Successful
Service Delivery Strategies
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A Dementia Network Serving Latinos
Developed by the Los Angeles Alzheimer's Association and the California Department
of Health Services
Of the nine million persons who reside in Los Angeles County, about 36 percent
are Hispanic or Latino. The east and southeast sections of Los Angeles County
have 54% of California's Latino population and nearly a fifth of the nation's
Hispanics. Yet the Latino community in Los Angles was not being served by the
existing dementia programs. There were no dementia specific services targeting
Latinos in the geographic area.
Initial discussions between state and local providers of aging services had been
ongoing for approximately a year and a half prior to the award of an Alzheimer's
Demonstration grant. These early discussions helped partners identify their roles
and needs. Partners included California Department of Health Services, the Los
Angeles Chapter of the Alzheimer's Association (lead agency for the grant), the
Department of Mental Health, the Department of Social Services, the Department
of Aging and local provider agencies.
For the project to succeed, trust had to be built among the partner agencies
and ways had to be found for the partner agencies to work together. All partners
had to be honest about the resources they could bring to the partnership, and
they had to be honest about the promises they made. It was essential that organizations
not promise services or resources they could not deliver.
The need for trust was also evident when the partnership agencies met to discuss
continuing the El Portal project beyond federal grant support. This required
each partner agency to discuss its own grant funding plans and to collaboratively
agree on which foundations would be approached for support for the whole project
and which would be most likely to support individual components of El Portal.
Without the trust that had been developed among all partners, this level of disclosure
would not have been possible and the continuation of El Portal would have been
in jeopardy when the HRSA funding ended.
To develop services in the Latino community, providers of dementia services set
out to become more familiar with the Latino community on the east and southeast
side of Los Angeles. Project meetings were held in the target area to familiarize
all partners with the community being served.
One aspect of the program that proved essential to success was the designation
of a key staff member from the Department of Mental Health as the Director of
the El Portal program. This person spent one day a week in the Los Angles Alzheimer's
Association chapters headquarters. This person is a well-known and respected
member of both the Latino community and the service-provider community. This
strategic integration of staff provided an effective means for teaching the staff
of the Alzheimer's Association and the dementia providers about cultural beliefs
and differences within the Latino community. It helped the project gain the trust
of the Latino community and gave the project an entrance to the network of mental
health providers.
Initial service efforts focused on educating local professionals and providers
about dementia issues. Media were widely used to reach the community. Press conferences
were held in the Latino community. Advisory groups were developed for outreach
efforts and to help inform the community about dementia. These advisory groups
included clergy, representatives from local businesses, caregivers and service
providers. Pharmacies agreed to insert El Portal postcards in prescription bags.
These postcards allowed potential clients to use a toll free number to ask for
more information or for help on specific problems.
El Portal staff provided on-going technical assistance to partners during start-up.
Partner agencies hosted educational events for caregivers and the general public.
Brochures were developed with full participation of partner agencies and caregivers.
Groups met monthly to assess the content and format of the brochure materials.
Representatives of six different Spanish-speaking cultural groups in the target
area reviewed the materials for clarity.
The initial, critical barriers to partnership were lack of knowledge and awareness.
At the beginning of the project there was a general lack of awareness of the
extent of dementia in the Latino community. Additionally, there was significant
cultural resistance to acknowledging dementia as an illness. Since Latinos were
very conscious of privacy issues, dementia was stigmatized in the community.
In general, service providers were not familiar with the Latino community culturally
or geographically. Also, because of citizenship issues, some Latinos are apprehensive
about government agencies and services. In working with Latino elders without
citizenship, eligibility for service from government programs becomes an issue.
Ongoing, supportive technical assistance provided an effective means for increasing
service capacity. Training sessions went both directions between El Portal staff
and providers. Each side had expertise to offer to the other. The goal was to
use the services that existed and enhance them through additional training and
communication. For instance, staff identified a need for training on how to work
with families at risk for violence and how to identify a potential violent situation
where a client might be a danger to self or others. Caregivers were offered training
on how to address combative behaviors.
Quarterly audits provided a structure to keep everyone informed about unmet needs
and new service needs. Strategic planning and steering committees met regularly
to identify and address service issues and how best to support the providers.
In addition to developing services in the Latino community, El Portal has trained
Care Advocates to assist Latino elders and their families in accessing available
existing services. Care Advocates are bilingual and bicultural and are from the
community. Care Advocates sometimes accompany case managers on home visits or
go with clients to service agencies. Care Advocates are also trained to address
the family's care needs. They have skills in identifying needs, providing dementia
education to caregivers and helping with translation.
The overall costs for developing El Portal were substantial, given the magnitude
and array of services that were newly created and the cost of doing business
in Los Angeles. If one looks only at a dollars-to-clients-served ratio, the program
may appear costly. But the true outcome of the project is the dementia service
network. It is difficult to put a dollar value on such a network. Thus, looking
only at the number of clients served is somewhat misleading. Networking, discussion
sessions, partner-building activities and trust-building efforts all take time
and money before a project can begin to reach an under-served population. These
up front costs should be amortized over the life of El Portal.
About one-third of the annual budget was earmarked for respite subsidies to families.
The average annual cost per bilingual care advocate was $50,000. Legal services
were approximately $22,000 per year. Day care centers that offered respite two
or three days a week cost $20,000 per year.
At the midpoint in the grant funding, partner agencies formed a work group to
collaborate on maintaining the program after the Alzheimer's Demonstration funds
ended. Collaborative grant writing and funding requests have generated $800,000
so far and other initiatives are currently pending. Additionally, there are plans
to increase the service area to include four more cities. The initial Alzheimer's
Demonstration sites are now positioned to receive state funds as the Department
of Aging looks to increase the number of day care sites in the area.
Keys to Success
1. Partners had a commitment to serve caregiving families.
2. Partners were willing to examine their own beliefs and cultural misunderstandings.
3. Partners made a commitment to serve and to collaborate.
4. Partners were willing to learn and accept their limitations.
5. Partners viewed the program as a means of building a dementia services network
that would ultimately reduce service costs.
Contacts:
Administration on Aging
330 Independence Ave.
Washington, DC 20201
(202) 401-4547
Rosa Ramirez
Alzheimer's Association
5900 Wilshire, Suite 1710
Los Angeles, CA 90036
(213) 938-3379
Other Projects that Serve Latino Populations
Dawn Harlock
Florida Alzheimer's Demonstration project
Office of Volunteer and Community Services
Dept. of Elder Affairs
4040 Esplanade Way, Suite #260
Tallahassee, FL 32399-7000
(850) 414-2060
Dalia Santiago
Puerto Rico Alzheimer's Demonstration project
Governor's Office of Elderly Affairs
Call Box 50063, Old San Juan Station
San Juan, PR 00902
(809) 721-3430
Hilari Hauptman or Lynne Korte
Washington Alzheimer's Demonstration project
Aging and Adult Services Administration
PO Box 45600
Olympia, WA 98504
(360) 438-8934
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