E-Health Technologies to E-Health Technologies to Address Underserved Address Underserved

Populations: A Training ProgramPopulations: A Training Program

Silvia Martinez, Ed. D., Howard UniversitySilvia Martinez, Ed. D., Howard UniversityKevin Lyons, Ph. D., Thomas Jefferson UniversityKevin Lyons, Ph. D., Thomas Jefferson University

Margaret Vescovich, MS, Holy Redeemer Home Care and Hospice Margaret Vescovich, MS, Holy Redeemer Home Care and Hospice Services Services

ASHA ConventionASHA Convention

eHEalth Summer InstituteeHEalth Summer Institute

Allied Health Center for Excellence in Allied Health Center for Excellence in eHealth Promotion Programs for eHealth Promotion Programs for Underserved Populations (Allied Health Underserved Populations (Allied Health CEEPs-UP)CEEPs-UP)

Center For ExcellenceCenter For ExcellenceIN eHEALTH PROMOTION: ALLIED HEALTH IN eHEALTH PROMOTION: ALLIED HEALTH

CEEPs UPCEEPs UP

Period of time: 2003-2006Period of time: 2003-2006

Disciplines involved:Disciplines involved:Occupational TherapyOccupational Therapy

Physical TherapyPhysical Therapy

Speech Language HearingSpeech Language Hearing

Allied Health CEEPs – UPAllied Health CEEPs – UPGoalGoal

To develop a center for excellence in eHealth To develop a center for excellence in eHealth promotionpromotion

PartnersPartners– Center for Collaborative Research Center for Collaborative Research – Journey HomeJourney Home– American Speech-Language Hearing AssociationAmerican Speech-Language Hearing Association– Occupational TherapyOccupational Therapy– Physical TherapyPhysical Therapy

Allied Health CEEPs – UPAllied Health CEEPs – UPObjectivesObjectives

Conduct a yearly summer institute designed to Conduct a yearly summer institute designed to teach allied health professionals how to teach allied health professionals how to develop eHealth programs tailored specifically develop eHealth programs tailored specifically to underserved populationsto underserved populations

Train 60 allied health professionals how to Train 60 allied health professionals how to develop eHealth websitesdevelop eHealth websites

Allied Health CEEPs – UPAllied Health CEEPs – UP

Teams of three individuals working in either Teams of three individuals working in either urban, rural or Native American underserved urban, rural or Native American underserved communitiescommunities

Combination of faculty and cliniciansCombination of faculty and clinicians

Preference to interdisciplinary teamsPreference to interdisciplinary teams

Summer Institute: OverviewSummer Institute: Overview

Week long, hands-on experience designed to provide the Week long, hands-on experience designed to provide the knowledge and skill to develop a web-based eHealth knowledge and skill to develop a web-based eHealth Promotion ProgramPromotion Program

Designed for interdisciplinary teams of clinicians and facultyDesigned for interdisciplinary teams of clinicians and faculty

Teams bring plan for a program and refine and revise the plan Teams bring plan for a program and refine and revise the plan during the week so that they will have the first phase of the during the week so that they will have the first phase of the website designed to address a significant health problem in an website designed to address a significant health problem in an underserved community and a plan for its implementationunderserved community and a plan for its implementation

Summer Institute: ComponentsSummer Institute: Components

Tailoring health information to a communityTailoring health information to a community

Establishing an infrastructure in an underserved Establishing an infrastructure in an underserved communitycommunity

Addressing issues of computer and health literacyAddressing issues of computer and health literacy

Developing a website using a template and a website Developing a website using a template and a website programprogram

Summer Institute: ComponentsSummer Institute: Components

Evaluating other health related internet websites as appropriate Evaluating other health related internet websites as appropriate links.links.

Conducting needs assessmentsConducting needs assessments

Developing a plan to evaluate the effectiveness of the eHealth Developing a plan to evaluate the effectiveness of the eHealth ProgramProgram

Understand the barriers to implementationUnderstand the barriers to implementation

ProjectsProjects

Creighton University-Omaha, NBCreighton University-Omaha, NB

– Omaha and Winnebago Ho-Chunk Indian TribesOmaha and Winnebago Ho-Chunk Indian Tribes– Interface with Tribal Community Health Education Interface with Tribal Community Health Education

Office and Diabetes ProgramOffice and Diabetes Program– Train community members to bring health Train community members to bring health

information to the communityinformation to the community– Training in computer and internet usage to Training in computer and internet usage to

increase access to allied health resourcesincrease access to allied health resources

ProjectsProjects

Springfield Technical Community College, Springfield Technical Community College, Springfield, MASpringfield, MA

– Develop “Healthline,” a user friendly health Develop “Healthline,” a user friendly health information website for underserved residents;information website for underserved residents;

Black, non Hispanic (21%)Black, non Hispanic (21%)Hispanic (27%)Hispanic (27%)Asian (4%)Asian (4%)Caucasian (48%)Caucasian (48%)

ProjectsProjects

Holy Redeemer Home Care, Philadelphia, Holy Redeemer Home Care, Philadelphia, PAPA

– Community outreach using the internetCommunity outreach using the internet

– Website for the care of the frail elderlyWebsite for the care of the frail elderlyResearch on four syndromesResearch on four syndromesTreatment protocols from Holy RedeemerTreatment protocols from Holy RedeemerTrue stories of those helped by the programTrue stories of those helped by the program

ConclusionsConclusions

If interested, go to the Center for Collaborative If interested, go to the Center for Collaborative Research website, Research website, www.jefferson.edu/ccrgrantswww.jefferson.edu/ccrgrants

Talking Fotonovelas for Talking Fotonovelas for Low-Literacy Hispanics Low-Literacy Hispanics and African Americans and African Americans

Silvia Martinez, Ed. D., CCC-SSilvia Martinez, Ed. D., CCC-S

Howard UniversityHoward University

SupportSupport

American Speech-Language-Hearing American Speech-Language-Hearing Association (ASHA)Association (ASHA)

Multicultural Grants Project Multicultural Grants Project

CollaboratorsCollaborators

Janice Trent, M. Ed. CCC-A – Howard Janice Trent, M. Ed. CCC-A – Howard University Speech and Hearing ClinicUniversity Speech and Hearing Clinic

Margarita Bautista-Vigas, M. A. CCC-S, Margarita Bautista-Vigas, M. A. CCC-S, Scottish Rite Center for Childhood Language Scottish Rite Center for Childhood Language Disorder Disorder

AssistantsAssistants

Tara Smith, CCC-S, Doctoral Student, Howard Tara Smith, CCC-S, Doctoral Student, Howard UniversityUniversity

Martine Ellis, CCC-S, Doctoral Student, Martine Ellis, CCC-S, Doctoral Student, Howard UniversityHoward University

Johanna Losi, Master Student, Howard Johanna Losi, Master Student, Howard UniversityUniversity

The IssuesThe Issues

One of the leading health indicators isOne of the leading health indicators is Access Access to Health Careto Health Care (Healthy People 2000-2010) (Healthy People 2000-2010)

For minorities, financial, structural and For minorities, financial, structural and personal barriers prevent access to health. personal barriers prevent access to health.

BarriersBarriers

Structural- A structural barrier includes the Structural- A structural barrier includes the lack of service providers to meet the needs of lack of service providers to meet the needs of clients. clients.

Personal - Includes language barriers and lack Personal - Includes language barriers and lack of knowledge about health procedures. of knowledge about health procedures.

Literacy IssuesLiteracy Issues

The Center for Health Care Strategies has The Center for Health Care Strategies has estimated that minorities and immigrants (50% estimated that minorities and immigrants (50% Hispanics and 40% Blacks) have Hispanics and 40% Blacks) have disproportionate literacy problems, which disproportionate literacy problems, which increase their health risks.increase their health risks.

In Washington, D. C., adult education levels in In Washington, D. C., adult education levels in the site communities are the second lowest the site communities are the second lowest with only 68.4% report having a High School with only 68.4% report having a High School education.education.

Literacy IssuesLiteracy Issues

As reported by the National Library of As reported by the National Library of Medicine (NLM), this study states that “one-Medicine (NLM), this study states that “one-third of English-speaking patients at two third of English-speaking patients at two public hospitals were unable to read basic public hospitals were unable to read basic health materials.” health materials.”

NLM also reports a Medicare finding that NLM also reports a Medicare finding that “34% of the English speaking and 54% of the “34% of the English speaking and 54% of the Spanish speaking patients had inadequate or Spanish speaking patients had inadequate or marginal health literacy” marginal health literacy”

Literacy IssuesLiteracy Issues

The Institute for Healthcare Advancement The Institute for Healthcare Advancement summarized from research that written health summarized from research that written health materials materials – usually appear at the 10th grade level or higher usually appear at the 10th grade level or higher

(above average abilities), (above average abilities), – that they include too much information and no that they include too much information and no

explanation of uncommon words, explanation of uncommon words, – and that treatments are accompanied by complex and that treatments are accompanied by complex

instructions instructions

Broad ObjectivesBroad Objectives

Increase the knowledge of African Americans and Increase the knowledge of African Americans and Hispanic populations about speech and language Hispanic populations about speech and language pathology, and audiology issues and services.pathology, and audiology issues and services.

Meet the needs of health providers by developing Meet the needs of health providers by developing materials to complement and enhance their services.materials to complement and enhance their services.

Carry out research activities to probe the Carry out research activities to probe the effectiveness of e-health web-based materials with effectiveness of e-health web-based materials with low literacy and limited English proficient clients. low literacy and limited English proficient clients.

Specific AimsSpecific Aims

To describe health literacy growth in low-To describe health literacy growth in low-literacy clients after using web-based materials literacy clients after using web-based materials developed. developed.

To describe health literacy retention in low-To describe health literacy retention in low-literacy clients after using web-based materials literacy clients after using web-based materials developed.developed.

Fotonovelas Fotonovelas

FotonovelasFotonovelas are similar to comic books, are similar to comic books, contain photographs and simple dialogue contain photographs and simple dialogue bubbles, which address the needs of cultures bubbles, which address the needs of cultures with low literacy rates and oral traditions. with low literacy rates and oral traditions.

Internationally and historically have been Internationally and historically have been effective as educational methods in the areas effective as educational methods in the areas of education, health, and citizenship. They of education, health, and citizenship. They also have been used for entertainment.also have been used for entertainment.

An ExampleAn Example

How to Read a BookHow to Read a Book

Come on honey, let’s read.

Isn’t he too little to read?

You can read to all children, even babies.

Oh, but I don’t read too well.

You don’t need to know how to read.You can use the pictures.

I’ll show you.Come here Michael and Davonte.

I can use the pictures to tell a story from my head.

Next StepsNext Steps

Holy Redeemer Home Holy Redeemer Home CareCare

-Founded in 1928 as a Catholic Health System-Founded in 1928 as a Catholic Health System

-Missions Statement-Missions Statement

-Located in Greater Philadelphia Area-Located in Greater Philadelphia Area

-Services provided-Services provided

JCAHO Disease Specific Certification JCAHO Disease Specific Certification in the care of the Frail Elderly in the care of the Frail Elderly

Holy Redeemer Home Care is first in the Holy Redeemer Home Care is first in the nation to be granted this distinction as of nation to be granted this distinction as of September, 2003.September, 2003.

Who are the Frail Elderly?Who are the Frail Elderly?

Recertification processRecertification process

Why Tailor Specific Care To Specific Why Tailor Specific Care To Specific Populations???Populations???

Commitment to care that is patient-centered.Commitment to care that is patient-centered.

Get beyond “generic” home care.Get beyond “generic” home care.

Quality of care should look different with Quality of care should look different with

different disorders.different disorders.

Model for chronic careModel for chronic care

Four Common Geriatric SyndromesFour Common Geriatric Syndromes

Often seen in combinationOften seen in combination Make living independently difficult, often Make living independently difficult, often

requiring more restrictive placementrequiring more restrictive placement Commonly affect the Frail Elderly:Commonly affect the Frail Elderly: 1. Depression1. Depression 2. Dementia2. Dementia 3. Falls Risk3. Falls Risk 4. Urinary Incontinence4. Urinary Incontinence

Four Common Geriatric SyndromesFour Common Geriatric Syndromes

DEPRESSIONDEPRESSION -affects about 6 million-affects about 6 million Americans over age 65Americans over age 65 -frequently co-exists -frequently co-exists

with other medical with other medical conditionsconditions

-only 10% of older -only 10% of older Americans receive Americans receive treatmenttreatment

DEMENTIADEMENTIA -affects about 45% of -affects about 45% of

the population 85 and the population 85 and olderolder

-chronic and progressive -chronic and progressive dysfunctiondysfunction

-whether temporary or -whether temporary or chronic, dramatically chronic, dramatically impacts every part of impacts every part of lifelife

Four Common Geriatric SyndromesFour Common Geriatric Syndromes

FALLS RISKFALLS RISK

-about 50% of those aged 80 -about 50% of those aged 80 and older are a falls risk and older are a falls risk each yeareach year

-falls, and injury from falls, -falls, and injury from falls, is a major reason for is a major reason for hospital and nursing home hospital and nursing home admissions.admissions.

URINARY URINARY INCONTINENCEINCONTINENCE

-experienced by 50% or -experienced by 50% or more of elderly persons more of elderly persons living at homeliving at home

-approximately 13 million -approximately 13 million Americans are incontinent Americans are incontinent (11 million are women)(11 million are women)

-UI accounts for many NH -UI accounts for many NH admissionsadmissions

Holy Redeemer’s responsibility to Holy Redeemer’s responsibility to Educate the CommunityEducate the Community

Along with the distinction with certification in the Along with the distinction with certification in the care of the Frail Elderly comes the responsibility to care of the Frail Elderly comes the responsibility to educate the Communityeducate the Community

This includes educating the public about the Frail This includes educating the public about the Frail Elderly, as well as specific problems relating to Elderly, as well as specific problems relating to clients, their caregivers and familiesclients, their caregivers and families

Informing the public of LifeAssess-a program Informing the public of LifeAssess-a program implemented by Holy Redeemer Home Care, implemented by Holy Redeemer Home Care, specifically designed to care for the Frail Elderlyspecifically designed to care for the Frail Elderly

An Interdisciplinary Approach to An Interdisciplinary Approach to Web-Site DevelopmentWeb-Site Development

June of 2004-June of 2004- Fran Moore, PT, Kathy Staples, OT, and Maggie Fran Moore, PT, Kathy Staples, OT, and Maggie

Vescovich, SLP, participated in week-long e-Health Vescovich, SLP, participated in week-long e-Health Summer Training Institute at Jefferson University in Summer Training Institute at Jefferson University in Philadelphia, PA. Philadelphia, PA.

Jefferson’s goal of e-health education for allied health Jefferson’s goal of e-health education for allied health professionals matched our desire to creatively educate professionals matched our desire to creatively educate the community as to the needs of the Frail Elderly.the community as to the needs of the Frail Elderly.

LifeAssess.orgLifeAssess.org

– CollaborationCollaboration– Design each syndrome to include a story, facts, self-survey Design each syndrome to include a story, facts, self-survey

and resources and resources – Focus GroupFocus Group– Grant-WritingGrant-Writing– Translations of website into Russian and SpanishTranslations of website into Russian and Spanish– Provide field staff with laptopProvide field staff with laptop– Continuing Education re: Four Common Geriatric Continuing Education re: Four Common Geriatric

SyndromesSyndromes

LifeAssess.orgLifeAssess.org

What is fastest growing group of computer What is fastest growing group of computer users and information seekers on the World users and information seekers on the World Wide Web?Wide Web?

Who is more likely to talk to their physician Who is more likely to talk to their physician about health information they found online-about health information they found online-those in poor health, or those in good health?those in poor health, or those in good health?

CONCLUSIONSCONCLUSIONS

LifeAssess.org connects clients, caregivers and LifeAssess.org connects clients, caregivers and families to needed health resources and information families to needed health resources and information through eHealththrough eHealth

LifeAssess.org empowers healthcare consumers to be LifeAssess.org empowers healthcare consumers to be active participants in managing their diseaseactive participants in managing their disease

LifeAssess.org will further our mission to help LifeAssess.org will further our mission to help seniors stay safely and comfortably in their own seniors stay safely and comfortably in their own homes for longer than they might otherwise havehomes for longer than they might otherwise have