docRundberg Health and Wellness Initiative Deliverable Report: Focus
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Rundberg Health and Wellness Initiative Deliverable Report: Focus
Rundberg Health and Wellness Initiative Deliverable Report: Focus Groups to Gain Insight into Health and Health Care Perceptions Presented to the City of Austin for the Rundberg Health and Wellness Initiative Contract Supporting Documentation: Discussion Guide and Narrative Summary of Focus Group Findings Submitted By The Latino HealthCare Forum April 2015 Focus Group Discussion Summary Report Part of the LHCF community engagement process was to conduct focus/discussion groups in the geographic areas of the Rundberg area, specifically zip codes 78753 and 78758, to find out the perceived healthcare needs of the community. Findings from this effort are provided below: Focus Groups Discussions Groups were selected based on service area representation and the categories of age group, priority population, and key community service needs. It should be especially noted that the LHCF conducted the discussion group interviews using a modified focus group approach to increase effectiveness with low-‐income persons such as: • Recruitment is more effective if the target audience knows the recruiter • The facility needs to be considered safe and easy to get to • Offering an incentive for focus group participation • To ensure accuracy use taping and video recording • Bilingual moderator • Translators • Spanish, Arab, Burmese and English sessions • Allowing for children to accompany their parents Discussion Group Process LHCF conducted five (5) 2 hour community engagement discussion groups on February 18, 19, 20 and March 11 and 13, 2015. The LHCF Recruited 8 to 12 participants for each group with total of 37 who participated. • The Five (5) distinct groups consisted of: o (2) Spanish first language, mixed ages, recent immigrants with school age children receiving MAP, Sliding Fee Scale (SFS), Medicaid, CHIP o (1) English speaking, Latino, African American, Asian students ages 18, receiving Medicaid/CHIP, SFS, Medicare and private insurance. o (1) Burmese, recent immigrants with school age children receiving MAP, Medicaid/CHIP and Sliding Fee 1 o (1) Arabic, recent immigrants with school age children receiving MAP, Medicaid/CHIP, SSI, Sliding Fee. Discussion Group Procedures The LHCF community group discussion coordinator worked closely with a member of the Rundberg community attending AISD schools to coordinate group dates, times, and locations. There were five (5) community engagement discussion groups held at elementary schools throughout the Rundberg area. Two of the five (5) meetings were conducted entirely in Spanish. Each of the discussion groups was audio and video recorded and took about two hours to complete. Twenty (20) key questions were posed to the participants. The questions were designed to produce information of participant needs, desires, and wants for the Rundberg area in terms of health and healthcare. Each of the five (5) community engagement group discussions documentation included: a.) a community engagement group profile, b). an engagement group participant profile, c.) a signed consent form indicating the group would be audio and video recorded, d.) the observer’s notes, e.) the paraphrased responses from participants and an audio recording of the group and f.) a written report (See Attachment A) summarizing the group’s responses to the questions. GENERAL OBSERVATIONS FROM FOCUS GROUPS: • • • • Respondents were aware that their health status was poor in many cases and expressed frustration at not being able to access health care. The issue of trust surfaced from respondents along with the hope that they can be treated with dignity, made to feel welcome by friendly staff. The process of becoming eligible for MAP was described as a process with barriers seeming to discourage eligibility. Respondents consistently indicated and described the inability to communicate appropriately with healthcare providers due to language barriers and faulty translation practices across all settings. • Respondents indicated lack of cultural competent healthcare providers resulted in poor service delivery. 2 • The lack of specialty services were particularly noted by respondents. Some indicated the wait being up to a year. • Respondents acknowledged the need to improve their diet to include healthy foods. Factors such as transportation, low wages, housing, and immigration status were consistently mentioned as barriers to obtaining healthcare as well as being healthy. • 3 ATTACHMENT I FOCUS GROUP #1: Hart Elementary Spanish Speaking Group Feb. 18, 2015 1.-‐How long have you lived in this community? Cuanto tiempo ha vivido en esta comunidad? • Resident A has lived in the Rundberg area 7.5 years. • Resident B has lived in the Rundberg area for 1.5 years, Moved from Dallas. • Resident C has lived in Rundberg for 12 years, notable changes in traffic were mentioned. • Resident D has resided in Rundberg for 8 years. 2.-‐How do you get information about what is happening in your community, especially about health and healthcare? Como recibe información sobre lo que pasa en su comunidad? Especialmente sobre salud y el cuidado de salud? • Univision, usually stay at home and don’t go out. • News, T.V, Radio, Univision, Telemundo and Radio 104 FM. • Do not get information, I’m out of the loop. (Facebook and Text are a good form of communication with this group) 3.-‐What are the most important issues in your community? Cuáles son las cosas más importantes en su comunidad? • The community needs spaces to go out and walk. • Health is a community issue, there is an obesity problem, and the community needs more health education. • Safety for the kids, as they walk to and from school; sidewalks are narrow and cars go at fast speed. • More police patrol for school dismissal are needed. • Everything is important in this community -‐-‐ housing, health, safety, clinics, parks, open spaces. • El Buen Samaritano or other clinic should be built in the community. • Access to health Insurance is important. • There are safety concerns for residents in the area of Rundberg and IH35 and Stone Gate. • Residents have not heard of the Restore Rundberg initiative and have not seen much change, there is still a lot of unsafety. 4 • • Problems exist when people live in private gated property, as police take forever to get to crime scenes and then officers are unable to help. Residents feel frustrated with authorities. Community has changed and residents have seen a decrease of gang activity and prostitution, after the installation of the cameras in the area. 4.-‐Which issues are priorities? De esas, cuales son prioridades? • Residents are interested in seeing how moneys for the Restore Rundberg are being allocated. • More information in regards to meetings and community engagement notices are needed, in order for the community to participate and give meaningful input. • Residents have seen notices about meetings, around the Northwood Neighborhood Assn. and wonder if that effort could be broadend to the whole community. 5.-‐Which healthcare providers are you familiar with? Cuales proveedores del cuidado de salud está usted más familiarizado? • Community Care • El Buen Samaritano • Austin Regional Clinic • Carousel Pediatrics • Community Care Dental 6.-‐How do you feel about your healthcare provider? Qué piensa usted de esos proveedores? • Community Care Dental, takes forever to take anyone or even make appointments. • Aside from the Dental clinic issues, residents feel okay about the service. • Carousel has had many provider changes and that affects the patients, residents expressed concerns with misdiagnoses and left clinic for that reason. • 14 years as a patient of Community Care until changed to Lamar location, there is a lot of wait for appointments. • Bad diagnosis on child, had resident switch provider from Community Care to ARC. • Lack of translation at clinic has residents, frustrated; sometimes using phone translation is problematic. • Transportation is no longer an issue, as more residents have their own car. • Community Care don’t deny service to patients without MAP. 5 7.-‐When you go to the doctor or clinic, which is most important to you? A timely appointment, cost, distance/location, quality, location, or the doctor? Cuando va usted a un doctor o clínica, cual es más importante? Cita, costo, distancia, localidad, calidad o doctor? • Time • Location • Ease of appointments 8.-‐What barriers do you feel exist in accessing the clinic or provider? Cuales barreras existen cuando trata usted de ir a su clínica o doctor? • Community Care doesn’t have walk in service in the area clinics, patients are sent to further locations for those services. 9.-‐Solutions to those barriers? Cuáles son las soluciones para quitar esas barreras 10.-‐What features do you think are important to a clinic or provider’s space? En una clínica u oficina de doctor, que cosas son importante? 11.-‐What type of services would you like in your community? Qué clase de servicios le gustaría ver en su comunidad? • Open space and sports complex for community members, divided by age. • Trails for people to walk in the community or in new parks. • A new park, like Zilker Park; in the community. • A park with pools and basketball courts; with spaces for adult, youth and children. • There is no spaces to take the children out to play, they spend too much time watching TV. • Community members use school facilities. • Transportation is an issue to get to the parks. 12.-‐Is it easy for you to make an appointment with your healthcare provider? Es facil para usted hacer citas con su provedor? • It’s hard to make an appointment, long waiting times when you call the Community Care phone line. • Hard to make appointment to get MAP and card Clinic. • If you don't have a map card or card clinic, Community Care clinics will refuse service. • People without a card are not accepted for appointment. 6 13.-‐Do you use the emergency if you cannot get appointment with your provider? Usa la sala de emergencia si no puede ver a su proveedor? • No, not much. • If residents go to emergency room, services are delayed and really expensive; disappointing when residents are sent home with Tylenol. • High cost for emergency visits, prevents patients from going to emergency room. 14.-‐If you could talk to your healthcare provider, what would you tell them about services in your community? Si usted pudiera hablar con su proveedor, que le diría sobre los servicios en su comunidad? • Front desk staff at the Community Care clinics needs to be more professional and have better customer service skills. • Clinic staff needs to be better prepared to perform their jobs. • If residents don’t have insurance, Community Care denies services to patients. • Community Care staff gives bad service to patients, they need better customer service skills. 15.-‐ Do you think there is easy access to food in your community? • HEB has a good selection of foods. • Walmart is near the neighborhood. • Mexican stores have fruits and vegetables. 16.-‐ How do you think the transportation is working in your community? • Transportation it’s complicated, as they have taken out some bus lines. • There’s a lot of traffic around the schools, especially in the morning and at dismissal time. • In order to get to the clinic you have to take two buses, it’s a long route. • Residents have to walk a lot in order to get to the bus station. 17.-‐Do you feel there is enough and sufficient housing in the community? • There is enough housing, but it is really expensive. • Renovated apartment complexes are okay. • Trailer parks have neighborhood association regulations. • Apartments are getting really expensive, every time you start a new contract there is a $120.00 fee increase. • Housing is hard to come by, especially if you are undocumented; if you want to buy a house it's impossible without a Social Security number and legal status. 7 • If fathers are deported or incarcerated, the family suffers; due to absence of income 18. -‐ Do you believe Immigration status affects health in your community? • Lack of papers, prevents you from getting a good employment; the economic situation prevents you from accessing healthier foods and healthcare services. • Immigration status prevents you from getting well paid jobs, not having documents; limits the amount of money and limits your access to healthcare. 19. -‐ Do you think, there is a prevalence of mental health issues in your community? • In the Latino Community it’s hard to talk about Mental Health, it’s a hard to accept problems with selves or family members. • There is a general assumption in the community in regards to drug use, Mental Health issue is associated with the prevalence of drug and alcoholism use especially in the homeless community. • Alcoholism is a big problem in the community, even in apartment complexes and gated communities in the area. • There's a lot of public alcohol consumption in the area. 20. -‐ Do you believe the cleanliness of your neighborhood affects health of your community? • There are good code regulations in most apartments and gated communities, those regulations are good; they help keep the community clean and make for a healthier environment. • Public spaces and also neighborhoods are dirty, neighbors put trash out; city needs to pick all that trash. (Many times they don't do it). • More education for children are adults in regards to trash disposal, as well as containers are needed in this community. None of the residents in this focus group, have ever heard of the Restore Rundberg initiative. 8 FOCUS GROUP #2 LATINO HEALTHCARE FORUM RESTORE RUNDBERG HEALTH INITIATIVE COMMUNITY ENGAGEMENT GROUP #2 Guerrero Thompson Elementary Feb. 19, 2015 1.-‐How long have you lived in this community? Cuanto tiempo ha vivido en esta comunidad? • Resident A has lived in the Rundberg area 4 years. • Resident B has lived in the Rundberg area for 2 years. • Resident C has lived in Rundberg for 4 years. • Resident D has resided in Rundberg for 10 years. • Resident E has lived in Rundberg for 12 years. • Resident F has resided in Rundberg for 7 years, she has seen a lot of changes in the area; there have been less deaths and residents have seen a decrease in prostitution in the area. • Resident G has lived in Rundberg for 7 years, moved to actual Rundberg street 5 months ago; sees a big difference (a lot of homeless) • Resident H has lived in Rundberg for 9 years, the addition of the elementary school has made the area safer. • Resident F has resided in Rundberg for 6 months, her impression is that the area is not safe at all. • Resident F has resided in Rundberg for only a month and sees the need for services all over the community. 2.-‐How do you get information about what is happening in your community, especially about health and healthcare? Como recibe información sobre lo que pasa en su comunidad? Especialmente sobre salud y el cuidado de salud? • Univision, Local Spanish news. • News, T.V, Radio 104 FM and word of mouth from neighbors. • News, neighbors, friends. • Word of mouth from friends and family and Telemundo News. • News and Newspaper. • Community meetings with police, community flyers and T.V. (Facebook and Text are a good form of communication with this group) 3.-‐What are the most important issues in your community? Cuáles son las cosas más importantes en su comunidad? • Education, safety. • School, and ESL classes for adults. • Safety for all and education. 9 Safety is very important we need a decrease in robberies. Safety, education, health, clean and affordable housing. Education, health, transportation, there is a lot of traffic in the community Health, offices for Health and Human Services presently too far away from the community. • Need more traffic lights to decrease congestion. • Sidewalks are needed, especially around school zones. • Safety • More education for children and adults. 4.-‐Which issues are priorities? De esas, cuales son prioridades? • Education 5.-‐Which healthcare providers are you familiar with? Cuales proveedores del cuidado de salud está usted más familiarizado? • Seton • Community Care (Appointment needed) • El Buen Samaritano • People's Community Clinic • Carousel Pediatrics • Community Care Dental • Insurance through work (Spain based insurance) 6.-‐How do you feel about your healthcare provider? Qué piensa usted de esos proveedores? • I like Community care (Still need to work on wait times) • People's Community Clinic, gives a lot of good information. • Community Care at Breaker takes in average 3-‐4 hours before you are seen. • Community Care Dental program takes up to 3-‐4 months before you get an appointment, sometimes you lose coverage before you get an appointment; it turns into a vicious cycle. 7.-‐When you go to the doctor or clinic, which is most important to you? A timely appointment, cost, distance/location, quality, location, or the doctor? Cuando va usted a un doctor o clínica, cual es más importante? Cite, cost, distance, local dad, collided o doctor? • Timely (It takes hours to make an appointment over the phone and be seen at Community Care). • Location, as transportation is an issue; you have to take two buses and a trip that takes 45 minutes to get to the Community Care Clinic. • • • • 10 Ease of appointments 8.-‐What barriers do you feel exist in accessing the clinic or provider? Cuales barreras existen cuando trata usted de ir a su clínica o doctor? • Dental services need improvement, at Community Care. Dental extractions instead of fillings are the norm. • Dental services are limited in the community. • Community Care provides bad costumer service skills, especially front desk and M.A's. • Long waiting times at Community Care phone lines to do appointments. • There are many barriers, including the language barrier, not enough translators and providers don't use the translation line as it is very ineffective (Community Care). 9.-‐Solutions to those barriers? Cuáles son las soluciones para quitar esas barreras? • Create more full service clinics in the community. • Bring more dental services to the area • Provide more information about the rights of patients and how to advocate for themselves in the clinics. • Provide Customer Service skills training to the Community Care staff so they can perform a better service. 10.-‐What features do you think are important to a clinic or provider’s space? En una clínica u oficina de doctor, que cosas son importante? • A full service comprehensive clinic. • Childcare for children while you are at an appointment. 11.-‐What type of services would you like in your community? Qué clase de servicios le gustaría ver en su comunidad? • Big Community Park with an appropriate play escape. • More safety. • Trails for people to walk in the community or in new parks. • Alcohol and smoke free parks and recreational spaces. • People drink and use drugs in the park, there is a big need for safe places to do physical activity in the community. • A park with pools and basketball courts • There is no spaces to take the children out to play or safe wide sidewalks to walk. • Transportation is an issue to get to the parks. • 11 The streets and park facilities are not clean; they need to be cleaned by the city; more trash pickup is needed in the community. 12.-‐Is it easy for you to make an appointment with your healthcare provider? Es facil para usted hacer citas con su provedor? • Appointments take a long time, residents have to call a month before to do appointments at Community Care. • It’s hard to make an appointment, long waiting times when you call the Community Care phone line. • Hard to make appointment to get MAP and Clinic card. • If you don't have a MAP card or clinic card, Community Care clinics will refuse service. • Services at Community Care without appointment are hard to come by (you have to wait a couple of hours in case you are seen). • Dental appointments at Community Care are hard to come by, you need to call 3 -‐ 4 months in advance. • Customer service needs to be improved at Community Care Dental clinic. • Some residents have expected a wait of 6 months before their Dental appointment at Community Care. 13.-‐Do you use the emergency room if you cannot get appointment with your provider? Usa la sala de emergencia si no puede ver a su proveedor? • Not much only used it once this year. • Some community members reported no recent use of emergency room services. • Community Care walk-‐in locations have been given to patients, distance and transportation are an issue to access those services. • Residents try not to use those services much, due to cost. • It takes 4-‐5 hours to be seen in the emergency room. • Patients sometimes have to use the emergency room, due to lack of walk-‐in services in the clinics. • Patients have used emergency services due to misdiagnosis from Community Care providers. 14.-‐If you could talk to your healthcare provider, what would you tell them about services in your community? Si usted pudiera hablar con su proveedor, que le diría sobre los servicios en su comunidad? 15.-‐ Do you think there is easy access to food in your community? • There is a prevalence of fast food with unhealthy options in the neighborhood. • 12 • • • There are WIC classes offered to mothers of toddlers and infants, the vouchers given can be cashed for organic produce at farmers markets; the problem is that the produce is really expensive and there are no farmers markets nearby. Mexican restaurants lack hygiene and don't offer the healthiest options to eat. There are a couple of fast food places that offer healthier options. 16.-‐ How do you think the transportation is working in your community? • There is a lot of traffic in the area. • In order to get to the clinic you have to take two buses to get to the Community Care Rundberg clinic, it’s a long 45 minute ride. • It takes 3 buses to get to the nearest emergency room. • Residents have to walk a lot in order to get to the bus station. • Residents use mixed transportation, both bus and private vehicle. 17.-‐Do you feel there is enough and sufficient housing in the community? • Rent has gone up in price a lot. • In many apartment complexes, living conditions are not good at all; it is affecting the health of the residents. • Complains about the living conditions to apartment managers, are faced with unresponsiveness. • Rent usually goes up by $120.00, every day you are late with rent; there is an average of $50.00 surcharge. • Residents suggested reporting lack of management response to corporate offices. 18.-‐ Do you believe Immigration status affects health in your community? • Lack of immigration status, prevents residents from getting a living wage. • Due to low income conditions, residents lack access to healthy foods and healthcare services. • Many immigrants still face discrimination at work, they are unable to get jobs and secure a healthy living. • Many residents are only working part time, due to the implementation of Health Care Reform. 19.-‐ Do you think, there is a prevalence of mental health issues in your community? 20.-‐ Do you believe the cleanliness of your neighborhood affects health of your community? 13 There is lack of response from the City of Austin to clean up the community, there is a lot of trash in the streets and big trash items in the neighborhoods. • Rent keeps going up, but apartment complexes only paint the outdated properties; units pose a health risk to residents, • Residents are willing to join neighborhood associations in order to clean up their neighborhoods and have a safe and clean environment. • Due to weather conditions, age of structures and lack of cleanliness; apartment complexes are plagued with critters. Only one community member had heard about the Restore Rundberg Initiative. • 14 FOCUS GROUP #3 Hart Elementary Arab Group Feb. 10, 2015 1.-‐How long have you lived in this community? Cuanto tiempo ha vivido en esta comunidad? • Resident A has lived in the Rundberg area 10 months. • Resident B has lived in the Rundberg area 4 years. • Resident C has lived in the Rundberg area 6 months. • Resident D has lived in the Rundberg area 2 years. • Resident E has lived in the Rundberg area 6 years. 2.-‐How do you get information about what is happening in your community, especially about health and healthcare? Como recibe información sobre lo que pasa en su comunidad? Especialmente sobre salud y el cuidado de salud? • Word of mouth from neighbors. • From the clinic, using the translation line. • Word of mouth from friends and family. • Get information from friends and family. 3.-‐What are the most important issues in your community? Cuales son las cosas más importantes en su comunidad? • Safety, they want to live in a welcoming community' • Translation services when they call EMS or police (Service is really fast) 4.-‐Which issues are priorities? De esas, cuales son prioridades? • Safety • Education • Health access 5.-‐Which healthcare providers are you familiar with? Cuales proveedores del cuidado de salud está usted más familiarizado? • Carousel Pediatrics • Community Care Rundberg -‐for adults • Refugee Clinic • Brackendrige Hospital 15 6.-‐How do you feel about your healthcare provider? Qué piensa usted de esos proveedores? • Patients often feel frustrated with the Community Care Clinic at Braker, appointments take forever to be made and patients see the doctors for less than 5 min. • Patients keep going back and take medications and tests as requested by providers, sometimes after long time under treatment; they still don't receive information about diagnosis or feel better. • If patients ask questions about their conditions, providers deny information and blame patients of begin upset. • Community Clinic staff had been nice to them so far. • Carousel staff treats them well. 7.-‐When you go to the doctor or clinic, which is most important to you? A timely appointment, cost, distance/location, quality, location, or the doctor? Cuando va usted a un doctor o clínica, cual es más importante? Cita, costo, distancia, localidad, calidad o doctor? • Appointments are very important (Specially for chronic disease patients, currently diabetic patients are a month apart) • Diabetic patient (type I) was sent home, without medication and asked to comeback in a year. • Follow-‐ups are important, diagnosis from Migrant Clinic are not followed up thoroughly ( Hepatitis C patient sent to Community Care, sent home with prescription and was asked to come back in a year} • Cost is important, so far there is no cost associated with services. • Timely (It takes hours to make an appointment over the phone and be seen at Community Care). • Location, as transportation is an issue; you have to take two buses and a trip that takes an hour and a half to get to the Refugee Clinic. • Sometimes Community Care works with them to accommodate their schedules. • Ease of appointments 8.-‐What barriers do you feel exist in accessing the clinic or provider? Cuales barreras existen cuando trata usted de ir a su clínica or doctor? • There are many barriers, including the language barrier, providers use the translation line as it is very ineffective (Community Care). • Misdiagnosis and excessive appointments keep sending patients to emergency rooms. (Patient went to clinic four times in a month, ended up hospitalized for a week; currently under 10 medications and not feeling any better) 16 • Information in regards to conditions, results, treatments and instructions are not being given to patients. 9.-‐Solutions to those barriers? Cuáles son las soluciones para quitar esas barreras? • Translation services need to be in the language of the patient's primary language (Not all the Arab speakers understand the different dialects; providers need to ensure that the patients receive the right translation) • Create more full service clinics in the community. • Be able to communicate to find out about health conditions, then getting health back to go to work. • Someone needs to help patients navigate the healthcare system. • An appropriate translator based on the dialect of patient, needs to be provided at appointment time. • There needs to be an increase of Specialty care services in the area, it takes from 6-‐8 months to secure an appointment with an endocrinologist at this time. • Information in regards to conditions, results, treatments and instructions needs to being given to patients, in a language that they can understand. 10.-‐What features do you think are important to a clinic or provider’s space? En una clínica u oficina de doctor, que cosas son importante? 11.-‐What type of services would you like in your community? Qué clase de servicios le gustaría ver en su comunidad? • Appropriate play scape for children is needed in the community. • There are no spaces to take the children out to play or safe wide sidewalks to walk. • Transportation is an issue to get to the parks. • The community needs spaces s to do physical activity. 12.-‐Is it easy for you to make an appointment with your healthcare provider? Es facil para usted hacer citas con su provider? • Pharmacies are good here, medication is provided almost for free. • It takes a long time for you to make an appointment. • Daughter has problems with tonsils, after a lot of appointments and doctor visits; they refuse to take tonsils out. • System requires 6-‐7 visits before surgery, not in their native country. • Families not used to this kind of service, faster appointments and treatment in their country. 17 • Appointments with specialist are hard to come by, patients wait for months before they are seen. 13.-‐Do you use the emergency if you cannot get appointment with your provider? Usa la sala de emergencia si no puede ver a su proveedor? • Community members rarely use the Emergency room, due to distance and time. • One took daughtofer to ER, just to wait for hours and be referred to a specialist; they have been waiting for 2 months and they won't be seen until the end of March. 14.-‐If you could talk to your healthcare provider, what would you tell them about services in your community? Si usted pudiera hablar con su proveedor, que le diria sobre los servicios en su comunidad? • They need more specialist in the area. • The community needs a better way to make appointments. 15.-‐ Do you think there is easy access to food in your community? • There is plenty of food to cook with. • There is a lot of fast food with unhealthy options in the neighborhood, but the Arab community doesn't consume fast foods. 16.-‐ How do you think the transportation is working in your community? • It's hard to get to the emergency room • There is a lot of traffic in the area. • In order get to the clinic you have to take two buses to get to the Community Care Rundberg clinic, it’s a long 45 minute ride. • It takes 3 buses to get to the nearest emergency room. 17.-‐Do you feel there is enough and sufficient housing in the community? • Complaints about the living conditions to apartment managers, are faced with unresponsiveness. • Due to environment and dilapidated units, residents have to deal with all sorts of plagues 18.-‐ Do you believe Immigration status affects health in your community? • Refugees are provided with a Medicaid benefit for 6 months, after that; they are on their own. 18 • It's hard for them to get employment as refugees and that prevents them from getting health services. 19.-‐ Do you think, there is a prevalence of mental health issues in your community? • Many community members suffer from stress and fears, those issues are not being addressed by the system; due to language barriers. • It is hard to adapt to the new way of living, it's hard for fathers to be providers and they feel depressed and with a lot of anxiety. • Newly arrived residents are very worried about their home country and the communities left behind, they leave in fear of the future and stress and anxiety are the norm. 20.-‐ Do you believe the cleanliness of your neighborhood affects health of your community? • There is a lot of trash in the streets and residential areas. • Rent keeps going up, but apartment complexes only paint the outdated • properties; units pose a health risk to residents, • Due to weather conditions, age of structures and lack of cleanliness; apartment complexes are plagued with critters. No residents report hearing of the Restore Rundberg Initiative. 19 FOCUS GROUP #4 Woolridge Elementary Burmese Group March. 11, 2015 1.-‐How long have you lived in this community? Cuanto tiempo ha vivido en esta comunidad? • Resident A has lived in the Ruberg area 10 months. • Resident B has lived in the Ruberg area 3 years. • Resident C has lived in the Ruberg area 5 years. • Resident d has lived in the Ruberg area 6 years. 2.-‐How do you get information about what is happening in your community, especially about health and healthcare? Como recibe información sobre lo que pasa en su comunidad? Especialmente sobre salud y el cuidado de salud? • Word of mouth from neighbors. • Through T.V but they really don’t understand the language, just see the pictures and try to understand what the message is. • Facebook and social media are out of the question as very limited people have access or even know how to use it. • Newspaper is hard to use, as they don’t understand the language, sometimes community members translate for each other. • Normally do not know anything in regards to health until they experience health issues. • The only way they know that a checkup is due, is when they receive a letter; community members have learned the word “Check-‐up”. Once they get the letter they go to their clinic and ask for an appointment. 3.-‐What are the most important issues in your community? Cuáles son las cosas más importantes en su comunidad? • Translation services are highly needed as the language barrier prevents them from accessing services throughout all the systems. • Translation services when they call EMS, hospitals, clinics or police. 4.-‐Which issues are priorities? De esas, cuales son prioridades? • Translation services. • ESL education for adults. • Safety. • Education. • Health access. 20 5.-‐Which healthcare providers are you familiar with? Cuales proveedores del cuidado de salud está usted más familiarizado? • Community Care Rundberg -‐for adults. • Brackendridge Hospital. • MAP program. • Medicaid. 6.-‐How do you feel about your healthcare provider? Que piensa usted de esos proveedores? • Patients often feel frustrated with the Community Care Clinic at Braker, Phone line translation can be highly problematic; as translators might be from different regions. Translators and providers get very frustrated and limit interactions. • Patients feel they can’t even ask questions in regards to their conditions. • Patients keep going back and asking about the prevalence of weakness, to do tests as requested by providers; they still don't receive information about diagnosis or feel better and are told that everything is ok. • If patients ask questions about their conditions, providers deny information and blame patients of being upset. • Community Clinic staff had been nice to them so far, but the only way to communicate well with them is to bring their own interpreter. 7.-‐When you go to the doctor or clinic, which is most important to you? A timely appointment, cost, distance/location, quality, location, or the doctor? Cuando va usted a un doctor o clínica, cual es más importante? Cita, costo, distancia, localidad, calidad o doctor? • Appointments are very important. • Timely (It takes hours to make an appointment over the phone and be seen at Community Care). • Location, as transportation is an issue; you have to walk for 30 minutes instead of taking the bus. (It takes longer) • Ease of appointments. • Quality of service and care are important too. • We would like to eliminate the language barrier. • All the things are important. 8.-‐What barriers do you feel exist in accessing the clinic or provider? Cuales barreras existen cuando trata usted de ir a su clínica or doctor? 21 • • • • • • • • There are many barriers, including the language barrier, providers use the translation line as it is very ineffective (Community Care). The front staff tries to be helpful. Doctors are very inpatient, they don’t allow patients to explain their health problems or ask questions. Making appointments over the phone is extremely difficult, patients do not know what buttons to press to get to a language line. Instructions are not provided in their language. Patients need to go to the clinic and pay a translator to help them get appointments, it can be expensive for them as they have very limited resources. Information in regards to conditions, results, treatments and instructions are not being given to patients. Using the language line can be very challenging and patients and providers try to rely on hand gestures to communicate, it’s very ineffective. When going to the pharmacy, many times the patients are asked to call their doctor, they are unable to do it due to the language barrier; patients have to go back to the clinics and it’s frustrating and time consuming. 9.-‐Solutions to those barriers? Cuáles son las soluciones para quitar esas barreras? • Translation services need to be in the language of the patient's primary language (Not all the Burmese speakers, understand the different dialects; providers need to ensure that the patients receive the right translation). • Someone needs to help patients navigate the healthcare system. • An appropriate translator based on the dialect of patient, needs to be provided at appointment time. • Information in regards to conditions, results, treatments and instructions needs to being given to patients, in a language that they can understand. • Letters of diagnosis for children with certain conditions need to be done by the clinics, in order to get children in to special education sooner. (Otherwise kids wait up to 3 years, before receiving services. • It would be nice to have a translator on site, someone that can guide patients through the system; parents of children with disabilities need their parents to advocate for them. 10.-‐What features do you think are important to a clinic or provider’s space? En una clínica u oficina de doctor, que cosas son importante? • A clinic big enough to have more clients. • An office where you can apply for MAP, Medicaid and scale services on site. 22 11.-‐What type of services would you like in your community? Qué clase de servicios le gustaría ver en su comunidad? • Transportation is an issue to get to the parks. • The community needs spaces to do physical activity. • Community members don’t do any formal type of exercise. • An inexpensive form of YMCA, the current services are way over their price range. • Mom’s typically walk kids to and from school. • There is a need for park, so that families can go and play with their children. 12.-‐Is it easy for you to make an appointment with your healthcare provider? Es facil para usted hacer citas con su proveedor? • Families not used to this kind of service, faster appointments and treatment in their country. • Appointments with specialist are hard to come by, patients wait for months before they are seen. 13.-‐Do you use the emergency if you cannot get appointment with your provider? Usa la sala de emergencia si no puede ver a su proveedor? • Community members use the Emergency room, communication is a big barrier; the way phone lines for translators are set up it’s highly problematic (Not working, as patients sometimes need to scream due to the distance between the phone and the beds). • One took daughter to ER, getting an ambulance was really hard, due to issues with translation. 14.-‐If you could talk to your healthcare provider, what would you tell them about services in your community? Si usted pudiera hablar con su proveedor, que le diría sobre los servicios en su comunidad? • They need more specialists in the area. • The community needs a better way to make appointments, maybe add Burmese in the instructions. • They need better translation services and be more patient with the patients and have longer appointment. • More clarity on diagnosis, there is a prevalence of fatigue, weight loss and pain combined and residents are not given a definite diagnosis; they are sent home without prescriptions (Provider’s say that everything is ok). 15.-‐ Do you think there is easy access to food in your community? • We believe that foods are not very healthy, mostly depend on rice and very few vegetables. 23 • • • • • Kids don’t want to eat much vegetables, they prefer meat. Due to limited resources, their diet is mainly rice. There is a lot of fast food with unhealthy options in the neighborhood, but the Burmese community doesn't consume fast foods due to lack of money and language barriers. Foods stamps are limited, so the residents get the cheapest produce, they don’t know about organic foods. Parents supplement the food stamp moneys as much as they can, but report having from 3-‐5 children in average. 16.-‐ How do you think the transportation is working in your community? • Many community members walk instead, bus routes take very long and go only through main streets. • There is a lot of traffic in the area. • In order to get to the clinic you have to take two buses to get to the Community Care Ruberg clinic, 17.-‐Do you feel there is enough and sufficient housing in the community? • Complains about the living conditions to apartment managers are delayed but they take care of the housing issues. • Housing is very expensive, a 1 bedroom is $900, and many families with up to three kids live in those units; due to limited resources. • Some apartment units have been renovated and the conditions are not that bad. • Dog poop in the apartment complex open spaces and parking lots it’s a problem. 18. -‐ Do you believe Immigration status affects health in your community? • Good paying jobs are really limited for these refugees in the city, many Burmese immigrants have to carpool to Seguin to work. • It's hard for them to get good paying jobs as refugees, the transportation and food are costly and that prevents them from getting health services. 19. -‐ Do you think, there is a prevalence of mental health issues in your community? 20. -‐ Do you believe the cleanliness of your neighborhood affects health of your community? • Yes it does. • Dog poop is in the parking lot and open spaces at the apartment complexes. • There is a lot of trash in the residential areas. • Residents express concern for their health due to environmental factors 24 No residents report hearing of the Restore Ruberg Initiative. 25 FOCUS GROUP #5 Lanier High School Youth English Group March 12, 2015 1.-‐How long have you lived in this community? Cuanto tiempo ha vivido en esta comunidad? • Resident A has lived in the Ruberg area 18 years. • Resident B has lived in the Ruberg area 5 years. • Resident C has lived in the Ruberg area 7 years. • Resident D has lived in the Ruberg area 18 years. • Resident E has lived in the Ruberg area 7 years. • Resident F has lived in the Ruberg area 6 years. • Resident G has lived in the Ruberg area 14 years. • Resident H has lived in the Ruberg area 13 years. • Resident I has lived in the Ruberg area 9 years. • Resident J has lived in the Ruberg area 7 years. 2.-‐How do you get information about what is happening in your community, especially about health and healthcare? Como recibe informacion sobre lo que pasa en su comunidad? Especialmente sobre salud y el cuidado de salud? • Through T.V, newspaper, Univision, Facebook, Word of mouth, Texting, Twitter, KVEW, Fox News, Online, Facebook link, E-‐mails, Yahoo News, ABC World News and Radio. • Parents listen to Radio. • Schools and flyers are a good source of information. • Friends and family members are good sources of information. • Mail information. 3.-‐What are the most important issues in your community? Cuales son las cosas más importantes en su comunidad? • Translation services are highly needed in the clinics. • A comprehensive healthcare center with all the services in a one stop shop. 4.-‐Which issues are priorities? De esas, cuales son prioridades? • Health access • Mental Health services • Access to healthier food • More education about healthy life styles • Healthcare awareness 26 • • • • • A Comprehensive Healthcare Center More services for the handicapped Sex education for youth Education for parents (how to talk to kids about sex and mental health) Providers and non-‐profits need to come out and meet with the community. 5.-‐Which healthcare providers are you familiar with? Cuales provedores del cuidado de salud esta usted más familiarizado? • Community Care Rundberg • Carousel Pediatrics • Brackenridge Hospital • Private Doctors • Seton Clinic • Community Care Braker • Austin Regional Clinic • MAP program • Medicaid 6.-‐How do you feel about your healthcare provider? Que piensa usted de esos proveedores? • Community Clinic staff needs to be more professional and more providers are needed for faster service. • Community Care Nurse reported to be really careless when treating a patient, hurting patient as she drew blood, not even looking at the patient as she performed the procedure “Her nails were really long, she really hurt me” reported patient. • Community care Doctors need to spend more time with patients and take time to answer questions. 7.-‐When you go to the doctor or clinic, which is most important to you? A timely appointment, cost, distance/location, quality, location, or the doctor? Cuando va usted a un doctor o clinica, cual es más importante? Cita, costo, distancia, localidad, calidad o doctor? • Appointments are very important. • Timely (It takes hours to make an appointment over the phone and be seen at Community Care). • Location, as transportation is an issue; you have to walk for 30 minutes instead of taking the bus. (It takes longer) • Ease of appointments • Quality of service and care are important too. • We would like to eliminate the language barrier. 27 • All the things are important. 8.-‐What barriers do you feel exist in accessing the clinic or provider? Cuales barreras existen cuando trata usted de ir a su clinica or doctor? • There are many barriers, including the language barrier, students report missing school days to go translate at doctor appointments for family members. • Transportation is a barrier, as many residents don’t have vehicles and have to take the bus to clinic; it takes a long time to get to clinic on the bus. 9.-‐Solutions to those barriers? Cuáles son las soluciones para quitar esas barreras? • Translation services need to be in the language of the patient's primary language, appropriate translator based on the dialect of patient, needs to be provided at appointment time. 10.-‐What features do you think are important to a clinic or provider’s space? En una clínica u oficina de doctor, que cosas son importante? • A clinic big enough to have doctors to tend to people in a timely manner. • A welcoming environment. • Quality health professionals. • More healthcare providers. 11.-‐What type of services would you like in your community? Que clase de servicios le gustaria ver en su comunidad? • Transportation is an issue to get to the parks. • The community needs spaces to do physical activity. • Community members don’t do any formal form of exercise. • An inexpensive form of YMCA, the current services are way over their price range. • Mom’s typically walk kids to and from school. • There is a need for park, so that families can go and play with their children. • Peer 1:1 programs, were trained students talk and educate other students about health issues. 12.-‐Is it easy for you to make an appointment with your healthcare provider?Es facil para usted hacer citas con su provedor • Families are having a hard time making appointments, due to availability and language barrier on the phone line. • Appointments with specialist are hard to come by. 28 13.-‐Do you use the emergency if you cannot get appointment with your provider? Usa la sala de emergencia si no puede ver a su provedor? 14.-‐If you could talk to your healthcare provider, what would you tell them about services in your community? Si usted pudiera hablar con su provedor, que le diria sobre los servicios en su comunidad? • They need to come out and do health education and awareness classes in the community. • There need to be more one-‐on-‐one education, especially Behavioral Health, Nutrition and Sex education. • This community needs a comprehensive health care center with all the services in the same place, from education to specialty care. (one stop shop for health services) • More health fairs and advertisement through the schools in different languages in the community are needed. • Public media campaigns on health and nutrition are needed, using radio, T.V and other social media. • Community meetings and health education on how the healthcare system works is needed in the community. • Many times parents are not aware of how to talk to youth about sex and mental health, they need to have the right information to communicate and share with their children. • An organization that can teach people about all the resources and services in the community, also it could teach people how to navigate the health system. 15. -‐ Do you think there is easy access to food in your community? • There is a wide availability of fast food restaurant in the area, the media does a very good job promoting it; very little promotion of healthy food options make people consume fast food. • We believe that healthy foods are more expensive, due to lack of information. • There is a lot fast food with unhealthy options in the neighborhood, but the Muslim community doesn't consume fast foods due to religious beliefs. • Lack of education in regards to preparation and how to eat on a budget are preventing people from consuming healthy foods. • It will be good to have more farmers markets and community gardens in the vicinity. • Community members are really busy, with 2 or more jobs; they don’t have time to cook. • There are a lot of small ethnic stores, but many don’t carry enough fruits and vegetables, there are no farmers markets in the area. 16.-‐ How do you think the transportation is working in your community? 29 • • Many people have to ask for rides from family members, they have to miss work for taking people to appointments. Buses don’t go through neighborhoods and it takes forever to go and back to the clinic. 17.-‐Do you feel there is enough and sufficient housing in the community? • Housing affects people’s health, if housing has sanitation problems, it affects resident’s health; people have no other option due to cost and have to live in places they can afford. • Many times in old apartments, the environment conditions are bad, management doesn’t respond to the needs of residents (leaks, broken ovens, A.C, mold etc…) 18. -‐ Do you believe Immigration status affects health in your community? • Not having an immigration status, prevent them from having a good paying job. This forces people to have 2-‐3 jobs, creating a lot of stress and not having tome to cook, workout etc… • People without papers are afraid of seeking health services, they are afraid of giving their information out. 19. -‐ Do you think, there is a prevalence of mental health issues in your community? • Yes, I believe that most of the homeless in the area have mental health issues. • At night, they create an unsafe environment, people are afraid of going out of their homes if it’s dark. • There needs to be more mental health information and treatment for parents, so they can seek help for their children and avoid more severe issues. • School and Healthcare systems need to evaluate all children and treat them as soon as possible to prevent more severe problems. • Mental Health needs to be a priority for all the providers in this area. • There is a prevalence of depression and mental health issues in the area. 20. -‐ Do you believe the cleanliness of your neighborhood affects health of your community? • Residents express concern for their health due to environmental factors No residents report hearing of the Restore Ruberg Initiative. 30
