Cultural Competence Through Awareness,Understanding and Experience:

Experiential Learning Aboard

The Family Van

Nancy E. Oriol, MDPresident & Founder

Toni K. WilliamsDirector of Service

What is The Family Van?

The Family Van is a mobile preventive health and social service program designed to increase access to health care and healthy life behaviors for men, women and children living in Boston’s economically disadvantaged neighborhoods.

Our Mission

To educate, counsel, screen and assist community members to take the necessary action to strengthen and protect their bodies, minds, families and communities.

Our Clients

The Family Van serves urban Boston. Its target populations are those who are underserved and living in poverty with less than adequate social supports.

Over 98% are people of color.For 33% English is a second language.

Our Clients

We serve all ages13% are children and youth61% are adults26% are elderly

Note: children and youth: ages 0-23; adults: ages 24-64; elders: age 65 and older

Our Collaborators

We have built a broad network of partners. Over100 Community Based Organizations and State and city sponsored programs including:

The Massachusetts Department of Public HealthCommunity Health CentersMedical and other health professions schools

including teaching hospitalsMassachusetts General HospitalBeth Israel Deaconess Medical Center

Service Provision

We provide cost effective medical screenings and health education including:Pregnancy and HIV/AIDS testingHypertension and cholesterol testingDiabetes, Glaucoma screening and much much moreWe do not duplicate services but rather facilitate the

clients’ navigation and use of these resources in order to ensure efficient and coordinated care

Education and Referrals

Nutrition educationDisease prevention educationCancer self-screening educationCounseling and Support Health and social service referralsReferral to Mass CHIP children’s health insurance

and other state sponsored insurance programsCare coordination and advocacy

The Family Van Services

FreeConfidentialCulturally Reinforcing

Cultural Competence in Health Care Delivery

The Office of Minority Heath defines Cultural Competence as the set of behaviors, attitudes, and policies that allows people and groups to work effectively in cross-cultural situations.

Source: US Department of Health and Human Services Offices of Minority Health (2001). National Standards for Culturally and Linguistically Appropriate Services in Health Care: Final Report, March 2001, Washington, D.C.

What is Culture?

Culture:The system of shared beliefs, values, and behaviors that members of a society use to cope with and make sense of their world and these customs are passed from generation to generation.

Office of Minority Heath, Class Standards onCulturally Competent Care, Standards 1-3

Standard 1: Health care organizations should ensure that care is understandable, and provided in a respectful manner compatible with their cultural health beliefs, practices and preferred language.

Standard 2: Health care organizations should implement strategies to recruit, retain, and promote a diverse staff that are representative of the demographic characteristics of the service area.

Standard 3: Health care organizations should ensure that all staff should receive ongoing education and training in culturally and linguistically appropriate service delivery.

Why Cultural Competence ?

The perception of illness and disease, healing and wellness, varies by culture.

Culture and personal experiences of bias influence help-seeking behaviors.

Care providers from these diverse cultures are underrepresented in our current system.

Source: Rationale for Cultural Competence in Primary Health Care, Developed by E. Cohen and T. Goode, National Center for Cultural Competence, Winter 1999

Teaching Cultural Competence on the Family Van

Each year 40-60 students join us curbside from many disciplines:

Medicine and Nursing Public Health and Public Policy Nutrition sciences Social work and more

Family Van Experiential Learning Goals & Activities

Students are lead in guided study The Family Van service team and faculty present

didactic sessions on health disparities.

Students learn about local resourcesStudents visit community-based agencies that serve as

the primary resources for van clients.

Exposure to target communitiesStudents tour the selected neighborhoods with the

specific task of learning, from the residents, their health concerns

Family Van Experiential Learning

The Goal of Direct Service is:

To learn to respond effectively to the health care needs of anyone who boards the van.

Every encounter is a cross-cultural encounter!

The Family Van Model:how it facilitates cultural exchange

We employ a multi-cultural, multi-disciplinary team.

We listen loudly to our clients and allow them to tell the entire story.

We allow the client to control the encounter.

LEARN – Guidelines for Health Practitioners

Listen with sympathy and understanding to the patient’s perception of the problem

E. Explain your perceptions of the problem

A. Acknowledge and discuss the similarities and differences.

R. Recommend treatment

N. Negotiate agreement

Source: Berlin EA. & Fowkes WC, Jr. “ A Teaching Framework for Cross Cultural Health Care” Western Journal of Medicine 1983, 12: 139, 93-98

Liaison Committee onMedical Education

LCME Educational Directives 2002ED-21 Faculty and students must demonstrate an

understanding of how people of diverse cultures perceive and respond to health, illness, symptoms and treatments.

ED-22 Students must learn to recognize and address biases in themselves, others, and the health care institutions

Why does The Family Van model optimize cultural awareness?

We are designed by the people we serve This non-traditional approach has the flexibility to

respond organically to changing needs. Our service team is familiar with our clients’

viewpoints, resources and their understanding, or lack thereof, of how best to utilize “helping” systems.

We share control of the health care interaction with our client, promoting self-advocacy.

Future Enhancements

We have already developed formal educational programs for allied health professionals and medical residents.

We are being built into the experiential arm of HMS’ Cultural Competence Curriculum

We are developing a formal clinical clerkship for medical students

And, as always, our students are taking it even further.

Student Sight Savers-

Glaucoma Screening & Education

Glaucoma is the leading cause of irreversible blindness among African Americans.

African Americans have 4-5X higher rates than Whites.

African Americans develop the disease earlier.

1 million or > unaware that they have the disease.