Outreach Program Adapted to Improve Health Care for Asian People in Philadelphia
From 1998 to 2001, Thomas Jefferson University Hospitals in Philadelphia, and New York University (NYU) Downtown Hospital worked together to develop and implement the Chinese Community Partnership for Health, designed to improve the health of Asian populations in Philadelphia.
- Opened a Chinese Health Information Center near Philadelphia's Chinatown, which 12,357 individuals visited during the grant period. Benefits counseling at the center enabled 215 families that would not otherwise have had medical insurance to receive benefits.
- Developed a program of health screenings and screened a total of 1,712 people in the Chinese and Vietnamese communities for hypertension, diabetes and high cholesterol; many of those with abnormal results were linked to a medical care provider.
- Instituted a Chinese Language HealthLine, which received 9,334 calls during the grant period. After a major outreach effort in 2000, calls from new mothers increased from none to 262.
- Conducted three culturally sensitive parenting workshops for parents of preschoolers, preteens and adolescents in June of 1999. The following year, the Pew Charitable Trusts provided funds to expand the program and enhance the curriculum.
- Produced a childbirth education video, Caring for You and Your Baby, available in the Cantonese and Mandarin dialects.
- Translated an array of patient information and education materials into Chinese dialects and obtained other Chinese health resources for use at the Health Information Center.
The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $461,366.
Asians from China, Taiwan, Hong Kong, Cambodia, Vietnam and Laos comprise the largest and fastest growing segment of the immigrant population in the Philadelphia metropolitan area. The 1990 census identified 100,000 Asians residing in Philadelphia and the suburbs 2.5 to 3 percent of the population within a six-county radius. The city's Department of Health data on the Asian population highlight medical problems that are common in poor communities: late enrollment in prenatal care and lack of attention to health problems such as cancer, heart disease and diabetes, resulting in the progression of these diseases.
Compounding these problems, a language barrier often prevents Asian citizens from taking such basic health actions as calling a physician's office to make an appointment. One example of the effect of limited health care access: women in Philadelphia's Asian community are two-and-one-half times more likely to have late or no prenatal care than white women in Philadelphia are.
Beginning in 1996, New York University (NYU) Downtown Hospital in New York City had mounted a successful program to promote health and prevent disease within that city's Chinese community. The New York project was funded by RWJF under its Robert Wood Johnson Foundation Local Funding Partnerships Program (ID# 022523), a matching grants program designed to establish partnerships between RWJF and local grantmakers to support innovative, community-based projects that improve health and health care for underserved and at-risk populations.
After developing relationships with an array of community service organizations, the New York program screened 7,500 people for hypertension, blood sugar, stroke, diabetes and other risk factors over the three-year life of the grant. The program has since established an endowment through the New York Chinese community to provide long-term support.
NYU Downtown Hospital contacted Thomas Jefferson University Hospitals about a possible partnership and the two institutions began to design a hospital/community partnership in Philadelphia and entered into a formal partnership. Philadelphia offered some unique challenges because its Asian population is dispersed over an area of approximately 60 square miles and includes not only Chinese, but large populations of Vietnamese and Cambodians. Prior to this effort, no single health district, hospital or medical practice group had had the dedicated economic resources or cultural expertise to design individual programs for families of Asian origin.
Under this grant, Thomas Jefferson and NYU Downtown worked jointly to complete their planning and implement culturally specific strategies to improve the health of Philadelphia's Asian populations. The Chinese Community Partnership for Health, as the Philadelphia project is called, built on New York's successful model and sought to:
- Identify underserved individuals at risk for problem pregnancies, hypertension, diabetes or cardiovascular disease.
- Provide personalized counseling and support for at-risk individuals.
- Encourage linkages with appropriate primary care services.
Project staff conducted in-depth interviews with 16 leaders in the Philadelphia Chinese community to assess its strengths, values and needs. They then established an advisory board to guide them in identifying community resources, setting program priorities and planning programs. The board, which grew to 27 members by the end of the grant period, represents an array of community groups, including the Thomas Jefferson Hospital, the business, banking and medical communities, the city health department and Chinatown-based children's services. In February 1999, the Chinese Community Partnership for Health appointed its first director, a Chinatown-based pediatrician.
Working under grant subcontracts, NYU Downtown staff provided ongoing consultation, technical assistance and other support to Thomas Jefferson staff. In turn, Thomas Jefferson's well-established bilingual childbirth and parenting education program provided a model for NYU Downtown to enhance its own program. The hospitals worked together to develop videotapes and written education materials in Chinese that strengthened maternity care outreach to Asian populations at both institutions.
In addition to RWJF support, the project received a total of $684,525 in funding from seven sources (see the Appendix), plus in-kind support from Thomas Jefferson. Two of the funders earmarked their grants for specific aspects of the project providing mental health services to Chinese-speaking patients and developing the childbirth education program.
- In September 1998, the Chinese Health Information Center opened in a prime location two-and-one-half blocks from Philadelphia's Chinatown. During the grant period, 12,357 individuals visited the center. The top four reasons they gave for their visit were:
- help in obtaining social services
- help with making a doctor's appointment
- health questions
- translation services.
Benefits counseling at the center enabled 215 families that would not otherwise have had medical insurance to receive benefits.
- Project staff developed a program of health screenings and outreach, conducting 28 sessions in the Chinese community and 19 in the Vietnamese community. A total of 1,712 people were screened for hypertension, diabetes and high cholesterol. In the Chinese community, 36 percent of those screened had at least one abnormality; half of them were linked with a medical care provider. Forty-one percent of those screened in the Vietnamese community had abnormalities and were referred to medical practitioners; almost three-quarters of this population were linked to a health care provider. Economic barriers were the primary reason that some individuals with abnormal test results did not receive treatment.
- Staff created a Chinese language HealthLine to link callers to health services and information; 9,334 calls were received during the grant period. The four top reasons for calling were:
- requests for general information
- translation services
- help with screening appointments
- health questions.
After a major outreach effort in 2000, calls from new mothers about their own health or concerns about their infants increased from none to 262.
- Project staff conducted three culturally sensitive parenting workshops in 1999 for parents of preschoolers, preteens and adolescents. The following year, the Pew Charitable Trusts funded the expansion of these workshops and the enhancement of the curriculum.
- Project staff developed a comprehensive childbirth education program in the Cantonese and Mandarin dialects for use at both Thomas Jefferson and NYU Downtown; targeted funding from the Connelly Foundation supplemented the RWJF grant. Patient material included:
- a childbirth education video, Caring for You and Your Baby, available in Cantonese and Mandarin
- two accompanying booklets with side-by-side Chinese and English texts Preparing for Your Baby's Birth and Caring for You and Your Baby (see the Bibliography for details).
All Chinese-language-speaking maternity patients at Thomas Jefferson and NYU Downtown received free copies of the video, which was produced in slightly different versions for each institution. Thomas Jefferson has distributed more than 400 videos to date. In addition, the RWJF grant allowed Thomas Jefferson to hire a bilingual childbirth educator/case manager, making it possible to expand the maternity clinic hours for Chinese-language-speaking women and boosting clinic attendance.
- Project staff translated into Chinese an array of patient information and education materials including a patient handbook, a patient bill of rights and advanced directives. In addition, the staff obtained a variety of Chinese-language health materials for use in the Chinese Health Information Center. By the end of the grant period, the Center had more than 30 books, 50 health education pamphlets, 40 tapes and eight CD-ROMs on health topics in its Chinese-language collection.
- With funding from the van Ameringen Foundation, project staff developed a program to identify and treat those in the Chinese community with mental health issues.
Project staff did substantial outreach to publicize the Chinese Community Partnership for Health, developing contacts with community leaders, distributing brochures, participating in community events and describing the services on the hospital Web site. Additionally, project staff presented the work of the partnership at various meetings of health care professionals, including a 1998 meeting in Washington of the American Public Health Association. The opening of the Chinese Health Information Center received local print, radio and television coverage.
- Build relationships in the community before requesting grant funding. The Project Director believes laying that groundwork contributed to the ultimate success of the project. (Project Director/Schraeder)
- Stay close to your mission, despite pulls from funding sources to pursue other projects. After much discussion, project staff decided to forgo funding from several sources because it would have meant introducing new programs that might have taken energy away from the core programs. (Project Director/Schraeder)
- Replication does not mean importing a successful program in its entirety. Some of the NYU Downtown project's strategies were not appropriate to the Philadelphia setting. Any new program must be adapted to its unique setting and circumstances. (Project Director/Schraeder)
- It is unrealistic to combine services for a variety of Asian groups. Significant differences exist between Asian population groups and even within the ethnic Chinese population in terms of language, cultural practices and beliefs about health and illness. To provide in-depth services, outreach efforts must be tailored to specific sub-groups and reflect a clear understanding of cultural nuances. (Project Director/Schraeder)
- Community programs of this scale need a long-term funding plan. This project has survived thus far by patching together grants from various sources. In order to thrive, the project needs a long-term endowment or another source of steady funding. (Project Director/Schraeder)
AFTER THE GRANT
Unlike the NYU Downtown project, the Philadelphia project has been unable to develop an endowment through the local Asian community and is exploring other long-term funding. Prospects include ongoing funding through Thomas Jefferson University Hospital and/or the establishment of the Chinese Health Information Center as a publicly funded health center. Since the end of the grant period, the project has established a volunteer service program at the Chinese Health Information Center, with 30 active volunteers; the Office of Minority Health (an agency of the federal U.S. Department of Health and Human Services) has provided funds to support this effort.
GRANT DETAILS & CONTACT INFORMATION
Replication of a Community-Based Partnership to Provide Health Education, Outreach, and Case Management to Urban Chinese and Other Asian Populations
Thomas Jefferson University Hospitals (Philadelphia, PA)
Dates: February 1998 to January 2001
Barbara D. Schraeder, Ph.D.
- Connelly Foundation (earmarked for childbirth education program), $25,000
- Women's Board of Thomas Jefferson University Hospital, $10,000
- van Ameringen Foundation (earmarked for mental health services), $126,525
- First Union Bank, $1,000
- Office of Minority Health (U.S. Department of Health and Human Services), $250,000
- Commonwealth of Pennsylvania, $150,000
- The Pew Charitable Trusts, $122,000
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Caring for You and Your Baby, with side-by-side Chinese and English texts. New York: New York University Downtown Hospital and Thomas Jefferson University Hospital, 1999.
Preparing for Your Baby's Birth, with side-by-side Chinese and English texts. New York: New York University Downtown Hospital and Thomas Jefferson University Hospital, 1999.
Audio-Visuals and Computer Software
Caring for You and Your Baby, videotape in Cantonese and Mandarin Chinese dialects and in two versions for use in either New York or Philadelphia. New York: New York University Downtown Hospital and Thomas Jefferson University Hospital, 1999.
World Wide Web Sites
www.jeffersonhospital.org/chic. Carries information about the Chinese Health Education Center and center events. Philadelphia: Thomas Jefferson University Hospitals.
Parenting Lecture Series (each attended by about 15 people):
"Relationship with Your Children," June 10, 1999, Philadelphia.
"Establishing Health Attitude and Habit," June 18, 1999, Philadelphia.
"Love and Discipline," June 24, 1999, Philadelphia.
Report prepared by: Kelsey Menehan
Reviewed by: Karyn Feiden
Reviewed by: Molly McKaughan
Program Officer: Robert Hughes
Program Officer: Judith Whang