Connecting Hispanic LGBT Communities with Health Care: A Focus on Smoking Cessation and Cancer Screening Services. Webinar Friday, October 14, 2016

Transcription

1 Connecting Hispanic LGBT Communities with Health Care: A Focus on Smoking Cessation and Cancer Screening Services Webinar Friday, October 14, 2016

2 Objectives Understand Hispanic LGBT intersectionality and associated health disparities relative to culturally competent health care services. Assess how immigration status and other vulnerabilities influence cancer screening and tobacco cessation/smoke free services for the Hispanic LGBT population. Identify strategies and other promising practices that connect LGBT Hispanics with culturally competent care and services that can be replicated in other settings.

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4 Nuestras Voces works to build Hispanic community infrastructure, as well as increase partnerships with regional and national tobacco and cancer control networks and other stakeholders, to: Decrease exposure to second-hand tobacco smoke, Increase smoking cessation, Network Overview Increase cancer prevention, and; Improve quality of life for those living with cancer.

5 Dallas, TX Seattle, WA Minneapolis, MN Chicago, IL Watsonville, CA New York, NY Denver, CO Philadelphia, PA Albuquerque, NM San Diego, CA Atlanta, GA

6 Network Overview Implementation of evidence-based tobacco and cancer interventions. Webinars Training and technical assistance Increase tobacco and cancer awareness and education through national media and social media activities. Radio, TV and print interviews Opinion Editorials Press releases Facebook and Twitter postings Text message campaigns Literature dissemination Share tobacco and cancer developments, research, and news to: Network members through blast s Lead agencies and their partners through literature dissemination General public through the Network website -

7 National Alliance for Hispanic Health Our Mission Best Health Outcomes for All We work to insure that health incorporates the best of science, culture, and community. Our Goal To close the gaps between: Research, services, and policy; Scientific discovery and benefit for individual; and, Community services and medical practice.

8 The Alliance Largest and oldest Hispanic network; the nation s expert in Hispanic health. Senior, bi-partisan Board of Directors Supported by the Healthy Americas Foundation and the Healthy Americas Institute Community-based organization members deliver services to 15 million persons each year; national organization members to 100 million. Supports community-based solutions. Does not accept funding from alcohol, tobacco, or sugarsweetened beverage companies.

9 Introduction to LGBT HealthLink Anthony R. Campo Outreach Manager, LGBT HealthLink October 14, 2016

10 ROADMAP 10

11 ABOUT US LGBT HealthLink is a CDC-funded program of CenterLink an association of LGBT centers offering training and TA HealthLink is a community-driven network of experts and professionals seeking to enhance LGBT health LGBT tobacco rates are approximately double the general US population 11

12 ABOUT US To reach LGBT populations, we utilize our network of community centers, which are safe spaces where LGBT often seek comfort and information, even prior to seeking care The LGBT community is comprised of every race and ethnicity, one of which is Hispanic As such, many centers offer tobacco cessation programs in Spanish and specifically serve Hispanic populations However, to effectively reach these populations, expansion of culturally and linguistically competent programs is needed 12

13 SERVICES Technical Assistance (TA) Webinars/presentations Facilitate clinical linkages Facilitate connecting and collaborating with local Departments of Health for potential funding opportunities for health programming 13

14 RESOURCES - EDUCATIONAL MATERIALS Request Online:

15 RESOURCES - EDUCATIONAL MATERIALS 15

16 STAY CONNECTED Homepage: We would love you to join LGBT HealthLink! Membership is all about building a community of people who are sharing expertise and resources. Click Be One of Us: This exclusive membership experience gives you access to: Chance to receive scholarship to attend our LGBT Health Summit Members-only online networking groups Exclusive webinars and resources Being part of the movement to achieve LGBT health equity 16

17 Webinar Presenters Francisco Dueñas Director, Proyecto Igualdad Yanira Arias National Campaign Manager Ruby Corado Founder & Executive Director

18 When Health Care Isn t Caring Examining Health Care Discrimination against Lesbian, Gay, Bisexual, and Transgender (LGBT) People of Color (POC)

19 Objectives By the end of this presentation: Lambda Legal s Health Care Fairness Survey Challenges LGBT POC surveyed report in accessing quality healthcare Examine ways LGBT POC experience intersecting forms of discrimination in health care Review and expand on our recommendations for governments, health care providers and community members

20 Why a Survey? Evidence suggests that LGBT people have less access and face greater obstacles to health care Few if any national studies focus on health care-related discrimination of LGBT people Increase inclusion of LGBT people in data collection Raising awareness of LGBT health care needs can make change possible!

21 Survey Summary LGB Two Perspectives of the Problem Discrimination and Substandard Care TGNC PLWH Barriers to Care

22 Who Took the Survey? Information is gleaned from 4,916 surveys Over 18% identify as people of color (POC) 42% of POC respondants idenitified as Latino/a; 26% as Black; 20% as Native American; 17% as Asian; 5% as Middle Eastern Approximately 12% of total respondents identified as transgender or gendernonconforming

23 Survey Says 56% of LGB respondents 70% of TGNC respondents 63% of respondents living with HIV DISCRIMINATION & SUBSTANDARD CARE Were refused needed health care Health care professionals refused to touch them or used excessive precautions Health care professionals used harsh or abusive language Were blamed for their health status Health care professionals were physically rough or abusive

24 Survey Data: Discrimination & Substandard Care Was refused needed health care

25 Survey Data: Discrimination & Substandard Care Health care professionals refused to touch or used excessive precautions

26 Intersectionality TGNC LGB POC

27 Survey Data: Discrimination & Substandard Care

28 Survey Data: LGB Discrimination & Substandard Care 20% 16% Refused to Touch/ Excessive Precautions 18% Physically Rough or Abusive Treatment 12% 8% 4% 10% 7% 4% 0% All LGB All LGB

29 Survey Data: Discrimination & Substandard Care 20% 16% 12% LGB Immigrants of Color 19% 18% 12% 8% 4% 0% Refused Medical Care Harsh or Abusive Language Blamed for Medical Conditions

30 Intersecting Forms of Discrimination: Low-Income or Uninsured Low-Income or Uninsured LGB respondents were almost twice as likely to have been refused needed care than higher income or insured LGB respondents 34.8% of Low-Income or Uninsured TGNC respondents had been refused needed care, compared to 21.8% of higher income or insured TGNC respondents

31 Intersecting Forms of Discrimination: TGNC TGNC respondents were 3 times as likely to be refused care than LGB respondents 65% of TGNC respondents reported that their provider was unaware of their health care needs

32 Survey Says BARRIERS TO CARE Not enough support groups Community fear/dislike of us I will be refused medical service Not enough substance abuse treatment Medical personnel will treat me differently Not enough health professionals adequately

33 Survey Data: Barriers to Care

34 Survey Data: Barriers to Care Cont d.

35 LGBT Health and Health Care Reform: The Struggle Continues Cultural Competency Data Collection Recognizing Diverse Family Structures Essential Health Benefits* Health Care and Public Health Research Health Care Workforce Health Disparities Mental Health and Substance Abuse Prevention and Wellness

36 Recommendations Implement standards of care specific to LGBT patients/consumers Mandate cultural competency training Increase funding to community based orgs Check out our Trans Affirming Hospital Policies Guide Make health education materials culturally specific to LGBT people

37 Share Your Story- John, East Stroudsbug, PA I am doctor who treated an 18 year old high school student. He moved from the West Coast, where he had lived with his dad, to move in with his mom on the East Coast because of trouble in school. He was having attacks of sudden shaking and weakness. His mom took him to her primary care provider, who referred him to a neurologist, suspecting [epilepsy]. He underwent thousands of dollars worth of tests all turned out normal. Turns out he had been gay bashed in the bathroom at his old high school. He received death threats while there. None of his new physicians had asked him about his sexual orientation. It quickly became apparent he was having anxiety and panic attacks as he recalled the events. The presumption of heterosexuality led to failure to correctly diagnose and treat his problem.

38 Latino LGBT communities and ACA: Access and opportunities for mobilization.

39 Agenda About Alianza Americas A Nation of Immigrants? Brief look into our history of unwelcoming foreigners. How immigration status and other vulnerabilities influence cancer screening and tobacco cessation/smoke free services for the Latino LGBT population. LGBT communities and ACA: Access and opportunities for mobilization.

40 About Us Alianza Americas is a network of Latin American and Caribbean immigrant organizations in the United States. It is the only national organization in the U.S. that is rooted in Latino immigrant communities and works transnationally to create an inclusive, equitable and sustainable way of life. Founded in 2004 by immigrant led organizations.

41 What We Do Shape and influence public policies that promote social, political, and economic justice across the Americas. Provides a platform for addressing systemic and transnational issues and develop practical solutions for change.

42 Our Strength is our Membership 41 organizational members representing more than 100,000 families across 12 states and the District of Columbia. List of Member Organizations California Illinois Florida Massachusetts Nebraska North Carolina New Jersey New York Ohio Oregon Texas Washington, DC Wisconsin

43 Our Issue Areas Economic, Racial and Social Justice Common-sense and Humane Migration Policies Transnational Civic Engagement & Participation Protection for Children and Families Across Borders

44 A Nation of Immigrants? A brief look into our history of unwelcoming foreigners

45 Unwelcoming Foreigners Alien and Sedition Acts of 1798 The Chinese Exclusion Act of 1882 Operation Wetbacks of 1954 Proposition 187 in CA, in early 1990 s The Illegal Immigration and Immigrant Responsibility Act of 1996, etc.

46 Unwelcoming Foreigners In spite of the changes in the make up of the new comers, we never enacted an immigrant integration policy to facilitate their journey to become new Americans. Fear and demonizing immigrants leads the rhetoric of mass media and public policy.

47 Where do We go from here The dominant narrative must change. Meaningful social interaction is the key. Reversing the 1996 legal framework must be a specific demand. Economic inequality and the fight against racism are great universal frameworks going forward. Migration has to be understood as an international challenge. We must come up with new approaches to immigrant rights and immigration policy reform. We must demand more from our so called friends. Let s not forget we are dealing with human beings, not raw materials or commodities.

48 Connecting the Dots Policy Intersectionality

49 Affordable Care Act: ACA The Affordable Care Act enables millions of people to secure access to more affordable health coverage and care through two mechanisms: the Health Insurance Marketplaces, where individuals and small businesses can shop for affordable plans, and the expansion of many state Medicaid programs. The Affordable Care Act also specifically benefits LGBT communities by addressing insurance market issues that previously prevented many individuals from accessing the coverage and care they need. The Patient Protection and Affordable Care Act, was passed in the senate on December 24, 2009, and passed in the house on March 21, It was signed into law by President Obama on March 23rd, 2010 and upheld in the supreme court on June 28, 2012.

50 Lessons Learned Six Anniversary of ACA At the end of first enrollment period, uninsured rate working age Latinos decreased from 35% to 23%. Barriers to insurance expansion: language 30% of Latinos who primarily speak Spanish remained uninsured compared with 19% of English-dominant Latinos. Comparatively few Latinos know about their coverage options: 50% eligible Latinos were aware of insurance marketplace options, compared with 74% of non-hispanic whites. As of December 2014, 28 states including the Washington, DC are expanding eligibility for Medicaid under ACA. As of March 31, 2015, about 10.2 million people have an active coverage.

51 What else we learned: ACA A major perceived barrier to enrolling in Medicaid or market place plan [for mixed-status families] is fear of deportation or that one s status eligibility for citizenship might be jeopardized. Covering those who are undocumented may reduce the negative externalities associated with that have large share of uninsured people. Offering affordable insurance to Latinos does not mean that they will enroll or benefit. Enrollment figures suggest that higher income people who receive smaller subsidies or none at all have not seen insurance as such a bargain.

52 What else we learned: ACA The marketplace faces a major test in the fourth annual open enrollment season, which starts on Nov. 1, a week before Election Day. In many counties, consumers will see higher premiums and fewer insurers, as Aetna, Humana and UnitedHealth have curtailed their participation in the exchanges, and many of the nonprofit insurance cooperatives, created with federal money, have shut down. NYT, October 2, Ailing Obama Health Care Act May Have to Change to Survive

53 States challenging Obamacare These are the 27 states challenging the Affordable Care Act or commonly known as Obamacare in federal courts: Florida, South Carolina, Nebraska, Texas, Utah, Louisiana, Alabama, Colorado, Michigan, Pennsylvania, Washington, Idaho, South Dakota, Indiana, North Dakota, Mississippi, Nevada, Arizona, Georgia, Alaska, Ohio, Wisconsin, Maine, Iowa, Wyoming, Kansas and Virginia. 20 million Latinos live in these states At least 16 states of those states have several anti-immigrant policies in place.

54 Why Does ACA for LGBTQ Matter? There are an estimated 9 million LGBT Americans. Among those in the LGBT community who are low or middle income those who make up to 400 percent of the Federal Poverty Level and who are therefore often eligible for financial assistance to gain coverage under the Affordable Care Act Too many Americans still strain to pay for their physician visits and prescriptions, cover their deductibles or pay their monthly insurance bills; struggle to navigate a complex, sometimes bewildering system; and remain uninsured, President Obama wrote in The Journal of the American Medical Association.

55 Advocacy Questions? Do plans cover transition-related care? What coverage exclusions exist? Will transgender people be able to get coverage for genderspecific services such as Pap tests, mammograms, and prostate exams? Is mental health care covered? Is there a network of providers competent in serving transgender people? What are we doing in terms of quality assurance for ACA? What can be done to provide care for undocumented LGBTQ under ACA?

56 Recommended Readings Online History of Migration and Immigration Laws in the United States Immigration Law ACA Enrollment Assistance for LGBT Communities Bipartisan opportunities to improve health policy LGBT Communities and the Affordable Care Act Findings from a National Survey BOOKS Lies My Teacher Told Me, by James Loewen Winner Take-All Politics, by P. Pierson and J. Hacker PAPERS Policy Dilemmas in Latino Health Care and Implementation of the Affordable Care Act The Affordable Care Act and Health Insurance for Latinos

57 Engaging Latinx LGBTQ communities in tobacco cessation and control Ruby Corado Founder & Executive Director October 14, 2016 Webinar

58 About Casa Ruby What we do? Who do we serve? Where are we?

59 About serving Latinx LGBTQ clients

60 What are the health issues among Casa Ruby s clients? (beyond sexual health)

61 What are the healthcare access issues among Casa Ruby s clients?

62 Why do Casa Ruby clients smoke?

63 Time to quit smoking!

64 About the Tobacco Cessation Funding About the cessation class: Number of people registered Number of sessions Moderated by DC Center Language of session Each session took place in Casa Ruby s

65 Benefits for participation Group support to quit smoking Peer-to-peer support Received treatment support DC s QUIT-NOW

66 Results Graduation rate was high Casa Ruby s front porch became smoking free after cessation class to support participants Participants are still smoke free Casa Ruby clients are asking for more cessation classes

67 Next steps Expand wellness programs Integrate cancer and tobacco control efforts to bring to our clients Working on an organizational-wide smoke-free policy Seek support from DC DOH Tobacco and Cancer Control Programs to expand offerings to clients.

68 Questions? Preguntas?

69 Contact Us Francisco Dueñas Director of Diversity, Inclusion & Proyecto Igualdad Yanira Arias National Campaigns Manager Ruby Corado Founder & Executive Director Paul Baker Senior Director for Programs National Alliance for Hispanic Health (202) Anthony Campo Education, Training and Outreach Manager Juan Carlos Vega (Moderator) Senior Community Engagement Manager