latino outreach guide content

Latino Outreach Guide

Latino Outreach Guide Content Available at www.nhpco.org under ‘Communications’, and www.LIVEpartners.org under ‘Resources’

I. OverviewII. CaringConnectionsLatinoFocusGroups:KeyFindingsIII. HospiceCaringProject“MensajerosdeConfianza”CommunityPartnershipProfileIV. TipsforBuildingPartnershipswiththeLatinoCommunityV. OutreachStrategiesandActivitiestoEngagetheLatinoCommunityVI. KeytermsforLatinoOutreach-includesdefinitionsofculturalpracticesandproviderresourcesVII. AcknowledgmentsVIII. Appendix–SampleDocumentsfromHospiceCaringProject(HCP) a.MemorandumofUnderstandingBetweenHCPandPartners b.LatinoOutreachandEducationalPlan c.Agendafrom“MensajerosdeConfianza”InitialMeeting

Other Latino Outreach Resources – located on accompanying CD and online:

PowerPoint presentations—withspeakernotes(SpanishandEnglishversions)MakingEnd-of-LifeDecisionsHospiceCanHelpYouandYourFamilyOptionalphotographsandcliparttoaddtoPowerPoints

Ad slicks —forflyers,posters,newspapers,newsletters,etc.(SpanishandEnglishversions)CompassionateCareHelpLine,LineaCuidandoconCariñoPartnershipforparents.org,padrescompadres.org

Fact sheets for consumers—canalsoserveashandoutstocomplementPowerPointpresentationslistedabove(SpanishandEnglishversions–availableonlineonly)

End-of-LifeDecisions:ClinicalIssuesEnd-of-LifeDecisions:AdvanceDirectivesHospiceCarePalliativeCarePlanningforLongTermCareCopingwithLossTalkingwithYourChildAboutIllnessandTreatmentYourChild’sPainWhenYourChildDies:CopingWithGrief

•••

••

•••••••••

National Hospice and Palliative CareOrganization 2006 - 2007 Outreach Guide

I. Overview

AsthenumberofLatinoslivingintheUnitedStatescontinuestoincrease,itisvitallyimportantforhos-picesandend-of-lifecoalitionstoexpandoutreachandprogrammaticeffortstoensureLatinosreceive

qualityend-of-lifecare.NHPCO’sCaringConnectionshascreatedaLatinoOutreachGuidetoprovideyouwithideasandresourcestoguideyouroutreachefforts.WehaveincludedresourcesthatareinEnglishandSpanishtohelpyoureachouttoSpanish-speakingindividualsandcommunities.

In2005,HospiceCaringProjectofScottsValley,CA,formedaLatinocommunitypartnershipcalled“Men-sajerosdeConfianza”(“TrustedAdvisors”)toengagelocalhealthandhumanserviceprofessionalsinaconversationaboutend-of-lifecarefortheLatinopopulation.TheLatinoOutreachGuidehighlightsthispartnershipasamodelforhospicesandcoalitionswhowouldliketoexpandtheircommunityoutreachtotheLatinopopulation.

Pleaserefertothe‘KeyTermsforLatinoOutreach’documentwhichincludesphrasesorwordsyoumayencounterwheninteractingwiththeLatinopopulation.WhiletheLatinocommunityinthiscountryiscom-posedofmanydifferentculturesandnations,mostLatinosintheUnitedStateshaveMexicanroots.There-fore,wehaveemphasizedMexicancultureandheritageinthesematerials,whilerecognizingthattherewillbevariationsinmanycommunities.Aswithallsuccessfuloutreachefforts,thecharacteristicsofthecommu-nityorregionshouldalwaysbetakenintoaccount.

Asyoubegintoimplementyouroutreachactivities,pleasefeelfreetoadapttheresourcesincludedintheOutreachGuidetoserveyourspecificneeds,however,weaskthatyoucreditCaringConnections.Youcancontactusatcaringinfo@nhpco.organdwewillprovideyouwiththetextforyourcreditssinceourmaterialsarecopyrighted.


II. Caring Connections Latino Focus Groups:Key Findings

InMayof2006,LakeResearchPartners(LRP)conductedfourfocusgroupswithLatinosforCaringConnec-tions,aprogramoftheNationalHospiceandPalliativeCareOrganization(NHPCO).Thesefocusgroups

werepartofabroaderstudyaimedatinformingNHPCO’soutreachandcommunicationeffortstodiverseracialandethniccommunities.Sincethegoalofcommunityoutreachistoengagepeopleinend-of-lifediscussionsbeforetheyarefacedwithacrisis,thefocusgroupswereconductedwithmiddle-agedLatinoswhohadnotlostaloved-oneintherecentpastandhadneverhadalife-threateningillnessorinjury.TwogroupswereconductedinSpanish,inHouston,andtwowereconductedinEnglishinLosAngeles.

ThefollowingaresomepreliminaryrecommendationsfromthefocusgroupsconductedinMay2006.

Advance Care PlanningAlthoughthemajorityofLatinosareunfamiliarwiththeconceptofadvancecareplanning,advancecareplan-ningresonatedwiththeLatinocommunityandparticipantsfeltbasiceducationmaterialswouldbehelpful.Latinos,morethanotherAmericans,aremorelikelytohaveplannedforwhatwillhappenafterdeath.Theymayhavemadefuneralplans,purchasedlifeinsurance,orwrittenawill.Participantsdiscussedtheimportanceforfamilymemberstocometoconsensusaboutthecareoflovedones.

Amajorityoffocusgroupparticipantssaidtheypersonallywouldnotwanttobekeptaliveonlifesupport,butaremoredividedaboutwithholdinglifesupportfromalovedone.Brief,descriptiveresourcesonend-of-lifetopicsincludingartificialnutritionandhydrationareneeded.

End-of-Life CaregivingAbetterunderstandingofthetermcaregiverisneededwithintheLatinocommunity.FormanyLatinostheterm“caregiver”impliesaprofessionalrolesuchasthatofanurseorhomehealthaid.Familycaregiversmaynotidentifythemselvesassuchsincecaringforfamilymembersathomeispartoftheircultureandtradition.

HospiceItisimportanttoemphasizetoLatinostheimportanceoffamilyinhospicecare.SomeLatinoshavenotheardofhospice,andmanywhohavedonotknowmuchaboutit.Someequatehospicewithnursinghomes.NursinghomeshavenegativeconnotationsinLatinofamiliesbecausetheygoagainsttheculturaltraditionofthefam-ilyprovidingcareforthesickandelderly.Itwaswiththisfocusgroupthattheterm“compassionatecare”wasfoundtobemoreeffectivethan“hospice.”


III. Hospice Caring Project’s“Mensajeros de Confianza” Community Partnership Profile

HospiceCaringProject(HCP),ahospiceproviderthatservestheSantaCruzareainCalifornia,raised$170,000fromthreefundersforaneighteenmonth“ChallengeofChange”initiativeto:Learnaboutpreferencesinvolvingterminalillness,death,andbereavementforthelocalLatinocommunity,andDevelopaplanforlesseningbarrierstohospicethatwillenableHCPtosuccessfullydeliverend-of-lifecaretothiscommunity.

IttookasignificantamountoftimeforHCPtogatherinformationfromthelocalcommunity,createandexpandcommunitypartnerships,andbuildawarenessaboutend-of-lifeissuesinthelocalLatinocommunity.Fromtheirexperience,HCPfoundthat:

Itisimperativethatculturally-relevantpracticesandproceduresareintegratedintoallservices.Astronginternalcommitteeandastrongexternaladvisorycommitteemustsupporttheproject.Tobestidentifyservicebarriersanddevelopthemeanstoremedythem,thetargetcommunitymustbein-volvedinyourorganizationasapartner.

TherewereseveralstructuralchangesthatHCPmadeinordertoachievetheirobjectives.Specifically,HCP:Hiredbilingual/biculturalcliniciansandstaffwhenpossible.Createdanewbilingual/biculturalLatinoCommunityLiaisonpositiontocoordinateoutreachA high school educated Latina woman was hired who brought her ties to the community (fifteen years work-ing at a local clinic) and the right personal traits (an outgoing personality, compassion, and strong commu-nication skills) to the position. ActivelyrecruitedLatinoleaderstoserveonHCPboard.ProvidedculturalcompetencytrainingsessionsforallHCPstaff.IncorporatedgoalsandobjectivesforservingtheLatinocommunityintotheirstrategicplanensuringalevelofaccountabilitytotheBoardofDirectorsandthemanagementteam.IntegratedknowledgefromresearchconductedwiththeLatinocommunityandgainedfromcommunitypartnersintoday-to-dayoperationstoensurethatallHCPstaffworktogethertoprovidecompassionateend-of-lifecaretoLatinos.

Community PartnershipsHCPrecruitedthreekeypartners(anon-profitcommunityhealthclinic,anumbrellagroupforCatholicchari-ties,andanorganizationthatsupportswomenwithacancerdiagnosis)astheirprimarycollaborators.HCPestablisheda‘MemorandumofUnderstanding’withtheseagencies,agreeingtoshareknowledge,resources,andprovideHCPwithreferralstoLatinofamiliesinneedofhospiceandbereavementservices(seeappendix).

Mensajeros de Confianza (“Trusted Advisors”) Advisory Committee ThethreeoriginalpartnershiporganizationsservedasfoundingmembersoftheMensajerosdeConfianza,anexternaladvisorycommittee,thatgrewtoinclude28organizationsofdiversesizeandpurposewhoservethelocalLatinocommunity;amajorityofmembersareLatino.Establishingthethreeinitialpartnershipsgave

•

•

•••

••

•••

•

continued on next page


credibilityandimportancetothedevelopmentofMensajerosdeConfianza,andtheircommitmentencouragedotherstoattend,asdidfamiliaritywithHCP’sLatinoCommunityLiaisonfromherpreviousaffiliationwiththelocalhealthclinic.

Throughitsmonthlymeetings,MensajerosdeConfianza,hasbecomeanimportantresourceforHCPtoengagethelargercommunityoflocalhealthandhumanserviceprofessionalsinaconversationaboutend-of-lifeedu-cationfortheLatinopopulation.Importantly,MensajerosdeConfianzaevolvedintoacommunityforumforaddressingawiderangeofLatinoservicebarriersaffectingvarioushealthandsocialservicedisciplines.Adi-versegroupoforganizations,fromthemedia,business,andpoliticalcommunities,aswellastraditionalserviceproviders,arefullyengagedinsupportingeachother,educatingeachotherintheirrespectivecommunityroles,anddiscussinghowtheycanworktogethertoensurethatallcommunitymembersareequallyserved.

Family InterviewsTobegintheirfocusonLatinofamilies,theLatinoCommunityLiaisonatHCPandanexperiencedbilingualcounselorconducted8interviewswithLatinoswhosefamilymembershadpreviouslyusedHCP’sservices.Throughtheinterviews,HCPgainedinformationaboutend-of-lifebeliefs,concerns,andtraditions.

Intervieweesmadeitclearthatbilingualandbiculturalstaffmadeasignificantcontributiontotheirhospiceex-perience.Theydescribedculturalnuancessuchastheimportanceoffamilyunity,andfamilymembervisitingfromtheirhomecountryattheendoflife,inwhichcasetravelandimmigrationassistanceisveryimportant.AllintervieweesdiscussedtheimportanceoftheElNovenarioritual,commoninmanyLatinAmericancoun-tries,wherethebodyofthedeceasedisheldinthehomeforaminimumof24hours.

Lastly,intervieweesfeltthatanimportantwaytoreachtheLatinocommunityisthroughSpanishlanguagetele-vision,radio,anddiverseprintmedia.

Internal WorkgroupInordertoensurethatHCPincorporatedoutreachtoLatinosthroughoutitsstructure,aninternalworkgroupwasformed,composedoftheExecutiveDirector,DirectorofClinicalServices,DirectorofVolunteerServices,LatinoCommunityLiaison,bilingual/biculturalnurses,homehealthaides,andabilingualsocialworkerwhometmonthlytodiscusssystemsissuesrelatedtoservingLatinos.

Thepresenceofbilingual/biculturalemployeeswasveryimportantbecausetheyarethefirsttoknowifanap-proachthatHCPusesisbeingreceivedwellorshouldbereconsidered.TheInternalWorkgroupalsoaddressedmanyoftheissuesthataroseattheMensajerosdeConfianzaAdvisoryCommitteemeetingsandcontributedtothedevelopmentofcommunityoutreachmaterials.Inaddition,theinternalworkgroupdiscussedhowtobestserveLatinofamiliesusingHCPservices.

Culturally-Relevant Bilingual MaterialsAnotherimportantcomponentoftheoutreachHCPhasdonehasbeenretainingapart-timeSpanishlanguageconsultantforthepurposeoftranslatingHCPadmittanceformsandotherappropriatedocumentation,translat-ingrecruitmentinformationtargetingbilingual/biculturalpersonnelanddevelopingaSpanish-languageHCP



brochureandaccompanyingoutreachmaterials.ThisconsultantworkedcloselywiththeLatinoCommunityLiaisonandtheothermembersoftheinternalcommitteegearedtowardsLatinoinitiatives.

CommunityresearchandfamilyinterviewsrevealedthatmaterialsdescribingHCPservicescouldnotjustbetranslated;theyneededtobe“transcreated”(translatedtoensurethattheymakesensebothliterallyandcultur-ally)toaddresstheconcernsandend-of-lifetraditionsoftheLatinocommunity.MembersoftheMensajerosdeConfianzaadvisorycommitteecontributedtoareviewandadaptationofthematerials,drawingupontheirownagencies’experiencesandtheirbiculturalbackgrounds.HCPcreatedtwobrochures,oneinEnglishandoneinSpanish,tointroducehospicecareandthewaysinwhichHCPcanhelpattheendoflife.Additionally,theinternaltranslationgroupiscreatinga“photonovella”forlow-literacyLatinos,describinghospiceservicesthroughphotographsandsimpletext.

Building AwarenessAwarenessaboutend-of-lifechoicesisbuildingintheLatinocommunitythatHCPserves.TheongoingsupportoftheMensajerosdeConfianzaadvisorycommitteeandthepresenceofbilingual,biculturalstaffmembersatcommunityeventshavegraduallyraisedtheprofileofHCPandend-of-lifecareinthecommunity.Theexperi-enceofHCPemphasizesthatchangeisgradualandbuildingtrustwithaLatinocommunitytakestime.Theongoing,consistenteffortsofHCPhavemadecommunitypartnershipsflourishandavitaldiscussionregardingservicebarriersfacingtheLatinopopulationhasensued.

AttheconclusionoftheeighteenmonthprojectHCPiswitnessinganewdirectionintheirLatinocommunity—thereisgreaterawareness,collaborationandinterestinend-of-lifeeducation.HCPisbeinginvitedtoconductin-servicepresentations,participateincommunityeventsandpresenttheirexpertiseincommunityforumspre-viouslyunreceptiveorunknowntothem.

Forexample,inApril2006,HCPhostedarepresentativefromtheMexicanConsulateattheMensajerosdeConfianzameeting.Therichdiscussionfocusedonend-of-lifeissuesincludingthetransportationofbodiesbacktoMexicoandthechallengesofbringingfamilymembersfromMexicotobewiththeirlovedonesatthetimeofdeath.MembersoftheMensajerosdeConfianzahaveexpressedinterestininvitingtheINS(Immigra-tionandNaturalizationService)toattendafuturemeetingtohelpbuildawarenessandrelationshipsthatcanbenefitourcommunity.

Latino Outreach PlanUsingthefindingsfromthefamilysurveysandtheMensajerosdeConfianza,HCPdevelopedandimplementedawritten‘LatinoOutreachandEducationalPlan’designedtomeetspecificgoals,objectives,andoutcomes.(seeappendix).

Over250LatinoshavereceivedinformationdirectlyaboutHCPservicesthroughspeakingengagementsandin-teractionswithHCPstaffandvolunteersatcommunityeventsandanadvancedirectiveworkshop.CommunityeventswhereHCPhashadapresenceincludeaMexicanIndependenceDaycelebration,alocalwomanoftheyearaward,andLatinobusinessassociationmeetings.



Lessons Learned HCPfeelsthatevenwiththesignificantinternalchangestheyadoptedtoservetheLatinocommunityandthecomprehensiveapproachtheyhavetakentowardscommunityoutreachwithLatinos,thetargetedcommunitymustbereadytolearnaboutend-of-lifeissuestotrulyimproveaccesstocare.Itisimportanttobuildtrustaswellasawarenessinacommunityandthisprocessoftenhappensonefamilyatatime.HCPhasacknowledgedpastweaknessesinservingtheLatinocommunityandmadeacommitmenttolearning.

Throughthisinitiative,HCPhasbroughtawarenesstothefactthatmanyLatinosdoexperiencethebenefitsofhospicecare.ByfosteringacontinualandcompellingconversationabouttheendoflifewiththeMensajerosdeConfianza,HCPhasbroadenedandeffectivelyincreasedtheirvisibilitywithcommunityagencies,leaders,healthandhumanserviceprofessionalsandorganizationsservingtheLatinocommunity.Throughthesemeet-ings,HCPhasbeguntodevelopasafetynetofcommunityresourcesthatwillencourageLatinofamiliestoseekhospice,andalsohelpourlargercommunityofserviceprovidersenhancetheirmethodsofservicewithinthecommunity.

Formoreinformationcontact:SalimaCobbProfessionalLiaisonHospiceCaringProject(831)[email protected]


IV. Tips for Building Partnerships with the Latino Community

Build trustOneofthemostimportantthingsthatanyorganizationmustdowhenworkingwithaculturalcommunityforthefirsttimeistobuildtrust.Gainingthetrustofacommunitytakestime.Buildingtrustneedstobeyourmaingoalinbuildingpartnerships.BelowaresuggestionsthatcanhelpyourorganizationorcoalitiontobuildtrustwiththeLatinoCommunity.

Recruit a liaison to the communityOneofthecornerstonesofyouroutreachneedstoincludetheinvolvementofabilingual,biculturalpersonal-readywellconnectedtothelocalLatinocommunity.Thinkbroadlyaboutwhomightbethebestpersonforyouroutreach—focusonthepersonandhisorherqualitiesandskills,suchashisorhereaseofworkingwithpeople,ratherthanonlyontraditionalqualifications,suchaseducationlevel.Itisimportanttoassesshis/hercredibilitywithandaccesstothepeopleyouaretryingtoreach.Besurethepersonyouselectisrespectedinthecommunity.

Get feedbackSeekinputfromyourlocalLatinocommunityandinterviewfamilieswhohavereceivedhospiceservicesandlearnabouttheirexperiences.InordertosuccessfullyprovideservicestoLatinos,itisessentialforthemem-bersofyourLatinocommunitytodescribetheirexperienceswithhospiceandvoicetheirdesiresandconcernsaboutend-of-lifecare.

Below is a sample of questions that Hospice Caring Project used for their family interviews:How did you learn about Hospice Caring Project? From someone at the hospital, a friend or family member?What did you think when you first heard about hospice? How did the people from hospice help?What did you and your family most need when your loved one was in the last stage of her/his life? Personally, practically, spiritually? And afterward?What are the main traditions in México when someone dies? Which of these traditions do you consider that hospice should be aware of to better serve your family?What are some ways to take the message of hospice into Mexicano/Latino communities? Would you be willing to speak of your experience with hospice to help us tell others about our services?

Establish clear goalsAfteryouhavegatheredinformationfromyourcommunity,developcleargoalsforyouroutreach.OnceyouhavecollectedfeedbackfromtheLatinocommunity,goalsshouldbeformulatedandclearlystatedtoserveasaguideforyouroutreachprocess.IncorporateyourgoalsforengagingtheLatinocommunitytothestrategicplanofyourorganizationorcoalition.ThisguaranteesalongtermcommitmenttocultivatingrelationshipswithandservingtheLatinocommunity.Havingthegoalsinthestrategicplancanhelptoensureadequatetimeandattentionisgivenforprogramdevelopmentandfunding(seeappendix).

•

•••

••

••



Create an advisory committeeCreateformalrelationshipswithafewkeyserviceproviderstobuildbridgestothepeoplewhoneedyourser-vices.InordertodoLatinooutreach,formanAdvisoryCommitteecomposedofcommunitystakeholderswhowillassistyouinthedevelopmentofculturallycompetentservices.Toinitiatethisprocess,focusfirstonafewkeyserviceproviderswhowillbemostimportanttoyourwork.

Sincemostserviceproviders,especiallytheonesthatwouldbemostinfluentialandthereforethebestpartners,areverybusyandtheirtimeisvaluable,considerdrawingupaformal‘MemorandumofUnderstanding’(seeappendix)andsettingasideacertainamountofmoneyforeachorganizationfortheirservicesifpossible.AformalrelationshipcanbethekeyfactortoensureyourAdvisoryCommitteehasastrongstart,astheseorgani-zationswillbeyourinitialAdvisoryCommitteemembers.

Recruit community stakeholders:InviteorganizationsandinfluentialindividualstoalsojointheAdvisoryCommitteeafteryouhaveinitialmembersinplace.Doyourhomeworktolearnwhoisinfluentialinthecommunityandthenmeetwithpotentialmemberstoexplainwhatyouaretryingtoaccomplish.IndividualswhomaybeinfluentialintheLatinocommunityincludeclergy,thosewhoworkwithmigrantfarmworkers,unionorganizers,andlocalLatinobusinesses.Otherstakeholdersincludehealthandhumanserviceorgani-zations,thepoliticalcommunity(localtownandcountyrepresentatives)andpossiblyalocalforeignconsul-ate(example:ConsulofMexico).

Make meetings meaningful:ThefunctionoftheAdvisoryCommitteeincludesencouragingandacceptingtheiradviceforyouroutreach,reciprocallearningamongcommitteemembersandenablingthememberstocollaboratetobetterservethecommunityaswhole.AdvisoryCommitteemeetingsneedtobeatimetogatherinputfromcommitteemembersandtowelcomeadvicethattheyhaveforvariousaspectsofyouroutreachactivitieswhichcanincludequestionsaboutterminologytothebestvenuesinwhichforoutreachactivities.Itisimportanttoreportbacktothecommitteeaboutwaysinwhichtheiradviceandinputhasbeenusedtoshapedifferentaspectsofthecommunityoutreachyourhospiceisdoing.Meetingsarealsoanexcellenttimeforcommitteememberstolearnfromeachother,andtohavetimetodiscusstheirownorganization.Itmaybethecasethatbringingpeopletogetheraroundend-of-lifeissuesservesalargercommunitypurpose,iftherehasnotalreadybeenawayforserviceprovidersfortheLatinocommunitytocollaborateandcreateabetternetwork.Themorethattheattendeesaregainingfromthemeeting,thestrongertheircommitmenttotheAdvisoryCommitteewillbe.Therefore,lookingatthewidercommunitypictureshouldbenefittheCommitteeandyourorganizationorcoalition(seeappendix).

The following are suggestions from Hospice Caring Project on how to conduct a successful advisory committee meeting:

Provide food.Provide a convenient meeting time and place. Ask the group to decide on frequency of meetings.Meetings need to be participatory as well as educational. Have 1 or 2 service providers give a brief presentation about their organization during each meeting. If participants are comfortable doing this, ask them to give a quick update of what is currently a focus in their organization at the beginning of every meeting.Leave time for networking amongst attendees.

•

•

••

••

•continued on next page


National Hospice and Palliative CareOrganization

Always have at least one subject that you want advice on. Follow-up on past issues where ad-vice has been given and then let them know what you have done that incorporates their input.Convey as often as possible to the Committee that their expertise and participation is a greatly valuable asset to your organization or coalition.Send out minutes to those who attended and those who could not attend.

Stay connected: EmailcanbeaveryeffectivemeansofcommunicatingandstayingconnectedwithAdvisoryCommitteemembersbetweenmeetings.AskingadviceontheuseofaSpanishterm,orlettingmembersknowthatyourorganizationhadasuccessfulexperienceatanoutreacheventcandemonstratethecommitmentthatyouhavetousingtheAdvisoryCommitteeandlearningfromitsmembers.Carefuluseofanemaillistservcanhelptoreinforceyourorganization’scommitmentandserveasanotherwayofbuildingtrust.

Focus on relationships, not projectsInourgoal-orientedsociety,itisalltooeasytofocusonprojectgoals.OneofthegiftsthattheLatinocul-tureprovidestousistheremindertofocusonrelationships.Meaningfulrelationshipsalwaysprovidethebestresults.Sowhenyouaregettingtoostressedaboutyourallwork-relatedprojects,sitbackandenjoyyournewfriendsfromadifferentculture.ThisisthebestguaranteetosuccessfullybuildpartnershipsandimplementoutreachactivitieswiththeLatinocommunity.

SpecialthankstotheHospiceCaringProject,ScottsValley,CA,fortheirinsightsandcontributionstothisdocument.

•

•

•

•

2006 - 2007 Outreach Guide

V. Outreach Strategies and Activities to Engage the Latino Community

ThefollowingareexamplesofoutreachstrategiesandactivitiesthatwereusedbyHospiceCaringProject(HCP)andotherstoengagewiththeLatinocommunityaroundend-of-lifeissues.

Photonovella (Fotonovela) Createafotonovelatopromotehospice,advancecareplanningorothertopics.Afotonovelaisasmallbook-letinpicturestoryformwithnarrationwhichcanbeusedtocarryamessageoreducationalinformation.Afotonovelausesphotosratherthandrawingstoillustrateastory.InMexico,thefotonovelaisapopularwaytoconveyinformationaboutthingslikesocialnormsandhealthmessages,andisaneasywaytocommunicatewithpeoplewhohavelimitedliteracyskills.

Hospice Caring Project created a fotonovela that demonstrates hospice services in action and pro-vides information about how to refer someone to hospice care. The story begins outside the church after mass, where two women friends are talking. One woman asks her friend, the wife of a very sick man, “How are you doing?” The woman tells her story and her husband’s, and then her friend reacts by explaining what hospice is. The wife of the sick man later calls a hospice. The fotonovela illustrates the process of becoming a hospice patient, receiving services, the experience of the family and the support hospice offers following the death of the family member. Most of this is conveyed in pictures and there are also a few sidebars with information.

English as Second Language (ESL) Classes MakeconnectionswithlocalESLprograms.Theyoftenhaveguestspeakerswhocometoexplainaparticularcommunityorganization.ManystudentsinESLprogramshaverecentlyarrivedfromanothercountry,arearangeofagesandhaveavarietyofexperiences.Manystoriesaretoldduringaclassandthereforeitisagreattimetosparkadiscussionaboutcommunityresourcesregardingfamilycaregiving,hospice,advancecareplan-ningandgriefsupport.

ThepresentationsaredoneinEnglishbutsincestudentsarenotyetfluentinEnglishsomethingsareexplainedinSpanishtoensurethattheclasscompletelyunderstandstheinformation.ESLinstructorswanttoencouragestudentstopracticetheirEnglishskillsandfurthertheircomprehension,butalsowanttomakesurethepresen-tationsareworthwhileforall.

StudentsarelearningEnglishinordertogetjobs,andmanyhaveaspecialinterestinhealthcarejobs.Theywillgoontoworkinradiology,dentistry,hospitals,andskillednursingfacilities.Thesenewhealthcareworkersoftenbecomeresourcesfortheirfamilieswhentheyneedknowledgeonhealthrelatedissues.ByspeakingtopeoplesoonaftertheirarrivalinAmerica,youcanplantseedsabouthospice—educatingthemaboutaserviceavailableintheirnewcountry,andpotentiallyinterestingtheminworkinginend-of-lifecare.

Migrant WorkersManyLatinosintheUnitedStatesaremigrantworkers,especiallyinruralareas.OftenmigrantworkersspeakonlySpanishandhavesub-standardaccesstohealthcareandeducation.Usually,youwillbeabletofindlocalsocialserviceprogramsthathavebeendevelopedtoassistthem.Bypartneringwiththeseestablishedprogramsyouwillbe



associatedwithatrustedentityandthereforehaveaneasiertimeeducatingtheworkersaboutend-of-lifecare.Manymigrantworkersareyoungandhaveschool-agedchildren.Someschoolsystemshavedesignatedteach-ersoradministratorswhoworkwithmigrantparentswhoarenewtoaschoolsystemandmayrequirespecialattentionastheyenrolltheirchildren.IntheexperienceofHospiceCaringProject,meetingsofmigrantparentsorganizedbytheschoolareespeciallywellattended,andareagoodplacetoreachpeoplewithinformalpresen-tationsandliterature.

Spanish-language Newspapers and RadioManyLatinosreceiveinformationaboutlocalservicesthroughSpanish-languagenewspapers.ManySpan-ish-languagenewspapersarenotdailypapers—theymayonlybeweekly,biweeklyormonthly.ContactLatinoserviceprovidersinyourareatodiscoverwhichpublicationsmightprovideafreeorreduced-rateadvertisementonend-of-lifeissues.BecauseoftheextensivehealthcareneedsoftheLatinocommunity,somenewspaperpublishersmayhaveapolicyofallowinghealthorganizationsornon-profitgroupstoadvertiseforfree.

RadioisanothergoodwaytoreachtheSpanish-speakingpopulation.EvenifyourareadoesnothavearegularradiostationforSpanish-speakers,youmayfindthatthereareoneormorelowwattageradiostationsinyourareathatareimportanttotheLatinocommunity.Apublicserviceannouncementcouldbeanexcellentwayofreachingthisaudience,andagain,itislikelythatthestationswelcomePSAsfromhealthorganizationssincemanyLatinosdonothaveaccesstogoodhealthcare.

Hispanic PR WireHispanicPRWire,Inc.(HPRW)isaMiami-basednewsdistributionservicereachingU.S.Hispanicmedia,organizationsandopinionleadersnationwide.HPRWfeaturesacompletemenuofHispanicmediacircuitsthatincludestheoptionsofnational,stateandU.S.-basedPanRegionalLatinAmericadistributions.Inaddition,HispanicPRWireoffersspecializeddistributiontargetingLatinoorganizationsaswellasHispanicelectedof-ficialsandopinionleaders.

OntheirWebsite,www.hispanicprwire.com,goto“TopLatinoLinks”tolinktopopularmediaoutletsallovertheUnitedStates.HPRWoffersafreemonthlynewsletterviaemail,theHispanicPRMonitor.SignupisavailableontheirWebsiteor,sendanemailwithyourfullcontactinformationtohispanicprmonitor@yahoo.com.

Local Farmer’s MarketFarmer’smarketstendtobepopularwithmanyLatinos,especiallyrecentimmigrants,becausefreshvegetablesareveryimportanttothemandfamiliesalwayscookandeatathome.

Hospice Caring Project found that the local farmer’s market has a booth paid for by the County Health and Human Services that signs up local organizations to provide information. At their booth, Hospice Caring Project displays a photo board they created that illustrates the hospice circle of care with pho-tos of a local family as well as the Latino staff of HCP. Often the HCP booth has as many as 40 direct contacts each time they attend the farmer’s market, giving staff the opportunity to answer people’s questions and distribute written materials.



PharmaciesPharmaciesanddrugstoresareagoodsourceofhealthinformationformanypeopleandmanyLatinosrelyupontheirservices.SpeakwithyourlocalpharmacytoseeiftheywouldbewillingtohaveSpanish-languagemate-rialsavailableonend-of-lifeissuestodistribute.

Health ClinicsLocalhealthclinicscanbeanotherexcellentwayofreachingtheLatinopopulation.FindoutwhichclinicsinyourareaservetheLatinocommunityandasktodistributeSpanish-languageinformationormakeadisplayfortheirpatients.

Funeral DirectorsIntheLatinofocusgroupsconductedforCaringConnections,itwasrevealedthatmanyyoungerLatinosmakefuneralarrangementsinadvance.TalktolocalfuneraldirectorsinyourareaabouttheirexperiencewiththeLa-tinocommunityandseeiftheyhavedoneoutreachtotheLatinocommunity.Youmaybeabletopartnerwiththemtoprovideotherend-of-lifeinformation.

Ifyouhavesuccessfuloutreachstrategiesandactivitiesthatyouhaveimplementedinyourcommunityandwouldliketoincludeintheonlineversionofthisdocument,pleasecontact:

AshleyHammarth,MPHManager,PartnerProgramsandServices,CaringConnections/[email protected],703-647-6689


VI. Key Terms for Latino Outreach

Key terms that may help you with your outreach to the Latino community are defined below.

BiculturalApersonwhoisbiculturalispartoftwodistinctcultures,suchasMexicanandAmericancultures.Abilingual/biculturalLatinostaffpersonwillbeabletorelatemoreeffectivelytoLatinofamilieswhiledoingoutreachthansomeonewhoisjustbilingual.BiculturalstaffaremuchmoreadeptatbuildingtrustwithLatinocommunitiesthanpeoplewhoaresolelybilingual.

BilingualApersonwhoisbilingualisabletocomfortablyspeaktwolanguages,withequalornearequalfluency.

CuranderismoCuraderismoisaformoffolkhealingwhichincludesvarioustechniquessuchasprayer,herbalmedicine,heal-ingrituals,spiritualism,massage,andpsychichealing.ItisasystemofbeliefsthatiscommonthroughoutLatinAmerica.Likeotherformsofalternativemedicine,therearereportsthatthesepracticescanimprovesymp-toms,alleviatepain,andrelievestress.Hospicepatientsmaydesiretohavecuranderismoincludedintheircare.Somecuraderismopracticesarewellknownbylaypeopleandaredoneathome,butsometimestheadviceorpracticeofaspeciallytrainedhealer,acurandero/curandera,issought.

Day of the Dead (Día de los Muertos)TheDayoftheDeadisanimportantMexicanholidayandsocialritualthatrecognizesthecycleoflifeanddeath.ThisisafestivalthathasrootsinAzteccultureyetithasChristianovertones.EachyearonNovember1stand2nd,familieswelcomethedeadbackintotheirhomesandvisitthegravesoftheirlovedones.Ingen-eral,peoplefromurbanareasinMexicoarenotaslikelytocelebratethisholiday,butitretainsgreatimportanceinruralcommunities.ThetraditionssurroundingtheDayoftheDeadmayserveasanavenuefordiscussingend-of-lifeissues.

Familismo (Family)Latinosplaceagreatdealofimportanceonthefamilyastheprimarysourceofsupportandinformation.Helpandadviceareusuallysoughtfromthefamily,andimportantdecisionsaremadeasagroup.Medicalcondi-tionsandtreatmentareconsideredafamilymatter.

Fatalismo (Fatalism)Traditionally,manyLatinosviewanillnessaseither“natural”(causedbyGod’swillorfate)or“unnatural”(causedbyevildonetoonebyanother.)Ineithercase,apersonfeelsthatcontrolovertheillnesshasanex-ternalinfluence,andisoutofhisorherhands.Thisconceptofillnesshasledtoafatalisticviewoflifeanddeath—resultinginapersonfeelingthattheyhavelittletodowiththesuccessorfailureofanillness.ItissuspectedthatbeliefinfatalismmaybeinpartareasonthatLatinoshavehigherratesofadvanceddiseaseatthetimeofdiagnosis.



HispanicWhile“Hispanic”isawidelyacceptedtermandoftenusedinterchangeablywith“Latino”,“Hispanic”accurate-lyrefersonlytopeoplefromSpanish-speakingcountries.“Hispanic”isthetermcurrentlyusedbytheUSgov-ernmenttodefinecitizensofanyracewhosefamilyisoriginallyfromaSpanish-speakingnation.Incontrast,inLatinAmerica,theterm“Hispano”(Hispanic)oftenrefersonlytopeoplewhotracetheirancestrytoSpain,anddoesnotincludethoseofindigenousorAfricanheritage.Becauseofthesecomplexities,“Latino”(definedbelow)generallyseemstobethemoreflexibleandaccurateterm.Listentothepeopleinyourowncommunityandrefertotheirgroupwithatermthatpeoplefeelisaccurateandrespectful.

HospicioWhile“hospicio”hasbeenadoptedbythehospicemovementinmanySpanish-speakingcountriesaswellasbyUShospicesdoingoutreachinLatinocommunities,itisimportanttonotethattheterm“hospicio”canhavenegativeconnotationsforLatinos.Peopleunfamiliarwiththeconceptofhospicecaremayassumethat“hospi-cio”isabadplacethatisofnointeresttothem.

ThroughoutLatinAmerica,theterm“hospicio”hashistoricallybeenassociatedwithinstitutionsforthemen-tallyill,thementallyretarded,andthepoororhomeless.AwellknownmentalhospitalinEcuador,“HospitalPsiquiátricoSanLázaro”isknownlocallyas“elHospicio”.InMexico,theterm“hospicioparaninos”wastraditionallythetermforanorphanagewhile“hospiciodepobres”(literally,hospiceofpoormen)wasthetermforthepoorhouse.

SomehospicesintheUnitedStateshavechosentousetheEnglishword“hospice”inSpanishlanguagedocu-mentstodistinguishitfromthenegativehistoryof“hospicio.”

LatinoThistermisusedtodescribeanyonefromaLatinAmericancountry,whetherthepersonspeaksSpanish,Portu-guese,oranindigenouslanguage.ThetermLatinoismoreaccuratethantheterm“Hispanic”whichrefersonlytopeoplewhospeakSpanish.Whilebothofthesetermsarewidelyaccepted,manyLatinosareuncomfortablebeingtreatedasonelargegroup,sinceLatinAmericaisacontinentwithmanynationsandvariedculturaltradi-tions.Therefore,whileitisusefultousethistermtorefertoalargesubsetofpeopleintheUnitedStates,itisimportanttolistentothepeopleinyourowncommunityandrefertotheirgroupwithatermthatpeoplefeelisaccurateandrespectful.

El Novenario/ La NovenaThistermisaspiritualmourningritualthattraditionallylastsninedays.Traditionally,inLatinAmericancoun-triesthebodyofthedeceasedwasheldinthehomeforninedaysandfamilymembersprayedaroundit.Today,itisstillcommonforthebodytobeheldathomeforatleasttwenty-fourhourssothatthefamilycanprayandmourn,andthispracticeisstillimportanttoLatinosintheUnitedStates,especiallyinimmigrantcommunities.Afterthebodyisremoved,thebereavedfamilyattendsmassandpraysforninedaysfollowingthedeathofthelovedone.WhenservingLatinohospicepatients,itisimportanttounderstandwhatthefamilies’expectationsandneedswillbedirectlyfollowingthedeathofthepatient.(R.FalconandC.YoderFalcon:Salsa:ATasteofHispanicCulture,Westport,CT:Prager,1998.)



TranscreateTheconceptof“transcreation”isthatdocumentsshouldnotjustbetranslatedwordforword,butmustbetrans-latedtoensurethattheymakesensebothliterallyandculturally.Misunderstandingscanoftenoccurifmateri-alsarenottranslatedinaculturallyappropriateway.Latinocultureisnotmonolithic—Mexican,Cuban,andGuatemalanpeopleallhavedifferentdialectsandexpressions,andtherefore,itisimportanttobefamiliarwithyourlocalLatinocommunitywhentranslatingmaterials.

TranslateTranslationofdocumentsoftenmeanstranslatingsomethingwordforword.Withoutsomeonewhoisbiculturaldoingthetranslation,itiscommonforliteraltranslationstobeconfusingorwrongforthetargetaudience.

El VelorioThisreferstotheallnightvigilfollowingthedeathofalovedone.Itiscommonforfamiliestoeatanddrinkwitheachotherduringthisritual,butthetoneisstillsomber,oneofmourning.InLatinAmericanurbanareas,elveloriomaybeconductedatafuneralhome,butintheUnitedStates,itusuallyhastobedoneathome.(R.FalconandC.YoderFalcon:Salsa:ATasteofHispanicCulture,Westport,CT:Prager,1998.)


VII. Acknowledgements

CaringConnectionswouldliketothankHospiceCaringProjectofSantaCruzCounty,CA,fortheirinspira-tionandguidanceincreatingtheLatinoOutreachGuide.TheinputofAnnPomper,ExecutiveDirector,

andSalimaCobb,ProfessionalLiaison,hasbeenessentialtothisprocess.Their“MensajerosdeConfianza”programisamodelthatwecanalllearnfromtobetterserveLatinocommunitiesacrossthecountry.

TheNationalAllianceforHispanicHealthprovidedanincrediblepartnershipopportunitytocreatetheCom-passionateCareHelpLine,LineaCuidandoconCariño-anationalserviceofferinginformationinSpanishonend-of-lifeissues.WealsowouldliketothankthePublicWelfareFoundationfortheirgeneroussupportoftheHelpLine.WehopethatallofyouwilljoinusinthepromotionandpublicityofthisvaluableresourceforLati-nosinyourcommunity.(SeetheAdslickincludedintheOutreachGuide.)

TheChildren’sHospiceandPalliativeCareCoalitionspearheadedanddevelopedpartnershipforparents.org,thefirst-everonlinesupportnetworkforparentscaringforchildrendiagnosedwithaseriousillnessavailableinbothEnglishandSpanish.ThecreationoftheseWebsitesisadream-come-trueforallofuswhowanttoseepediatricend-of-lifeissuesacknowledgedandsupported.(SeetheAdslickincludedintheOutreachGuide.)

Mostofall,TheRobertWoodJohnsonFoundationofPrinceton,NJ,madethisOutreachGuideandallCaringConnectionsresourcespossible.Weareverygratefulfortheircontinuingsupport.

For assistancewiththeLatinoOutreachGuide,email [email protected] or call 1-800-658-8898.


VIII: Appendix a: Challenge of Change InitiativeMemorandum of Understanding Between Hospice Caring Project and ___[Partner]___

HospiceCaringProjectisdevelopingrelationshipswithMensajerosdeConfianza(trustedmessengerswithintheLatinocommunity)tohelpreachourgoalofcreatingculturally-relevantend-of-lifeinformationand

servicestotheLatinocommunity.___[Partner]___agreestoenterintoacollaborativeagreementwithHospiceCaringProject(HCP)byprovidingthefollowingservicesfortheChallengeofChangeInitiative.

Follow-upcounselingasneededforfocusgroupparticipants:HCPisconductingfocusgroupmeetingswithuptotwelvefamilieswhohavereceivedHPCservices.FamilymembersmayexperiencefeelingsofgriefasaresultofthesemeetingsandwillbeencouragedtocalltheHCPprogramcoordinatorifneeded.Ifthecoordinatorassessesthatcounselingisneeded,shewillmakeareferralto___[Partner]___.___[Partner]__willprovideuptothreecounselingsessionsatnochargetotheclient.Reviewoftranslatedmaterials:___[Partner]___willreviewtranslatedmaterials(postcards,brochures,let-ters),consultingonculturalrelevanceofmaterialspresentedtothecommunity.HCPand___[Partner]___willpartnertopresentin-servicetrainingonend-of-lifecareonceduringtheyear.Asystemwillbedevelopedanddocumentedforreferringappropriate___[Partner]___familiestoHCPwhenappropriate.

Funding: HospiceCaringProjectwillallocate$______forservicesprovidedduringtheinitialyearofthegrantcycle,and

anadditional$_____duringthesecondyear.

•

•

•

•

AnnCarneyPomper,ExecutiveDirectorHospiceCaringProjectSantaCruz

Date

[Representative/Partner]

Date


VIII: Appendix b: Hospice Caring ProjectLatino Outreach and Educational Plan

ThefollowingplanhighlightsHospiceCaringProject’splannedoutreachservicestotheLatinocommunity.Athree-yearagencystrategicplan,adoptedinAugust2005guidesthedailyoperationsofHCPservicesto

theLatinocommunity.Thefollowingmeasurableobjectivesandoutcomesoftheplanarereviewedandreport-edtotheboardonamonthlybasis.Additionally,methodsforincreasingLatinoshareofcensusandoutreacharereviewedquarterlyataqualityassessmentandimprovement(QAandI)meetingofmanagementandkeystaff.

IncreaseLatinoshareofcensusby10%peryearto30%in2008.IncreasethenumberofLatinovolunteers800%by2008.IncreasebilingualpersonneltomeettheneedsoftheLatinopatients.

Public EventsInformational Tables: LatinoCommunityLiaison,HealthEducatorandvolunteerstoattendeventsandcreateawarenessofHCPandend-of-lifeservices.

CincodeMayo–May5th(annual)–AllDayEventMexicanIndependenceDay–September16th(annual)–AllDayEventHospiceFoundationTeleconference(April)–Onceayear–AllDayEventCabrilloCollegeWellnessOutreachatWatsonvilleCampus–(twiceayearduringFallandSpringsemes-ters)AllDayEventNationalHospiceMonth(November)–DisplayatWatsonvilleHospitalWatsonvilleFarmersMarket(twiceayear)–HalfDayEvent

Major Public Event:DayoftheDead–November1st.EventwillbeheldincollaborationwiththeMensajerosDeConfianza.

Educational PresentationsIn-servicepresentationstoprofessionalstaffconductedannuallyClinics:

SaludParaLaGente(StaffandMD’s)LaPlazitaMedicalClinic(AllStaff)ClinicadelMar(AllStaff)ClinicaFamiliarCostaCentral(AllStaff)

Hospitals:WatsonvilleCommunityHospitalSantaCruzDominicanHospitalSalinasValleyMemorial

•••

••••

••

••••

•••



Agencies:WomenCARECatholicCharities

Community:MigrantRegionalParentMeetingLatinoBusinessAssociation(LocalBusinessandserviceagencies)St.Patrick’sChurchAssumptionChurchOurLadyofChristians

Media::EducationalPresentationsbi-annually

TV(Channel67)Radio(Telefutura)

Adsandpressreleasesasneededrelatingtoevents:SantaCruzSentinelRegisteredPajaronianLaGanga

Networking and Collaborative OrganizationsMensajerosdeConfianzaAdvisoryGroup(sixperyear)PajaroValleyChamberofCommerce

LatinoBusinessAssociationMeetings(monthly)Mixers(threeperyear)

••

•••••

•••

••••

••

••


VIII: Appendix c: Mensajeros de Confianza Advisory GroupHospice Caring ProjectChallenge of Change ProgramInitial Meeting

AGENDA

I. WelcomingbyAnnPomper,ExecutiveDirector(threeminutes)

II. GoalsandObjectivesofmeeting-LupeMendoza,LatinoCommunityLiaison(twominutes)

III. SelfIntroductions–Everyone(15minutes)

IV. HospiceCaringProjectServices-SalimaCobb,ProfessionalLiaison(10minutes)

V. ChallengeofChangeProgram-LupitaMock,RegisteredNurse/LupeMendoza,Latino CommunityLiaison(15minutes)

HowdidChallengeofChangeProgramStartandWhy?RolesandResponsibilitiesofExternal/InternalGroups

(MensajerosdeConfianza/HospiceStaff)Goals/Objectives/AccomplishmentsofProgram

VI. UpdateonLatinoFamilyInterviews–CathyConway–DevelopmentDirector(10minutes)

VII. MensajerosdeConfianzaAdvisoryGroup-Everyone(45minutes)Whathasworkedinyourcommunity?Whatcanwelearnfromyou?HowdoyouwanttobeinvolvedinhelpingHospiceCaringProjectbuildtheircapacitytoservetheLatinoCommunity?

VIII. DevelopMeetingCalendarforMensajerosdeConfianzaAdvisoryGroup-2005-2006(threeminutes)

IX. ClosingRemarks–AnnPomper/LupeMendoza,LatinoCommunityLiaison(twominutes)

••

••

•••
