder engagement, Clay County Public Health Center has broadened that scope to include all in the community. This means that when addressing changes to the local public health system, members who receive services from that system are engaged from the very beginning of the process. The Mobilizing for Action through Partnership and Planning (MAPP) process was also used for Clay County Public Health Center’s Community Health Assessment. As part of this process and the assessment, Clay County Public Health Center created the Diversity Advisory Council for Health Equity to assess barriers to care and gather community input. There are four assessments in phase 3 of MAPP. The Diversity Advisory Council for Health Equity was used in several of these assessments to gather input, spread our reach, and discuss assessment outcomes. This allowed us to verify our data collection process included vulnerable and hard to reach populations and truly reflected the views of our community. Both of these processes are evidence-based models and have given Clay County Public Health Center a sound platform to begin our practice. Participatory research has been used in several interventions recommended by the Centers for Disease Control and Prevention, including Chronic Disease and Occupational hazards. The MAPP process, created by the National Association of County and City Health Officials (NACCHO), is recommended as an evidence-based process when completing a Community Health Assessment. 
The Diversity Advisory Council for Health Equity was created using a participatory and community empowerment model with two goals in mind. The first goal was to increase the cultural competency of the local public health system in Clay County and the Kansas City region. The Diversity Advisory Council for Health Equity worked hard for several meetings to create a vision and mission statement with the help of partners and the community. The mission and vision are as follows: The Mission of the Diversity Advisory Council for Health Equity is to facilitate access to equitable health and to provide culturally competent tools and information to members of the local public health system, so that all residents feel safe and have access to health where they work, play, live and worship. Our Vision is Healthy People in ALL Communities! Our objective to complete this was to bring together members from diverse communities and public health to initiate a dialogue on issues/barriers impacting health and health outcomes. This has allowed us to understand the barriers diverse communities face when accessing health and health care and use this information in the Community Health Assessment, looking for common themes of health inequities of diverse communities if possible. Information learned from each meeting is disseminated via several forms through partners in the local public health system. The second goal is to work with diverse communities through the Diversity Advisory Council for Health Equity to inform local health departments’ emergency preparedness plans. The objective to achieve this goal was to complete one tabletop exercise to better prepare our emergency operations plans to serve access and functional needs populations. For the first goal, Clay County Public Health Center reached out to many diverse partners within the local public health system and the general community. This was done via phone calls, one –on-one visits, and emails to partners, community members, and anyone stakeholders recommended. Our first meeting, held October 1, 2014 was used to discuss what diverse groups exist in our communities and their view of public health. As monthly meetings continued, it was the goal of the Diversity Advisory Council for Health Equity to develop a mission and vision. This took many meetings relying on stakeholder engagement to be reflective and inclusive of all. As the group began to form and understand its direction, the main goal was to create a dialogue around the issues and barriers faced in our communities related to access to care. To do this, we invited speakers to share their experiences and the experiences of their community. We provided guidelines so that all speakers would have a focus for their presentation, but also remain flexible to the ideas and thoughts they wanted to share. Those guidelines included a “description of the community you are a part of or serve”, “health inequities faced by your community”, and “what the Diversity Advisory Council for Health Equity or others can do to help reduce disparities.” This provided us with some solutions to access to care barriers from the communities themselves. Those barriers, solutions, or general themes are then disseminated to other community partners or those interested in changing their culturally competent practices. Dissemination happens via social media, newsletters, and emails to various partners. As a second goal, Clay County Public Health Center organized a public health emergency tabletop exercise. This exercise was used to invite diverse partners and community members including the local public health system to gain their insights on how to better work with and serve access and functional needs populations. We tested our current public health emergency preparedness plans specifically Annex C and P by utilizing a novel influenza scenario. Local community members and members of the local public health system were intermixed at tables with local emergency responders to give us a wide range of answers to our scenario injects. Questions tested participants’ knowledge of public health response to emergencies as well as how it is best to reach their communities in emergencies. We used archived press releases from the 2009 Pandemic Influenza to obtain feedback on the communication approach used in the past when reaching out to diverse communities. This will give us recommendations on format, language, and how to share information in press releases for future outbreaks. This is open to anyone who is part of a diverse community, beyond race and ethnicity, and those who work with diverse communities. It has been very important to Clay County Public Health Center that anyone who attends the Diversity Advisory Council for Health Equity meetings understand that this is a non-judgmental forum for the community to express the barriers they have faced. It is common for the local public health system’s reaction to be defensive when someone mentions a resource that is unavailable to them or a time when an organization treated them unfairly. But, it is our goal to allow community members to share their experiences so we only change presentations or information when it is factually inaccurate. This is an ongoing practice for Clay County Public Health Center. The initial year required a vision and mission to be completed as well as a public health tabletop exercise. While Clay County Public Health Center has been the leader for the first year, it is a goal to transfer leadership roles to the community. Current goals and objectives are planned yearly with community input, with strategic planning to be completed in early 2016. There have been many stakeholders involved in the development and growth of the Diversity Advisory Council for Health Equity. From the beginning, there has been wide representation both from the community and the local public health system. At this time, we have had representation from schools, parks and recreation, city council members, social service agencies, hospitals, federally qualified health centers, public health agencies, community centers, and universities along with many diverse general community members. It has been the key factor in this council that all are welcome and encouraged to attend and share their expertise/experiences in a non-judgmental forum. We have used the diverse representation of partnerships to spread our reach even further and allow partners to invite guest speakers for future meetings. All attendees have also had ample opportunity to provide input on the mission and vision as well as goals for the Diversity Advisory Council. As of this application, 38 organizations have participated in the Diversity Advisory Council for Health Equity and new members are joining each month. This council continues to successfully promote these meetings via word of mouth. There have been little costs associated with the development of the Diversity Advisory Council. Time spent at community spaces for meetings have been donated to the Diversity Advisory Council. Clay County Public Health Center has spent money on breakfast or other food cost at several meetings. A Community Development Specialist has been devoted to working on this .025FTE. An estimated 0.25FTE has been applied from three other Community Development Specialist and 0.1FTE from a Volunteer Specialist. Clay County Public Health Center has allowed any staff interested in participating to attend the meetings.
One of the objectives was the have diverse communities members provide presentations to the Diversity Advisory Council on Health Equity on the barriers they face to accessing health and the resulting health inequities. As of November 2015, the Diversity Advisory Council for Health Equity has heard presentation from 5 different communities (Native American, Visually Impaired, Same-sex partner with children, Foster parents, Domestic Violence interpreter), and received input on health inequities from many more. It was also an objective to complete a tabletop exercise for public health emergencies to improve our emergency operation plans for access and functional needs populations. This was completed in November 2015 with 42 people attending. An After Action Report will lead to a complete review and rewrite of the Emergency Response Communications Annex. Since its inception, the Diversity Advisory Council for Health Equity consists of 38 organizations or community members and continues to grow with each meeting. One objective has been to bring together diverse members of communities and public health to initiate a dialogue on issues/barriers impacting health and health outcomes. In a survey conducted 9 months after the initial Diversity Advisory Council for Health Equity meeting, over 75% of respondents said the meetings have accomplished this purpose. As of November 2015 there have been 38 organizations participating in the Diversity Advisory Council for Health Equity and we’ve had presentations from 5 different speakers. The council has also developed surveys to verify the goals and objectives are clear and the meeting dates, times, and locations are adequate. The Diversity Advisory Council for Health Equity listened closely at each meeting and during outside conversations to identify common themes among various diverse groups. Some of the common themes identified through meetings are inadequacy of medical forms to address patients’ needs, lack of access to healthcare services, lack of resources for community, and to “just ask” when you are unsure of how you can help. For example, medical forms are an issue for several communities such as LGBTQ+ parents (who need more options than “Mother, Father”) or visually impaired (whose computer software need properly formatted forms to read). Transportation is a major issue among diverse communities as we learned from groups such as Somali (who often have one car per household and used by males) or those with disability (who have to schedule transportation sometimes 48 hours in advance. Lack of resources is a huge issues for almost all of our diverse communities. While not everyone in these diverse communities face these issues, it is important to understand those who do and how we can work together as a system to address them. Focusing on process outcomes in year one gave us many opportunities to be more inclusive of community participation. Clay County Public Health Center sends out a survey to members of the Diversity Advisory Council for Health Equity once every 4-6 months to ask questions about meetings and future directions. It was clear from surveys that consistent meeting dates and times are key. We also found out that proximity to public transportation was very important to attendees and all meeting locations now require us to be within a half a mile of public transportation. Clay County Public Health Center has also included findings into its communication plan by having a website that is ADA compliant and selected the languages identified in Clay Count for inclusion in its translation services.  
One of the biggest lessons learned from the Diversity Advisory Council for Health Equity is that words matter. Creating buy-in from the community required engagement at all levels of the vision and mission process. When developing the vision and mission, it was asked of the community what words are critical to reducing health equities. The inclusion of words such as “safe” and “access to health” were non-negotiable in the eyes of the community in order to have equitable health. This also meant careful inclusion of words in all agendas and meeting materials, as well as Emergency Operation Plans. The system also learned that it is okay to just ask diverse communities as an important first step to address many of the issues affecting their community. In the first year of development, the Diversity Advisory Council has learned to be flexible and fluid in work related to growing the membership, but also be clear and concise about purpose and goals of the council. It is also especially important to find a process that allows everyone to lend their voice to the group and contribute to goals. Accepting that Clay County Public Health Center, as part of the local public health system, does not have the right answers to the diverse needs has been an important first step. Broadening diversity beyond race and ethnicity has been key for success, as well as highlighting how each individual is part of a more diverse and inclusive community. This also means that when it comes to partner collaboration, the needs of the community come first. It has been difficult for some members to sit back and listen when they feel they have a “quick fix” to a community problem. But the important thing for members of the Diversity Advisory Council for Health Equity is that community members have a chance to tell their whole story or experience and the potential solutions before partners from the system jump in to the conversation. It has also been clear to engage as many staff from our own organization in planning and meeting to make this effort successful. There are about 4 staff who regularly plan meetings and events and an additional 6-8 who attend meetings on occasion. As our staff continues to be involved, we have also learned that it is important to include partners in the meeting planning or strategic planning process. This has resulted in transitioning leadership roles to the community for 2016 which will create more community ownership and buy-in, ultimately growing the Diversity Advisory Council for Health Equity. In surveys conducted by the Diversity Advisory Council of its members, many stakeholders said they agreed that participating in the council was a good use of their time and the work of this council is important. Moving forward, this council will transfer some leadership roles from Clay County Public Health Center to community members or community organizations. This will allow for more community ownership, increased trust, and more resources to implement activities developed by the council. There will be two community co-chairs who will be mentored or supported by Clay County Public Health Center staff in the initial year.
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