The Colorado bill would fund health training to “culturally respond”

A bill awaiting the signing of Governor Jared Polis, which would fund training for Colorado health care providers to help them work better with diverse populations, is a good start, but it will not fix all the ways it excludes some people, advocates say.

HB22-1267, which cleared the legislature on the penultimate day of the session, would create a $ 900,000 grant program to train contractors to provide health care providers with a focus on how to respond culturally to “priority populations”. Polis has not said whether he will sign the bill.

The definition of priority populations is broad, including people of color; veterans; LGBTQ people; homeless people or people in criminal justice; People with HIV or AIDS; adults; “Children and families”; and people with disabilities.

Although the boards that oversee medical licensing would instruct providers to encourage them to complete their training, there is no penalty for non-sanctioned providers.

Interest in serving different patients seems to be growing, especially since the pandemic highlighted health inequalities, said Robert King, vice president of diversity, equity and inclusion at Colorado Access, which manages the care of some Medicaid members in Colorado and has bought some . to offer lessons from an outside vendor to suppliers.

Training biases, privileges, and how the system has failed or actively harmed people of color can affect whether or not they now trust medical providers.

“Training itself will not achieve sustainable results, but it is a necessary component,” King said.

In a survey conducted by the Pew Research Center in September 2020, about 76% of black respondents believed that they were less likely to be treated fairly in health care areas than whites. The majority of white respondents did not believe that blacks were more likely to be treated unfairly. The survey did not ask whether other groups had been treated unfairly.

Provider-patient interactions can be daunting, especially if there is a difference in culture or social class, said Robert Friedland, director of the Center on Aging Society at Georgetown University. Knowing that patients in other communities may have different ideas than doctors, for example, if a brain-dead person doesn’t have a heartbeat that should be considered dead, it can help create better conversations, he said.

“I think this is very much based on the topic of communication and understanding,” he said. Caring for the cultural response is a “package of tools and sensibilities”.

Typically, medical students are trained for a few days to communicate with different patient groups and can occasionally take ongoing training courses on the subject as a provider, Friedland said. Typically, the training focuses on people of different ethnicities or religions, although sometimes training is available for LGBTQ people and people with different disabilities, he said.

When patients trust doctors, they are more likely to follow medical advice, whether it is to get vaccinated or to take steps to manage their chronic conditions, King said. And it’s likely to be trusted by suppliers who understand where they’re coming from and are trying to meet their needs, he said.

“When you look at (COVID) vaccination rates … the key factor is trust,” Friedland said.

Having a better relationship with patients is only part of the solution, however, King said. Patients will not receive better care if the office is only open while they are working, is not accessible to people with disabilities, and does not provide support for navigating complex care systems for the elderly, he said.

“Training is about 20% of the equation,” he said. “If the system doesn’t change, if the structure doesn’t change … it will have a marginal effect.”

Cultural gaps in the spread of vaccines

Maria Gonzalez, CEO of Adalante Community Development, based in Commerce City, said the need for cultural capacity was clear during the pandemic.

Initial efforts by the state and local health departments to extract COVID-19 vaccines were not focused on the needs of the Latino community, and the request for identification at some sites raised suspicions among people who did not trust the government with health information or were concerned. about their immigration status, he said.

Some sites did not have bilingual staff to answer people’s questions, and it may be difficult to find Spanish versions of the forms filled out by vaccine recipients, Gonzalez said.

In the early months of the vaccine, the recipients were overly white Hispanic, although the gap has narrowed somewhat since the state took over clinics in low-care areas. Colored people were unlikely to catch COVID-19 and die nationwide, although it is difficult to know how far Colorado saw the same pattern, in so many cases lacking data on race and ethnicity.

“There have been so many obstacles,” he said.

Practical considerations, such as whether a medical site is accessible, convenient to schedule, and providing interpretive services at all points of interaction, can be as important for cultural competence as having well-trained staff, according to Georgetown University Institute of Health Policy guidelines. It can work with people who know a community well, such as staff who share the patient’s background, community health workers, or traditional healers (whenever possible without compromising care).

Adalante is not usually involved in health issues, focusing on economic development and helping Latino business owners. But staff are part of the community and they knew how to talk to people about their concerns, Gonzalez said, and estimated that they facilitated about 15,000 shots through a partnership with Colorado Access that provided staff and funding.

They also knew that putting them in the weekly Mile High Flea Market and in the apartment and mobile home complexes meant they weren’t against getting vaccinated but could bring in people who couldn’t easily get shot, he said.

“We didn’t have to beg,” he said.

Patients who feel supported seek more care

Although they appear most often in discussions about racial and language cultural competence, some of the biggest sponsors of the training funding bill are organizations that represent the LGBTQ community.

In a 2018 survey conducted by One Colorado, one-third of people identified as LGBTQ said they did not have adequate access to health care providers who understood their needs, and 36% said they did not have access to their gender identity or gender. guidance because they were concerned about discrimination in the provider’s office.

Leave a Comment