Session #3: Culturally Competent Care Learning Collaborative

hello everyone thank you again for joining the third session of the culturally competent learning collaborative hosted by the national center for health and public housing this is the third of four sessions on this topic if you are just joining us for the first time you should have access to the recording and the slides and handouts for the previous sessions through moodle and if you are joining us again thank you and welcome back my name is saki malik cho i am with the national center for health and public housing and since this is our third time together i'm just going to move through some of these background slides at this point you've seen them several times just a reminder the national center for health and public housing is a national training and technical assistance provider we work with health centers and housing authorities and other stakeholders to increase the access quality of care and improve health outcomes for public housing residents just uh some basic housekeeping items we would like for this to be a very engaging session and there are many opportunities to interact and we have the chat open and we are hoping that you use it throughout our time together feel free to add an introduction to yourself over the chat and while you're listening to the content today please add your thoughts and questions as they come to you so that when we get to the q a portion it'll be ready and if you have and if you see a question or a comment please by all means respond i will also be asking you questions through the chat periodically so please go ahead and open that chat box so you're able to view all of the discussion easily you can also raise your hand if you'd like to make a verbal comment but please meet yourself and only turn your mic back on when you're speaking again just a reminder of the contents of the welcome packet you should have received this when you register for the learning collaborative it has the main goal of this learning collaborative which is to assist health centers in the adoption of the class standards standards and to help health centers and providers treat the diverse patient population again my name is saki malik cho i'm the director of research policy and health promotion at nchph i'm joined by my colleagues fide sandoval our research assistant and dr jose leon our chief medical officer so together the three of us will be covering the fundamentals of cultural competency language access and community partnerships through a combination of case studies and didactic learning and and we're going to do that over these we did it for the past three session uh two sessions and then another two to go so the welcome packet has the dates and times for all of the sessions and it also provide some instructions on how to access moodle um you can that's where the recordings and the slides and the handouts are and all of the resources for these sessions oh i uh just briefly i know we had a little bit of technical issues with the moodle but i think those have been worked out so you should be able to have access to that now again you're able to receive continuing education credits by participating in this learning collaborative you have to register online and take a pretest and then the protest post test after each session the information on how to register in or in the welcome packet this is the last session that has cmes available so make sure you sign in and do the pre-test and post-test if you're interested in the continuing credits so just a brief recap of what we talked about last week last week we just we talked about the role of language and patient provider communication we talked about the legal and the policy requirements for providing language access services and we described some of the the business practice issues related to providing language access services and the costs of not doing it we also talked about the components of effective personal intercommunication the roles of an interpreter understanding the characteristics and the qualifications for assessing the competency of interpreters and we also talked about the importance of effective language access services with respect to written materials and then the components of the interview process and the factors that are necessary for providers to effectively work with interpreters so structuring culturally competent care this is the last of the sessions that are going to be talking about content again class standards is an acronym for the national standards for culturally and linguistically appropriate services in health care this is developed by the office of minority health and today's session is going to be a little bit different from our previous sessions but because we are kind of switching from the clinical setting to talking about cultural competency overall in the organization again each theme or each session consists of three lessons called modules and i'm going to be providing you with the learning objectives for each of the model modules as we move through so the first one is the importance of environment and climate so the the three learning objectives for the first module are listed here the office environment is is a really critical element for providing culturally competent care because it's not just the responsibility of health care personnel and and physicians but also staff and it's important to understand and assess your organization according to um sorry according to the principles of providing culturally competent care and and this will help you develop specific strategies to improve the clinical environment that serves the patients in your community and that's not to say that your office staff does not treat patients appropriately but we're just saying that it's everyone's responsibility to recognize situations that can be handled in a more culturally competent manner so we are going to start with a case study about um gabriel gadada he is an ethiopian immigrant who recently um experienced a heart attack and he is coming to the office to get assistance with health education in this community so fidei would you mind starting that video please [Music] can everybody see the video i think there's a mistake mr godadda has been dr rivera's patient and he's been seeing the cardiologist in blueville for months i'm not sure what's going on but he specifically asked to see you hmm burning in the chest heaviness and pressure some pain in the arm and shortness of breath and he had a heart attack he needs a cardiologist why me hello sir what can i do for you today dr johnson you know that the cardiology team at blue field is providing me medical care that is not why i'm here i'd like to speak with you and to man here's the thing while i was in the hospital i had time to sink and dr rivera was right about everything she said about my heart disease months ago i wish i had listened to her then but i felt i was healthy from all the work i did in ethiopia doctor there's a whole community of people from my country just like me or just like i was before my heart attack they smoke they eat bad food they never exercise i wish i could tell them all the things that dr rivera told me before my heart attack but i do not know how i need your help nobody feels that something like this will happen to them they think they don't have any control so they just keep on acting the way i used to act uh before i went to the hospital i wish i could change that well we'd be happy to see any one of them here in the office that is part of the problem my people do not feel welcome here that is why i come to you they need to see you people are not treated well here they're not made to feel welcome they feel as if this place has nothing for them here and many of my people don't speak english well enough yet there's nothing to help them understand what to do or what people are saying to them dr johnson would you come to a meeting with my community and teach them about heart disease i could translate for you people very badly need to know about preventing what happened to me mr gadata was a poor farmer who emigrated from ethiopia many years ago i came from a wealthy family and graduated from a prestigious medical school but differences aside i can't ignore a call for help why don't you give me some dates and i'll see what i can do we'll work around your schedule let me know when you are free okay thank you so much fidei i'm gonna turn to um dr leon and ask you dr leon what are your thoughts about um what you just saw thanks saki this is a great video and there are a few things that i would like to highlight first is uh the need that we have in the community to assess the uh the needs in our population uh it's very very uh [Music] needed to have uh health centers going to to the uh to different uh partners in the community to check what the needs are uh specifically regarding the population that you serve whether you need health educators you need to also see what the needs the health care needs are in your population and what preventive services you can offer from the health center perspective is very uh uh it is very important to notice that you also need some sickness and different um uh uh different uh things in the health center showing the that you offer uh your services in another language the uh the need to hire a patient with people within the community who are able to speak that language and so people feel that they are welcome to the health in this case to the health center and then the need as a provider to go beyond your your role sometimes you will be asked to provide some health education and promote a health education so uh those are those are the items that we have to consider and and even if you cannot do it as a clinician you need to have or you can use your your health educators or your uh or your uh promotors or use communion healthcare workers to to provide these services thank you so much dr leon so today we are going to discuss some strategies for assessing community health needs and building capacity to respond to those needs with culturally appropriate community health services [Music] so cultural competency needs to be fully integrated into the daily life and practice of an organization it needs to be grounded in an organization's identity how it recruits staff how it treats patients how it provides care and it needs to flow throughout an organization both from the top down and from the bottom up so the class standards eight and nine can help an organization integrate aspects of cultural competency into their daily practice i would say that it's important to be realistic in the goals that you set up and take them one step at a time assigning responsibilities and establishing clear measures of success each health center should perform a baseline cultural competency needs assessment and that self-assessment should focus on the capacities the strengths and the weaknesses of the organization and implementing the class standards these results should be reviewed and discussed to identify assets weaknesses and opportunities and also used to develop action plans that might include training and interpreter programs all staff must be trained and educated in various aspects of cultural competency because front desk staff are the first point of contact for patients miscommunications that are encountered there often carry over into the office visit so as soon as patients enter the office environment they may encounter attitudes and behaviors that aren't congruent with their perception of respectful health care and those situations may include delays and appointments due to miscommunication loss of revenue because families don't feel welcome at the front desk loss of referrals and reputation when families report to other people in their community about their negative experiences at the office and or a possible filing of grievances or reports of discrimination based on the treatment by clinical staff so the first bullet here on this slide mentions cultural sensitivity training for all staff and although there is no standard curriculum for this topic the office of minority health offers some suggestions about important issues to discuss including the effects of differences in the cultures of staff and patients during the clinical and other workforce encounters including the effects of the culture of american medicine and clinical training the elements of effective communication among staff and patients with different cultures and languages um including how to work with interpreters and telephone services and strategies and techniques for the resolution of um conflicts between staff and patients that might be due to racial or ethnic or cultural conflicts healthcare organizations grievance procedures and how they're handled developing cultural competency in an organization is a long-term task with many activities and developing a strategic plan that completely implemented over several years with interim measurements and evaluations of results can help make that task manageable information should be obtained from the organizat information obtained from the organizational assessment should be analyzed to identify areas for improvement the information can be used for strategic planning to address weaknesses and develop cultural competency throughout the organization the purpose of the strategic planning is to help an organization define and structure goals and activities and resources to achieve their objectives and developing cultural competency and providing culturally and linguistically appropriate services should be included as an integral objective in all healthcare organizations strategic plans and planning should be coupled with evaluation and a continual process to ensure the success of um to ensure success and improvement successful planning also includes other principles such as community input and involvement in the planning and the evaluation process and ongoing assessment that ensures the continual re-evaluation of the results directed towards even further improvement although the class standards provide guidance about strategic planning they don't suggest a connection between compensation and culturally competent care so in your handouts you have an office of environmental assessment checklist that will help you consider your organization in terms of culturally competent practice fide sent you an email earlier giving referring you to this handout with some questions and i just would like to take a moment to reflect on some of the themes that are covered in this checklist please take a look at the questions under the materials header does your office post signage in languages appropriate to your practice and the community as dr leon mentioned do videos or other media for education and treatment reflect the culture and the ethnic background of your practice does anyone have on this call have a successful technique for developing patient materials that you would like to share so i'm going to pause there and see if anyone um wants to comment in the chat or raise their hand and and speak verbally about anything that they do at their practice for developing patient materials that they would like to share and while we were waiting to see if anyone wants to share who's dr leon would you mind um uh letting us know what you would suggest for um developing patient materials the first time i saw this assessment uh came to my to my mind the uh 19 program requirements and i've questioned that we have many health centers very familiar with the versus 19 requirements and the signage i know and all the other instructions are are part of the 19 program requirements so um it's very important to match the needs in the community with the 19 program requirements so you can offer uh the uh health services that you that your population needs but at the same time you are you are being um you you you also have everything that you need when you have a side visit and and and you can provide uh that you are uh that you are doing uh your 19 program requirements as well the other thing is that sometimes it's very difficult and and i understand this issue that to translate materials specifically uh if you are looking for something uh follow for a chronic medical condition and um we've been discussing uh uh when we had the first and second sessions that uh sometimes you can go to the federal agency's websites and cdc provides a lot of fact sheets and materials in several languages that you can use to promote uh uh some prevention preventive measures for some patient with some chronic medical conditions or if they need any other services you can also go to nih and it has some very good materials translated specifically if you're looking materials for your patients with diabetes so those are the uh the strategies if you cannot translate the materials and also also make sure that you contact or you have at least some kind of communication with your state health department they also provide materials in other languages that's a good point thank you dr leon okay um now we're going to move to the second module and fide is going to give us the overview for this section all right thank you so much saki and dr leon so in the next section of this presentation we're going to talk we're going to highlight some approaches to assess in your community so this module discusses the importance of data collection and analysis and strategies for using and managing data so through our next poll question um please let us know how many of you are currently collecting some form of data about your community in in your practice area so are you currently collecting demographic data about your community all right so 89 percent uh said yes and 11 said no it's very interesting all right so to set the stage for discussing community assessment and achieving a greater understanding of health trends and issues in your practice area we're going to view a case study featuring a four-year-old named holly ivy give me one second this is ivy she's been to the emergency room three times in the past month why can't these parents just learn to give their kids the medicine like they're supposed to i don't envy mrs ivey she cleans houses for a living and on a meager salary she can't afford daycare for her daughter so she brings her to work as if having asthma wasn't enough poor girl has to tolerate dust dirt all manner of cleaning chemicals on a daily basis holly it looks like you have had some adventures at the hospital since the last time i saw you i brought her to work one day and let her play outside i was cleaning the walters house they are big smokers her breathing sounded so bad that i brought her right to the emergency room then the other time i had forgotten to bring the medicine they gave us i brought it to the walters house again and she was short of breath so i brought her back to the emergency room just in case why didn't you bring her to see us after the first emergency room visit i had to leave work early and i didn't get paid and then the car was broken before that and i spent all my money fixing it without my without my car i can't work we just didn't have the money to come here we can't pay the emergency room bills either i just tell them that it's true what was the third emergency room visit i was breathing and it sounded funny i get really scared and i couldn't breathe even more has holly been taking her medicine we tried a while but she still has a tax you've got to give me something to cure it i can't stand to see her suffer so much when she tries to breathe mrs ivey holly needs to take her medicine i know it takes a while but you need to make sure that she takes it we also need to find out what triggers her asthma like smoke exposure and we need to try to manage it that way too i'll tell you what can you can you come into the office next week i'm going to explain to you then how to manage holly's asthma in the meantime you've got to make sure that she takes her medicine oh and and mrs heidi i'll have our staff check into something for you before your next visit remind me next time next week there are children there are children's health insurance for children with our children and i'm quite sure that holly would be eligible dr leon um if you were holly's doctor how would you have helped her sorry i was i was muted uh there are a couple of uh things here that we have to to analyze first is that as a clinician or someone who is taking care of a patient also needs to consider the social social determinants of health affecting uh your patient either the patient is underinsured or has no insurance uh that's going to be a a big issue whether your patient in this case is either unemployed or just is working part-time so those are other uh things that you have to consider when you are when you are with a patient it's very important to notice as well that you need to know your community in this case um our experience with public housing is for instance uh a recent uh publication uh a hot cdc publication shows the thirty 30 one-third of those living in public housing are currently smokers so that that's another issue that you need to know that you have that's the reason why you need to assess the needs in your community and what are and what the issues are and the other factor in public housing for instance is lead exposure these are usually old buildings and you need to make sure that you know everything not only the determinants of hell but the environmental issues affecting the population uh i had the opportunity to work with uh with rural agricultural workers first for some years and you and they have or they are more likely to have kidney conditions for instance because they are under the sun for several hours working outside and and those are the things that you need to know as a clinician my recommendation and this is uh my personal recommendation is if you are new or if you have a uh someone of your staff who is new is always a good idea to go see the neighborhood you know and learn it it's going to give you a better perspective of the needs of your patients yep that's correct dr noun thank you so much so network next we're going to talk about why is data collection analysis important so collecting data on the use of on the use of and access to healthcare helps providers increase their understanding of existing disparities and develop strategies to combat them these are just a few reasons why collection and analysis are so important so can you think of any other reasons from the ones that are listed here you might want to begin with developing a community profile to gain insights on the demographics of the community you serve in your materials you have a handout called data collection resources to help get you started and this will be in handout 3.2 so this information can assist you in developing individual practice profiles and needs assessments for the populations you serve class standards 10 and 11 provide direction on data collection and analysis on the next slide we will cover these in more detail so we talked about collecting data to develop to develop a community profile and needs assessment goes hand in hand with data collection these assessments also include summary profiles of healthcare conditions and needs and identify issues or concerns that require special resources or attention so for example individual data about language needs such as a patient's need for an interpreter should be available to those who can arrange for for interpreter services your office should have an intake and registration process that includes the patient's self-identified race and ethnicity country of origin and language spoken and this information should be also integrated into the organization's information management systems community members should be involved in designing and implementing data reports such as community profiles and needs assessments and community profiles include demographic information such as income levels and employment of the population um fiji do you mind if i ask you to pause for just a second i did see someone with their hand raised uh mr eugene noor um i am going to unmute your line and please um let me know if you have any comments you're self-muted if you can unmute your line you should be able to talk there you go i'm really sorry that was um done in error i really apologize oh no problem no problem at all um i did see somebody else with their hand raised miss sherry adams i'm going to unmute your line and if you want to unmute and let us know if you have any thoughts or comments perhaps that was an error as well okay sorry about that feta go ahead no no not a problem so if so now we're going to talk about um how about addressing needs to provide language services right so information about language access services is thoroughly covered in theme two however i would like to highlight a few points about organizational assessment in terms of providing oral and written language services as a reminder lep stands for limited english proficiency so it is critical to remember that individuals with limited english proficiency lep are protected by the 2003 office of civil rights decree which which states that any group who accepts assistance from hhs must take reasonable steps to provide meaningful opportunity for individuals with limited english proficiency to participate in hhs funded programs we recommend a four-factor organizational assessment to determine if your organization is taking the appropriate steps so the intent the intent of assessing these four factors is to offer a balance that insurance meaningful access to critical services for persons with limited english proficiency while not imposing under burden burdens on small businesses local governments or non-profit organizations so it is also important that when we collect data to protect patients rights we protect patients rights and privacy we can't mention patients rights to privacy without automatically thinking of hipaa regulations so hippa was designed to assure that an individual's health information is properly protected by while allowing the flow of health information needed to promote high quality health care and to protect the public's health and well-being hipaa also does not preclude collecting patient data but does not provide guidance on using the data so the identified information is basically information from which common identifiers have been removed command identifiers include name birth date and social security number summary statistics that are developed using only de-identified health information are often very useful to healthcare organizations and do not violate hipaa requirements also it is important that your office staff receives training so that they understand privacy procedures and keep patient records secure if they contain identifiable health information so careful planning can create efficiencies and reduce data collection costs especially in smaller practice settings so what data collection procedures have been implemented in your office has this been beneficial and you're also more than welcome to provide your response to that in the chat and would you recommend it to other practices as well so other sources for collecting targeted data from individual patients include interviews surveys and focus groups and we have now finished the material for the second module and we will move on to the last module in this theme of building community partnerships with dr cho okay thanks fidei okay so um this module provides information about forming partnerships in the community to assist in developing cultural competency and providing culturally competent care um i have a polling question fiji do you mind showing it i'd like to know how many of you are in practices that are involved in community health partnerships so feeding i see you have it so the question is are you involved in community health partnerships okay fida can you close that poll oh great everyone is perfect so um the three of learning objectives oh can you not see my screen there you go okay so the three objectives for this module is are first to describe the importance of developing health-related partnerships with the community to identify components of forming community health partnerships and then list the characteristics of the successful community partnerships and then to describe the benefits of including minority community members and health partnerships community health partnerships are relationships between two or more organizations to achieve common public health goals healthcare providers and organizations who work together can achieve common public health goals and this is particularly important for health centers that are located near public housing to improve care for public housing residents it's crucial that members of the community fully participate in giving out input to the strategic planning and the community interventions and participate in the community health partnerships there are many different potential partners in your community this slide highlights some of the folks that you might want to contact including other health care providers or health organizations state and local health departments but also other local state and federal agencies including housing authorities and non-profit groups because each partner organization has its own expectations for the partnership the partnering really has to benefit each each of the member organizations partners need to articulate the benefits they hope to achieve for their organization and they should design the relationship so that each member organization benefits from that partnership and partners should seek each other seek other partners that have a vested interest in the specific public health problem that's being addressed the real work of creating partnerships requires not just capitalizing on each other's strengths but also mitigating weaknesses for example keeping the number of partners manageable assigning tasks to small groups and streamlining administrative processes in your materials you have a handout that lists factors for successful collaborations it's handout 3.3 but the factors that are outlined for successful partnerships include a shared vision agreement on the mission goals and outcomes mutual trust and respect identified strengths and assets clear and accessible communication flexibility as well as processes that are based on the input of all partners partnerships with minority community members can assist providers in developing appropriate services in a more cost and time effective way building community relationships can provide valuable resources for language services or education about chronic diseases and other conditions for non-english speaking patients without help from the community it might be time consuming for a health center to identify and track demographic and epidemio epidemiological information so we're almost done with this last module i'd like to just summarize the content we just discussed in this session healthcare providers and organizations must work together with the community to achieve shared public health goals and partnerships include both soliciting input and demonstrating outreach behaviors a partnership should be structured to meet the needs of individual partners and to achieve the partnerships goals it's especially important that members of minority communities have full access to provide input and participate in community health partnerships one opportunity for engaging members of the public housing community is to go to the resident advisory groups or the resident leaders and the tenant groups that are or the program managers at the housing authority all of those are different avenues to get public resident input into into your activities so we're going to conclude this session by watching another case study where the members of the office make progress towards assessing their service area and reaching out to the community i hope this case study will provide you with some ideas for ways to approach your community assessment and partnerships in your offices and your health centers so fide can you please um load that one up okay linda why don't you go first i've been keeping track of a lot of patient data here in the clinic and i think we've got some major concerns that need to be addressed but the problem is we don't have the time or the money to do what's needed now i just simply looked at every chart that came across my desk for a few data items and kept track nothing too scientific but what i discovered is that many kids in this county have never been immunized and also a lot of kids mostly blacks don't have current immunizations or health insurance even though they'd be eligible for it for state insurance and many of them have asthma now i've been trying to train parents about asthma convince them to get their kids immunized and get them information on the insurance but i feel like i never leave the office and i'm still not making a dent in the problem i need some help i've got the same problem mr godadda wants someone to help teach the ethiopian community about heart attack risk factors and healthy living there's no doubt they need it but i just don't know where to find the time i've been doing some research myself our ethiopian population has significant percentages of untreated high blood pressure very high cholesterol and obesity apparently they believe that the heart regulates the body through heat and they don't need to be too concerned about anything relating to blood okay then what are you suggesting well i was wondering if we could do some research into patient education maybe talk to the health department or the community college in blueville to see if anybody could help us if we could get an asthma education program together maybe we could teach some classes or or train others in the community to mentor others in managing their kids asthma exactly what about um talking to a foundation or maybe we could get a student intern to help by determining where we should target our efforts sounds like it might cost some big bucks yes but if you consider all the time that we spend on explaining the same thing over and over i think it would benefit us in the long run if we did some patient education now plus i bet there are some great materials that are available to us for little or no cost we just have to find them you know the hospital might be interested in helping too they'd probably love to get parents to manage their kids asthma and they'd certainly love some help in getting the kids insured there's one more thing about cost i think we're losing patience i know for sure we're losing a large ethiopian patient population because we can't provide them with the services that they need it's a simple problem on the surface they just need basic training in proper diet exercise and heart health but the problem is it has to be in their language all right well since you seem so enthusiastic about this i think we should take a day away from the office to come up with a good strategic plan for dealing with this i mean if we're going to do this let's do it right all right let me write some of this down all right first of all i think we need to get some community leaders into the office and um to see if they can't get the minority communities okay can you see my screen okay hold on okay so i just want to add um to what the conversation that the folks were having around the round table we talked a lot about members of racial and ethnic minority groups but another strong culture at least in our health centers is the public housing community in the public housing culture and another important level of information to gather is whether or not um your patient is a public housing resident and what the housing status um is for your patients and looking at that segment of your population for um prevalence of disease and chronic conditions and then and seeing what issues are most challenging for those public housing residents patients in your community i'm going to pause for a second and ask dr leon his thoughts about what we just heard in the case study and then go to q a go ahead dr lam thank you dr show this video reminds me a recent activity that we that we hosted we had a national um a national conference and uh we were talking about community partnerships and uh you were uh mentioning dr show about the need to go to different organizations in this case if you are a public housing primary care grantee probably you will have to go to the public housing agency or agencies or any other organizations that can help you with the services that you provide this one in particular was very interesting because um the the community health center was trying to put together a promo uh uh a health promotion program on on uh on a prostate cancer and they wanted to screen some patients and there were no place where they could do it so they contacted the barbershop and through everybody goes there and everybody had their hair uh done and all that stuff so they basically were providing uh to the appropriate population uh the uh health promotion and the uh and the education at the barbershop so uh you you need to be creative uh you need to go in addition to all the agencies that you work with uh um you need to see where they get together where they congregate and that's the reason why i said in the very beginning that if you are not familiar with the neighborhood go to the we'll go to the neighborhood look at where people go and congregate and you will find good ideas and so you can promote any of the either your health promotion activities or anything else that you have in mind uh just uh as a reminder as well dr joe has been work or is working right now and updating a toolkit on community partnerships that one is going to be probably ready by diana but probably by the f uh by early spring uh so uh that's something that you will be able to find on our website uh that is going to give you ideas on how to establish additional partnerships in the community great thank you dr leon does anybody else have any questions that they'd like to share you can do that either through the chat function or raising your hand and if not i would like to thank you all for your intention attention and participation in all of the sessions that we've had so far um again if you need to get cme credits you can go to the think cultural health website and obtain them there we will be sending an evaluation survey shortly after this it's very helpful for us to understand ways to we can improve our sessions and our next session which will occur on december 1st is really an office hours we're really hoping that this is an opportunity for you all to communicate with each other and share your best practices and challenges and and we can discuss some potential solutions for any challenges that you face um we will be inviting a health center to kind of talk through their efforts to improve cultural competency at their health center and so it would be nice i think to have that um health center perspective or real life perspective sharing and we would like to um invite you all too to um describe some of the things that you're doing in your health centers dr leon or fide do you have anything else that you'd like to add at the moment the other um community partnership and i know the health centers are working on this but this is not mentioned is uh the need to go to churches uh again those are where uh your patients congregate where the patients talk to each other where you will find a lot of information about the health status of your patients so um if you have a chws or or health educators that's another good place to go in the community great that's a that's a good inclusion anything else dr leon before we wish everyone a happy thanksgiving and we'll see them after the break for the last session no just to remind the audience to have uh happy thanksgiving a safe thanksgiving and follow the prevented measures next week as well all right thank you so much goodbye

Channel: National Center for Health in Public Housing

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Length: 53min 4sec (3184 seconds)

Published: Thu Nov 19 2020