Healthy Start projects serve a culturally
diverse population. As a result, all projects
employ strategies to ensure a culturally
competent staff. Of the 95 grantees, 86
percent indicated that they hired staff
who represented the racial and ethnic
makeup of their target population; 64
percent provided cultural competence training/sensitivity
training; and 44 percent required contractors
to hire diverse staff that were racially/ethnically
similar to the target population. Whether
a grantee performed 1, 2, or all 3 of
these activities was distributed fairly
evenly, with 35 percent indicating that
they performed 1, 36 percent indicating
that they performed 2, and 28 percent
indicating that they participated in all
of these activities to ensure culturally
competent staff.
Seventy-four grantees indicated that
their target population included individuals
whose preferred language was other than
English (data not shown). Within this
group, the number of other languages spoken
was 1 or 2 languages (62 percent of grantees),
3 or 4 languages (20 percent), or 5 or
more languages (18 percent). In addition,
grantees reported a variety of ways to
communicate with their participants who
did not speak English. Of the 74 grantees
to which this applied, the grantees primarily
used 3 strategies: assigning participants
to Healthy Start staff who spoke their
preferred language (77 percent); enlisting
participants’ friends or family
members to translate (46 percent); and/or
contracting with outside agencies for
translation/interpretation services (30
percent).
More than one-third of grantees found
it challenging to ensure the cultural
competence of Healthy Start staff (data
not shown). The most frequently reported
challenge was a lack of culturally competent
applicants who met job specifications
(reported by 19 percent of grantees),
followed by strong competition in the
community for culturally competent staff
(18 percent). Only two percent of the
grantees indicated that there was inadequate
funding to hire culturally appropriate
staff.
Healthy Start participants have diverse
medical and social needs that can lead
to adverse perinatal outcomes if not addressed
during pregnancy or the interconceptional
period (up to two years postpartum). Thus,
a multidisciplinary approach to case management
is intended to ensure that people with
a variety of skills and experience are
involved in care coordination to meet
the needs of participants. Healthy Start
grantees employed case management staff
from a wide spectrum of disciplinary backgrounds,
including lay/paraprofessional (71 percent),
social work (66 percent), nursing (60
percent), and public health (14 percent).
The strong use of lay/paraprofessional
staff reflects their unique position as
members of both the community and the
Healthy Start staff. This dual role may
enhance the projects’ ability to
address cultural and language barriers
as well as obtain buy-in from the community.
Three-quarters of all grantees (74 percent)
employed case management staff from two
or more disciplinary backgrounds. The
predominant staff background was multidisciplinary
(45 percent), followed by social work
(22 percent), lay/paraprofessional (17
percent), and nursing (16 percent).1
Although lay/paraprofessionals represented
the most common type of case management
staff background, they were often part
of a multidisciplinary team. Data shown
in Figure 5 on page 5.
1Predominant case management
staff background is defined as
lay/paraprofessional, social work, or
nursing when a grantee
employeed 75 percent or more of their
FTE staff from a single
disciplinary background. Multidisciplinary
programs are those
in which no one single disciplinary background
predominates;
instead, they are staffed from a mix of
lay/paraprofessional,
social work, nursing, and other disciplines.
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