Lobby

Are you currently a member of a substance misuse prevention coalition? If yes, in what state or jurisdiction?

Disclaimer

The views expressed in this webinar do not necessarily represent the views, policies, and positions of the Substance Abuse and Mental Health Services Administration or the U.S.

Department of Health and Human Services.

This webinar is being recorded and archived, and will be available for viewing after the webinar. Please contact the webinar facilitator if you have any concerns or questions.

Purpose of the PTTC

•Develop and disseminate tools and strategies needed to improve the quality of substance abuse prevention efforts

•Provide training and learning resources to prevention professionals

•Develop tools and resources to engage the next generation of prevention professionals

Pacific Southwest (HHS Region 9) PTTC

CA

NV

AZ

HawaiiAmerican Samoa

Guam

Palau

Northern Mariana Islands

MarshallIslands

Micronesia

Parent Organization: CASAT, University of Nevada, Reno

Mark Your Calendars!Two-part webinar series on sustaining substance misuse prevention outcomes:

PART ONE:August 20th at 3:00 PM Pacific Time

The Prevention Coalition’s Role in Addressing Health DisparitiesAlbert Gay, MSJune 26, 2019

Albert Gay, M.S. is a national trainer and consultant in the field of substance use prevention. Over the years, he has worked on many federal level projects for the Substance Abuse and Mental Health Services Administration (SAMHSA). Currently, he works within Indiana University’s School of Public Health as an Education and Training Specialist and Research Associate. Nationally, he has trained the behavioral health workforce, the United States military, and diverse population groups and community coalitions within a collaborative strategy framework. Currently, he is the chair of a local coordinating council for the county and a key leader for the Gary Drug Free Communities coalition.

Agenda

• Coalitions• Systems• Cultural Competence Continuum• CLAS Standards• Public Health Approach• Strategic Prevention Framework• MAPP IT Process

Coalitions

CADCA defines coalitions as the following:• A formal arrangement for collaboration between groups or sectors of a

community, in which each group retains its identity, but all agree to work together toward a common goal of building a safe, healthy, and drug-free community.

Power at the Table

State, local, tribal

MediaBusiness

Schools

Law EnforcementParents

YouthOther

Coordinator

Youth-serving Orgs.

Healthcare

Civic/ Volunteer

Religious/ Fraternal

A Coalition Is…

• A diverse group of individuals and agencies with deep connections to the local community

• A group that serves as a catalyst for the goal of community change A group that adapts, creates, or develops public policy

• A group that influences population behavior • A group that works to create a healthy community

A Coalition Is… (cont’d)

• A partnership of the many sectors of a community which gather together collaboratively to solve the community’s problems

• A group that guides the community’s future • A group that is driven by citizen-identified issues

Here’s Why Coalitions Form

• To respond to an urgent situation that demands action• To control the future of the community• To acquire and/or provide services• To deliver effective and efficient practices, policies, and

programs • To facilitate communication among groups• To strategically plan community-wide initiatives• To foster leverage within the community• To create and sustain social change

Here’s What Coalitions Do

• Connect with their community members on a grassroots level • Use multiple strategies across multiple sectors of the

community• Solve problems collaboratively and develop a strong

community

What Makes Coalitions Perfect for Disparities Work?

• Ability to work upstream and working at root level causes• Constant surveillance (updating assessment data)• Work with Strategic Prevention Framework (SPF)• Value of Cultural Competence • Working together for leverage

Systems

Systems Change

A system is an organized entity made up of interrelated and interdependent parts

Systems Change addresses root causes of social problems

Causes (like biases) are embedded in networks

Social Determinants of Health within Systems

Life-enhancing resources whose distribution across populations effectively determines length and quality of life.

Institutions

20

Principle 1: Non-Discrimination

Prevention professionals shall not discriminate against service recipients or colleagues based on race, ethnicity, religion, national origin, sex, age, sexual orientation, education level, economic or medical condition, or physical or mental ability. Prevention professionals should broaden their understanding and acceptance of cultural and individual differences and, in so doing, render services and provide information sensitive to those differences.

Principle 2: Competence

Prevention professionals shall master their prevention specialty’s body of knowledge and skill competencies, strive continually to improve personal proficiency and quality of service delivery, and discharge professional responsibility to the best of their ability. Competence includes a synthesis of education and experience combined with an understanding of the cultures within which prevention application occurs. The maintenance of competence requires continual learning and professional improvement throughout one’s career.

Principle 4: Nature of ServicesPractices shall do no harm to service recipients. Services provided

by prevention professionals shall be respectful and non-exploitive. a) Services should be provided in a way that preserves and supports the strengths and protective factors inherent in each culture and individual. b) Prevention professionals should use formal and informal structures to receive and incorporate input from service recipients in the development, implementation and evaluation of prevention services. c) Where there is suspicion of abuse of children or vulnerable adults, prevention professionals shall report the evidence to the appropriate agency.

Principle 5: Confidentiality

Confidential information acquired during service delivery shall be safeguarded from disclosure, including - but not limited to - verbal disclosure, unsecured maintenance of records or recording of an activity or presentation without appropriate releases. Prevention professionals are responsible for knowing and adhering to the State and Federal confidentiality regulations relevant to their prevention specialty.

Principle 6: Ethical Obligations

According to their consciences, prevention professionals should be proactive on public policy and legislative issues. The public welfare and the individual’s right to services and personal wellness should guide the efforts of prevention professionals to educate the general public and policy makers. Prevention professionals should adopt a personal and professional stance that promotes health.

Cultural Competence Continuum

Cultural Destructiveness

Cultural Incapacity

Cultural Blindness

Pre-Cultural Competence

Cultural Competence

Cultural Proficiency

1. Cultural Destructiveness• Attitudes, policies and practices which are

destructive to cultures and individuals within them• Purposeful destruction of a culture• Assumes one race superior• Dehumanization of specific cultures or individuals

signifying an underlying bias toward the superiority of the dominant or majority group.

• There is an intention to ignore issues affecting minorities and promote policies and standards that have an adverse impact on them.

• Ex: The Tuskegee Experiment.

2. Cultural Incapacity• The inability to work with diverse populations. • There is not an intention to ignore issues or promote

policies and standards that have an adverse impact on minorities; instead, their practices are based on a lack of understanding and ignorance.

• Intent not to be intentionally culturally destructive• Lack of capacity to work with minorities• Extreme bias and belief in racial superiority of dominant

group• Examples:

• 1. Not providing bilingual personnel when needed.• 2. Drawing accurate but inappropriate clinical or educational

conclusions based on the professional's view of the world, not on the child's view that may affect how he or she makes eye contact, respond to group activities.

3. Cultural Blindness• Midpoint on the continuum• Approaches used by and for the majority are perceived as

relevant for all others. Practices are adopted for "the greater good”, which is generally the majority perspective.

• Inability to examine or even recognize existing biases in approaches to practices, education, and research that perpetuates the continued existence and development of models that support stereotypes of diverse populations and thus further promotes prejudice.

• Systems/agencies provide services with philosophy of being unbiased.

• Belief that color or culture makes no difference• Belief that dominant culture approaches are universally

applicable

4. Cultural Pre-competence

• Implies movement• Weaknesses recognized in working with minorities• Attempts to improve practices and increase knowledge• Although this phase is a positive movement, false "comfort"

may set in after making only minimal efforts to be responsive to diverse populations. The efforts may only be peripheral and not sufficient to truly address cultural issues.

• Danger of tokenism

5. Cultural Competence (Basic)

• Acceptance and respect for difference• Continuing self-assessment regarding culture• Careful attention to dynamics of difference• Continuous expansion of cultural knowledge and resources• A demonstrated commitment to diverse populations in all

aspects of the structure and functions of the organization. • Characterized by a sustained, systematic integration and

evaluation at all levels of significant collaboration from diverse populations into the infrastructure of the organization.

6. Advanced Cultural Competence (Proficiency)• Culture held in high esteem• Is demonstrated by the centrality of an organization's

commitment to diversity and by its external expertise, leadership, and proactive advocacy in promoting appropriate care for diverse populations.

• Influences systems and governance• Knowledge base of cultural competence sought by

• conducting culture-based research• developing new approaches based on culture

Cultural Competence Continuum

Cultural Destructiveness

Cultural Incapacity

Cultural Blindness

Pre-Cultural Competence

Cultural Competence

Cultural Proficiency

Does Your Organization

• Conduct cultural self-assessment?• Value diversity and inclusion?• Manage the dynamics of difference?• Adapt to diversity and the cultural contexts of individuals and

communities served?• Identify cross-cultural dynamics?• Institutionalize cultural knowledge?• Respect and respond to cultural needs of clients/participants?

How Do We Acquire Cultural Competence?

• Progress along the cultural competency continuum requires a continual assessment of an organization's /one’s ability to address diversity, celebrating successes, learning from mistakes, and identifying opportunities for rediscovery.

• Recognize the broad dimensions of culture• Respect cultural stakeholders as the primary source for

defining needs and priorities• Increase sensitivity to alienating behaviors

cont.

Movement Toward Cultural Competence

• Attitudes must change to become less ethnocentric and biased.

• Policies must change to become more flexible and culturally impartial

• Practices must become more congruent with cultures

1st Steps to Readiness for Coalition Equity Work• Invite leaders or allies to share at meetings• Have some focus group• Share information on local disparities and links to SDOH (articles,

social media posts, stories from the news, etc.)• Attend cultural functions (celebrations, parades, listening sessions,

forums, places of worship, places of learning, etc.)• Highlight attention to Social Justice issues (protests, statistics,

forums)• Listen/learn from Health Equity and Social Justice groups,

workshops, conference, or other.

2Systemic BiasDiscrimination

3Ignore differencesEncourage assimilation

4

Values Diversity. Tends to tokenize

5

Exemplify cultural competenceMission statement & policies reflect respect for cultures.Recruit/hire diverse workforce

6

Systemically holds cultures in high esteem. Use as foundation. Develop organizational practices. Employ persons with expertise. Publish / use evidence‐based models. Mentor / support other organizations..Advocate for populations

Cultural Incapacity

Cultural Blindness.

Cultural Pre‐Competence

Cultural Competence

Cultural Proficiency

Cultural Destructiveness

Destructiveto cultural groups

1

Cultural Competence Continuum

CLASStandards

Mission

Quality of Care

Demographic Changes

LegislationAccreditation

Reducing Litigation

Access to Care

The National Standards for Culturally and Linguistically Appropriate Services (CLAS)

• CLAS were designed by the Office of Minority Health within the U.S. Department of Health and Human Services.

• CLAS Standards address health disparities by providing guidelines for organizations to advance health equity by implementing culturally and linguistically appropriate services.

• The language focuses on health care, but SAMHSA promotes the use of the CLAS Standards for substance abuse prevention efforts.

Department of Health and Human Services, 2015

Policy / Enforcement

Buy-in / Outcomes

Practice / Culture

Governance, Leadership,

and Workforce (Standards 2-4)

Communication and Language

Assistance (Standards 5-8)

Engagement, Continuous

Improvement, and

Accountability (Standards 9-15)

PrincipalStandard

1

Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.

• Identify and develop informed and committed champions of cultural competency throughout the organization in order to focus efforts around providing culturally competent care.

• Ensure that a commitment to culturally competent care is reflected in the vision, goals, and mission of the organization and couple this with an actionable plan.

• Implement strategies to recruit, retain, and promote at all levels of the organization a diverse leadership that reflects the demographic characteristics of the populations in the service area.

• Develop, maintain, and promote continuing education and career development opportunities so all staff members may progress within the organization.

• Conduct ongoing assessments on the demographics of your community to ensure you are providing appropriate services.

• Offering language assistance• Offering services in languages other

than English• Translating documents into

languages other than English• Ensure that the literacy level of your

audience is reflected in your communications (verbal & written).

• Create policies to ensure that language and cultural considerations are addressed and monitored.

• Make sure that your coalition is representative of your community.

• Promote mentoring opportunities.• Create a feedback loop for clients to

tell their honest experience with organization.

CLAS Examples

The Public Health Approach is Coalition Work

Define Problem Identify Risk / Protective Factors

Select Interventions

Program Implementation /

Evaluation

The Framework

Coalitions Use the Strategic Prevention Framework Assessment

Profile population needs, resources, and readiness to address needs and gaps

CapacityBuild capacity to address needs

PlanningDevelop a Comprehensive Strategic Plan

ImplementationImplement evidence-based prevention programs and activities

EvaluationMonitor, evaluate, sustain, and improve or replace those that fail

CLASStandards

Strategic Prevention Framework Tool

ASSESSMENT• Ensure that data is culturally responsive and appropriate

• Use a culturally competent evaluator for assessment

• Gain approval of the community for data collection and analysis

• Create a process for identifying culturally relevant risk and protective factors and other underlying conditions

• Formulate culturally-based assumptions of change (Identify change from the community’s perspective)

• Assesses organization diversity

CAPACITY•Develop  policies, procedures, and resources that facilitate the ongoing development of cultural competence and inclusion

• Willing to commit the resources necessary to build or strengthen relationships with groups and communities

• Learn to be an ally to groups that experience prejudice and discrimination in the community. Help others learn to be an ally to their own cultural groups

PLANNING• Make sure the community is represented in the planning process

• Identify mutually acceptable goals and objectives

• When selecting programs and strategies, consider their fit with:• Community culture• Existing prevention efforts• Past history

IMPLEMENTATION• Encourage and accommodate a variety of learning and participation styles, building on community members’ strengths.

• Community has opportunity to create and/or review audiovisual and printed materials, to ensure they are accessible to, and attuned to their community or focus population.

EVALUATION• Ensure that data collection tools reflect community culture

• Use a culturally competent evaluator for evaluation

• Obtain permission to disseminate the evaluation findings from the organization or entity implementing the intervention

• There is a regular forum for a wide variety of community members to provide both

• formal and informal feedback on the impact of interventions in their community

Leverage is the Name of the Game

• Controlling the course of the community• Transforming systems• Altering the historic course of outcomes

Systems Change

Risk & Protection

Poverty

Neighborhood Attachment Poverty

NEIGHBORHOOD ATTACHMENT!!!!!

Substance Misuse, Risk / Protection & Social Determinants of Health• Coalition’s priority

substances?• Priority risk/protective factors?• In which SDOH are they

found?

Recruitment of Community Resources for SDOH

• Identify key leaders within each sector• Notoriety • Outcomes • Passion• Decision makers/ influencers• Culturally Competent Approach • Shared interests/values/goals• Culturally Responsive• Clear responsibilities• How coalition benefit sector• Positive outcomes (Win – Win)

Where Are Those Resources Found Within The Community?

• Religions/FBO• Fraternal • Civic/Volunteer • Healthcare Field• Government• Other Organizations• Champions

• Youth• Parents• Businesses• Media• Schools• Youth Servicing

Orgs• Law Enforcement

MAPP – The Public Health Infrastructure

National Association of County Health Officials

MAPP - Mobilizing for Action through Planning and Partnerships

1. Organize for Success 2. Visioning 3. Four

Assessments

4. Identify Strategic Issues

5. Formulate Goals &

Strategies6. Action

Cycle

1. Organize for Success & Partnership Development1. Determination of necessity of undertaking2. Identify and organize participants (key stakeholders)3. Design of planning process4. Assess project resource needs (meeting space, travel, etc.)5. Conduct Readiness Assessment for planning process6. Determine how process will be managed

2. Visioning

1. Identify other visioning efforts 2. Design visioning process / select facilitator3. Conduct visioning process4. Formulate the vision statement / common values

3. Collecting and Analyzing Data

The Four Assessments• Community Themes and Strengths • Local Public Health System• Community Health Status• Forces of Change

4. Identify and Prioritize Strategic Issues

1. Identify potential strategic issues from 4 assessments2. Understand why certain issues are strategic 3. Determine consequences of not addressing certain issues4. Consolidate overlap and related issues for manageability5. Prioritize issues and consider relation to one another

5. Develop, Goals, Strategies, and Action

1. Develop goals related to vision and strategic issues2. Generate strategy alternatives to address goals/vision3. Consider barriers to implementation (resources, support, etc.)4. Explore implementation details (who, when, resource needs)5. Select strategies from among list and begin processes6. Draft and adopt planning report

Planning

ImplementationEvaluation

Planning1. Organize for action2. Develop measurable objectives3. Develop action plans

• Implementation1. Review action plans/

coordinate resources2. Implement and monitor action

• Evaluation1. Engage stakeholders to

prepare for evaluation2. Focus evaluation design3. Gather credible evidence4. Ensure evaluation results are

used and shared with others.

6. Taking and Sustaining Action

Please provide your feedback!https://www.surveymonkey.com/r/9909TR1017_HealthDisparities_Post

Thank You!