Striving for Cultural Competence in an HIV Program: The Transformative Impact of a Microsystem in a Larger Health Network

Abstract

With increasing U.S. population diversity, it is paramount for health care professionals to provide high-quality medical services that are not only accessible, but also culturally appropriate for their patients. Social workers can be at forefront of process of developing and implementing practice-based, patient-centered approaches that are both medically sound and culturally sensitive. An example of such an approach is described in this case study, which examines how an HIV/AIDS hospital-based outpatient program, AIDS Activities Office (AAO) of Lehigh Valley Health Network (LVHN), designed and implemented programming to ensure provision of culturally and linguistically appropriate care for its Latino patients in Allentown, Pennsylvania. MICROSYSTEM APPROACH The focus on clinical microsystem in this case study illustrates how clinicians and social workers can respond to increasing diversity of their service areas by developing unit-based innovations that, in time, will diffuse to larger, surrounding health care system. Using a holistic perspective, social workers interact with multiple dimensions of individuals, including their ethnic, cultural, religious, and gendered traditions and preferences. Nelson et al. (2002) used example of clinical microsystems to describe diffusion of systemwide patient-centered quality care from a small functional unit to larger hospital. Clinical microsystems can be defined as the small, functional, front-fine units that provide most health care to most (Nelson et al., 2002, p. 473). Therefore, any program or process could be considered a microsystem based on how it fits within these concepts of patient experience at micro level. This concept is helpful in understanding development of AAO cultural competency program at microsystem level, as program provides a framework that was modeled at an organizational level. SERVICE POPULATION Latinos are largest and fastest growing ethnic minority group in United States, constituting 15 percent of total U.S. population (Bernstein, 2008). The Latino population in Allentown, Pennsylvania, has more than tripled since 1990, and accounted for 34 percent of city's population in 2006 (U.S. Census Bureau, 2006) (see Table 1). Furthermore, among more than 25 percent of Allentown residents age 5 and over who speak a language other than English at home in 2000, majority (70 percent) reported that language as Spanish (U.S. Census Bureau, 2000). Latinos are disproportionately affected by HIV/AIDS epidemic. In 2006, Latinos accounted for 19 percent of people living with AIDS in United States and District of Columbia, even though they represented 15 percent of U.S. population (Centers for Disease Control and Prevention, 2008). In six-county region of mideastern Pennsylvania in 2006, proportion of Latinos riving with AIDS was 5.4 times greater than their overall representation in regional population (AIDSNET, 2007). AAO CULTURAL COMPETENCY PROGRAM Established in 1989, AAO initially provided social case management to facilitate end-of-life support for community's almost 100 HIV-infected patients. Over next two decades, in response to changing patient needs, office became region's largest HIV service provider (with more than 500 patients), offering longitudinal primary care, social case management, mental health counseling, nutrition services, patient education, adherence support, prevention services, on-site clinical trials, and HIV counseling and testing. In response to region's growing Latino population, AAO strengthened its capacity to deliver linguistically and culturally sensitive care to this client group. Relationship Building To ensure awareness of and access to its services, AAO formalized relationships with community-based organizations, local leaders, and other care providers who serve members of Latino population in Allentown. …