January 25, 2001
Written and submitted by
Christine Wilson Owens, Project Coordinator

Attn: Gail Dutcher, Project Officer
NLM Minority Consumer Health Outreach Program

Narrative Description of Project Activities October 2001-January 2002

Progress toward project objectives has been slower and less predictable than the original proposal and timeline outlined, but steady still. From the start, the project work has gained momentum and acceptance among original partners and others. Planning methods and timeline have been modified and adapted for practical reasons.

Time was spent in October and November 2001 to set the administrative budgeting plan for this project. Establishing the plan for maintaining swift and accurate financial administration of the contract has been challenged by recent leadership changes within Interpreter Services (my home department and the administrative location of the project budget) and the recent personnel and accounting changes in Harborview's Finance Department. I have confidence that now the correct process has been determined for accurate administration of the contract and will be used in the first budget management activities to be processed in the coming weeks - hiring community trainers.

As communicated with and approved by the NLM Project Officer for this contract, in November, I changed one budget item to exclude CCM salaries and benefits as a project expense. It is not necessary to compensate CCMs for time spent on this project, as their community-liaison work falls within their current job role, which is already paid. Instead of this budget item I have added a new expense category for Community Participation Fees, to supplement the funds available to pay trainers and other community participants throughout the project activities.

In October and November 2001, efforts to bring a large planning team together to discuss the project proposal in its whole form failed. Our target groups are diverse and spread throughout the city. Project partners - the community organizations, caseworker cultural mediators (CCMs), Community House Calls Advisory Board, technology centers and the City of Seattle Department of Information Technology - all have full schedules and agendas. Enthusiasm for involvement in project activities has been consistently expressed by all partners, despite lack of participation in unified planning. A more piece-meal approach has been adopted to work among the diverse communities and the busy partner groups. This new approach, which has included many smaller meetings and conversations among partners, is functioning well.

Around the same time that the planning team approach was modified, a change was suggested by my program supervisor, who advised that project activities would be better planned separately. The training the trainer activity was selected to be planned and implemented first, to be followed by materials development for Ethnomed.
It is for this reason that the narrative portion of this first quarterly report will focus on the first objective, improving the target communities' knowledge of and access to the Web for health information, which includes the training the trainer activities. Please refer to the updated matrices for timeline and planning adjustments for the other project objectives and activities.

Between October 2001 and January 2002, several training curriculum development meetings were held at the UW Health Sciences Library. Ellen Howard, Harborview's Medical Librarian, and Nancy Press, a UW Health Sciences Librarian modified and expanded a template used by Nancy in previous work with Native American tribes. Ellen contributed culturally relevant graphics and links to the template, essentially creating seven different versions that will be used in the training activities and which can be adapted further for each community's specific health information needs. The curriculum template and most other project materials can be accessed online at the project home page:
http://depts.washington.edu/ethnomed/HMCproject/HMCtrainer.html
Ellen maintains the site and is available to provide technical web support throughout the training activities.

An initial training the trainer strategy planning meeting was held in November 2001 and attended by myself, Ellen Howard, Tracey Gooding (a Harborview employee interested in patient resources projects), and our City Technology partner, Emily Bancroft. We discussed the challenges to addressing the needs of all the community trainers if we chose to use a one group training model. Instead, we decided that a multi-tiered scheme for developing and implementing the training program would be most helpful for emphasizing the importance of community participation among our diverse target populations. At this meeting, Tracey volunteered to coordinate identifying and training the Vietnamese community trainers by working directly with the CCMs and partnering community organizations.

Ellen Howard, Nancy Press, Emily Bancroft, and myself put forth efforts to recruit other "volunteer training coordinators" to play the same role among our other target groups as Tracey is doing with the Vietnamese community. Successfully, we have sought and found volunteer training coordinators from among Harborview staff, technology centers, public libraries and the Library Information School students at UW. These recruits fit the profile of a volunteer with interest and/or experience in training programs related to health and technology, and interest in working among our target communities.
Eight people have committed to spend a minimum of 30 hours time to coordinating the training the trainer activities with the two community trainers.

A workshop was held January 5, 2002 for the potential volunteer training coordinators and CCMs to gather and learn about the project logistics and the training curriculum content, and to commit to fulfilling project roles. Nancy Press and Ellen Howard helped organize the meeting and presented the curriculum templates, while I explained the project logistics. Most of the 26 people in attendance (librarians, students, community advocates, community technology workers) committed to project participation. Eight people chose to be volunteer training coordinators, including students and professionals with community training program experience locally and internationally. An additional four people committed to working closely with the training coordinators as they fulfill their role of recruiting, training and mentoring community trainers/health education advocates - the second tier of participants.

Currently, the volunteers are working with the CCMs and community organizations to get recommendations for qualified trainers/advocates, and with myself to coordinate a plan for interviews and selection of trainers. This process is evolving a bit differently for each target community. A situation of unresolved division among past and present leadership within our partnering Somali community based organization has encouraged actions for involving a broader representation of community members. Recommendations for community trainers/health education advocates are now being sought from original partners and additional community groups. Adjustments in the process for identifying and recruiting the community trainers are being made in order to reach more people with the training program and to support equal opportunities for project participation.

A supplemental plan to reach more members of the target communities includes planning several curriculum workshops for librarians, technology lab coordinators, and other service providers who may incorporate the training into their own work with community members. Staff at Seattle and King County Public Libraries, and at New Holly, Rainier Vista, South Park and Yesler Terrace technology labs have been contacted about the training curriculum and the opportunity to participate in the project. Response to the suggested collaboration with local libraries and labs has been enthusiastic and will be pursued in the second quarter. Already, the curriculum is being explored for potential use in an ESL classroom setting at Highline Community College - an effort facilitated by a library information school student volunteer. The lab coordinator at Yesler Terrace is planning to incorporate the curriculum into classes he teaches to East African immigrants in the Yesler Terrace housing community. Mary Ross, Training and Development Managing Librarian at Seattle Public Libraries, has offered general training the trainer materials to help partners facilitate successful work.

Evaluation forms for measuring the curriculum and training success have been drafted, along with a log to track the community trainer services once they begin. The project has been termed a work in progress and adjustments by participants of evaluation materials, like the curriculum templates, are expected to occur to better address cultural appropriateness. I will be meeting in the second quarter with Catherine Burroughs, a UW Health Sciences Librarian whose evaluation materials were helpful in drafting the original project proposal. Catherine has offered assistance in directing project evaluation.

I am in contact weekly with all the volunteer training coordinators and many of the community partners to facilitate the training program moving steadily toward its goals. I am responsible for ongoing weekly schedule updates, and planning for a large group meeting of all training coordinators and community trainers once the training has begun for each community. I have incorporated the ideas and suggestions of project partners into resource materials that inform about the project, the roles and responsibilities of partners, and contact information. Ellen Howard has made these materials available online. Ellen is also planning to create a list service for the project that hopefully will facilitate better communication among partners.

The Community House Calls Advisory Board (CHCAB), a key member of the proposed planning team and liaison with the target communities, meets quarterly. Notification of the purchase order happened after the CHCAB Fall 2001quarterly meeting agenda was set. Presentation of the project with an invitation to the CHCAB to participate as a partner was presented at the Winter 2002 meeting, January 23, 2002. The Advisory Board welcomed the opportunity to hear about the project, reviewed the training site and responded positively to the idea of consulting about the project and development of education materials.

The Advisory Board listened to a presentation by a Somali community representative who reported on the ongoing dialogue between Somalis and the King County Medical Examiners. The dialogue aims to improve cross-cultural understanding of the legal and traditional practices surrounding death in the U.S. and in Somalia. The Advisory Board supported the usefulness of this effort, commenting on the importance of knowing what is expected of their communities when a death happens here. Development of educational materials for our target communities and providers concerning death issues is a possible topic area for our third objective: increasing communication and understanding between the seven target communities and their providers for the improvement of cross-cultural health care.

The Advisory Board meeting agenda also included discussion and plans for addressing the mental health information needs of the House Calls communities, focusing on the kinds of information that are needed and how to best share that information. Using the internet was suggested as one viable option for the East African communities, while radio, TV "commercials", print media and one-on-one encounters were others. The Latino community members suggested including a resource guide for locating mental health services along with shared health information. Fortunately, our training curriculum already includes links to sites that may be resources for the communities. Further modifications and additions to the curriculum by training participants will hopefully incorporate more of the same.

Briefly outlined for each target community are the following mini-progress reports:

Cambodian: Valerie Wonder and Grace Ko, UW Library Information School students, are volunteer training coordinators. Valerie has extensive experience in development and implementation of training and information projects in her work with the Gates Foundation, locally and in South Africa. Contact with the Cambodian Women's Association and High Point technology lab is happening. Jeniffer Huong, Cambodian CCM, participated in the training coordinator's workshop and is working at facilitating a presentation of the curriculum and the project at an up-coming Refugee and Immigrant conference.

Ethiopian: The Ethiopian Community Mutual Association will host training sessions and make recommendations for community trainers. Myself and Mary Neuman, a UW library student, are facilitating these activities with the help of Yodit Wengel-Mengst, Ethiopian CCM and Tita Begashaw, community member and a .

Latino: Nancy Press, Paula Munoz, Amy Fields and Lorie Vik are the volunteer training coordination team. They are in touch with a high school health program involving Latino students, as well as the Latino CCM to recruit trainers. Emily Bancroft may coordinate lab use at El Centro de la Raza.

Oromo: The Oromo Community Organization will be discussing the appropriate way for their community members to participate. One suggestion from the board is to have more than two people involved in the training, with commitments to fulfilling the trainer role. Instead of individuals receiving financial compensation for their time, the community organization would receive the funds and facilitate a sustainable program. The volunteer training coordinator for this group is Tsegaye Gebru, the lab coordinator at Horn of Africa Services.

Somali: Salah Dodi and Mike Pruzan are the volunteer coordinators. Salah has been helpful in adjusting our model to include a broader representation of Somali participants by communicating with the leadership of the Somali Community Services of Seattle (SCSS) and several other community organizations, and by guiding the project away from involvement in the community's internal conflicts. Mike is a library student who is doing research on online health information access for Latinos and Hispanics in Eastern Washington. I presented the project at a SCSS board meeting in December 2001.

Tigrean: The board of the Tigray Community Association invited me to present the project at a community meeting. The board is making recommendations for trainers and will be working with Hassan Osman, the volunteer coordinator. Hassan is a computer expert with experience teaching computer classes at labs in the Somali, Vietnamese and Tigrean communities.

Vietnamese: Tracey Gooding is working closely with Kim Lundgreen, Vietnamese CCM, to plan reaching out with the training activities to the community temples and churches serving the Vietnamese community, as well as to our Vietnamese Senior Association partner.

SERVICES MATRIX:
Services Methods Time FrameProposed Time FrameActual Measures Evaluation Methods Additional and modified Evaluation Methods
Training 2 representatives of each target community how to access online health informationAdditional service in planning stage: training workshops for public librarians, technology lab coordinators, and others who can incorporate the curriculum in their own work settings Develop training curriculum; identify trainees; schedule training sessions and locations;Deliver training October 2001October-November 2001November 2001-March 2002 Curriculum developed October - December 2001Trainers are being identified: January 2002Training locations are being identified: December - January 2002Training will be delivered January - April 2002 Success of curriculum; Success of training;Usefulness of service;Sustainability of "training the trainer" Feedback of trainees;Skills and knowledge checklist and count of trainees; feedback forms and recorded count of times service is used; count of people trained by trainees Measuring success of curriculum and sustainability: more partners (like public libraries, ESL program) are emerging to incorporate the curriculum into their programs.Feedback form, observation, and culturally-specific modifications of the curriculum (rather than a skills checklist) will likely measure training success
Translating information about cancer, diabetes and tuberculosis into the target groups' languages Locate information to be translated;Hire translators;Publish on EthnoMed October-November 2001November-December 2001November 2001- September 2002 January-February 2002Identify informationMarch 2002 Hire translatorsMarch - September 2002Publish Usefulness of translated information; Feedback forms from trainees who access this new material;Count of number of translated articles; Tracking EthnoMed user numbers Possibility that feedback from the Community House Calls Advisory Board and CCMs will supplement the trainers' evaluation of new materials.
Promotingpatient-provider communication with the development and publishing of new EthnoMed articles (2 per community) Solicit community contributions of new material;Identify topics;Write articles; Publish articles on EthnoMed April 2002 - September 2002 The Community House Calls Program is facilitating organized dialogue between representatives of our target communities and the King County Medical Examiners to develop cross cultural understanding of practices and issues relevant to families, communities and the Examiners work. A series documenting the dialoguemay be one of our outcomes in this project area. Usefulness for providers and community. Count the number of new articles; Count the number of community contributors;Track EthnoMed user numbers

TARGET COMMUNITIES MATRIX:
Target Communities Methods Time Frame Measures Evaluation Methods
Ethiopian, Oromo, Somali, Tigrean, Vietnamese, Cambodian, and Latino populations in Seattle Consortium members using their experiences of working with these communities to plan and deliver successful project work October 2001-November 2002 The usefulness of the services provided to the communities in this project Feedback forms for phase 1; Community input and discussion with program coordinator at community meetings

PARTNERS MATRIX
Partners New Partners Methods Time Frame Measures Evaluation Methods
Ethiopian Community Mutual Association, Somali Service Center of Seattle, Tigray Community Association, Oromo Community Organization, Cambodian Women's Association, Vietnamese Senior Association Somaliland Community Association; Refugee and Immigrant Health Promotion Program staff; Seattle Public Libraries Identifying potential trainees; Discussing the project at community meetings; Hosting training sessions (the 3 groups with computer labs); Identifying phase 3 article topics; Posting announcements regarding health information services At community meetings, ask how the project is impacting the community's health information needs, and ask for an assessment of the partnerships; Log how many visitors to these centers use the information access service.
CHC Advisory Board Participating in project planning meetings; Assisting with deciding topics for phase 3 articles At the end of the project, ask them for an assessment of the project and partnerships during the consortium's evaluation meeting.
El Centro de la Raza, Casa Latina, Neighborhood Computer Centers: New Holly, Rainier Vista, South Park, and Yesler Terrace Hosting training sessions in their computer labs; Posting announcements about the health information services Ask trainees to say how they feel the service has impacted the health information needs of the communities they serve.
City of Seattle Department of Information Technology Acting as liaison between El Centro de la Raza, the neighborhood computer centers and the program coordinator At the evaluation meeting, ask how they would assess the project and partnerships.
Cultural Caseworker Mediators Participating in planning meetings; Assisting with the identification of trainees; Acting as liasons and interpreters at community meetings where project is discussed At the evaluation meeting, ask how they would assess the project and partnerships.
HMC Medical Librarian Participating in planning meetings; Developing training curriculum; Delivering training and recruiting other trainers; At the evaluation meeting, ask how she would assess the project and partnerships. Ask how this project impacted the work she did previously to improve the groups' access to technological resources.
Ethnomed Staff Publishing new material on the website; Participating in planning meetings At evaluation meeting, ask how they would assess the partnerships and project work, with relation to their own work.
Medical Personnel Assistance choosing information about cancer, diabetes and TB for translation; Posting announcements about new EthnoMed topics While choosing the information, ask for their assessment of the impact that the new translated materials could have on the target populations.
"Health Information Access Specialists"/ Trainees=Community trainers/health education advocates Learn how to access health information online; access information for their communities; train other community members how to access the information. Ask how they feel about their role as a community source for health information and how do they feel when training others (competent, useful?)