Welcome and thank you for standing by. At this time all participants are in a listen only mode. After the presentation we will conduct a question and answer session, to ask a question please press the star one and please record your name. Today's conference is being recorded, if you have any objections you may disconnect at this time, I would like to introduce the host for today's conference. Ms. Lydia Sermons, you may begin.

Thank you Cathy, and again thank you all for joining the Office of Minority Health at the US Department of Health and Human Services' stakeholder call to announce Promoting Healthy Choices and Community Changes: An E-learning Program for Promotores de Salud. Again, thank you for joining today and we just want to announce a few housekeeping matters before we get started with our presentations today. We have four speakers for the call today, and following their presentations we will open up the lines for question and answer sessions. We also want to advise you that the call is being recorded and the call will be available through the Office of Minority Health website, as well as the Think Cultural Health website as early as tomorrow, and the call will be available for thirty days for anyone who would like to access the call or share the information regarding the call following today's presentation. We should also note that this call is not open to press, so if there are any press on the phone, please let us know that, but it is not a call open to press as well as for press attribution. If there are press on the call, we ask that you let us know and we can certainly set up an opportunity to speak with you following the call. And with that, we will commence with the presentation of our speakers, starting with Dr. Nadine Gracia. She is the deputy assistant secretary for minority health, and director of the Office of Minority Health at the Department of Health and Human Services. Welcome, Dr. Gracia.

Thank you, Maria. And hello everyone, thank you for joining us today, your participation in today's call is a reflection of the pressing need for culturally and linguistically appropriate care and services to promote the health of communities across the country. It's also a testament to your commitment to improving quality of services, ending health disparities, and advancing health equities. On behalf of the Office of Minority Health, I am very pleased to announce the launch of Promoting Healthy Choices and Community Changes, an exciting new e-learning program designed to build the capacity of promotores de salud to promote individual and community level changes towards better health.

I am joined by a great group of partners who will describe the e-learning program in more detail, and I'd like to thank my great team at the Office of Minority Health, the staff at SRA, and the national project advisory committee who provided important expertise for the development of this e-learning program.

This new program builds on the Office of Minority Health's long history of promoting and implementing culturally and linguistically appropriate initiatives and programs, and the strategy for reducing health disparities and advancing health equity. For almost thirty years, the Office of Minority Health has worked to improve the health of racial and ethnic minority communities by developing health policies and programs that will help eliminate health disparity. Among our key efforts in making sure health and healthcare organizations have the tools and resources they need to implement culturally and linguistically appropriate services.

To accomplish this, the national standards for culturally and linguistically appropriate services and healthcare, are simply known as the National CLAS Standards, were developed by the Office of Minority Health in collaboration with federal and non federal partners across the country and were first published in 2000 and updated standards were released in 2013. The National CLAS Standards intended to advance health equity, improve quality and help eliminate healthcare disparity by providing a blueprint for health and healthcare organizations to deliver culturally and linguistically appropriate care and services to our nation's diverse community.

And why is this important? Because culture, which includes deeply held beliefs, customs and influences, often shape our attitudes toward health and healthcare, it influences our beliefs about healing and wellness that affect how we think about the perceptions of disease and its causes. And it can impact the relationship and quality of communication that individuals and communities have with health workers and healthcare providers. The national class standards reflect a broad definition of culture to include elements such as race, ethnicity, primary language, whether one comes from a rural community or urban community. Spirituality, education level, and what country you are from. Culturally and linguistically appropriate services are especially important and necessary in light of the rapid changes that are happening in the US population. Given that minorities are expected to represent the majority of the US population by 2050 with Latinos projected to make up about 30% of the US population, and the fact that minorities continue to experience significant health disparities, for example in higher rates of diabetes, obesity, and cancer. It is important now more than ever, to implement programs that will help to close the gap on health disparities in communities and to work in partnership with trusted community members. Promotores de salud are among those partners, and trusted community members who are well positioned to take up this charge.

In 2011, as part of the HHS Action Plan to Reduce Racial and Ethnic Health Disparities, our department, through the Office of Minority Health, launched the Promotores de Salud Initiative to recognize the important contributions of promotores de salud in health education and in reaching Latino communities. The Promoting Healthy Choices and Community Changes program that we are announcing today is a key component of the HHS Disparities Action Plan, and the Promotores de Salud Initiative. And I'm thrilled that Brendaly Rodriguez, one of the members of our promotores de salud steering committee and the national project advisory committee who helped develop the e-learning program, will speak to you today about the program.

We recognize that promotores de salud serve as cultural and linguistic brokers, advocates, and educators between their communities and to gaining access to social services and healthcare. Because they share the same social, cultural, and linguistic characteristics in the communities they serve, promotores de salud play an important role in promoting health and wellness in their communities by removing language barriers, helping to navigate the healthcare system, and conducting health education in a culturally and a linguistically appropriate manner. With this understanding and respect for the roles that promotores de salud play in the health and lives of their communities, we have developed a Promoting Healthy Choices and Community Changes program to provide promotores de salud with the basic knowledge at the individual and community level, to apply principles and strategies to motivate behavioral changes among the community members they serve, and to empower those individuals to create change in their communities. Whether you are a promotores de salud or a community, or a state based organization that works with promotores de salud, whether you're a partner organization or a public health or a healthcare provider, you are all working toward an important goal for our country, ensuring that everyone has the opportunity to reach their full potential for health.

And while the work of promotores de salud is focused on local communities, together promotores de salud are part of a larger effort that impacts our entire nation. I know today's call will give you an opportunity to learn more about our new e-learning program, but more than that I hope it inspires our collective momentum toward achieving a nation free of disparities in health and healthcare. Please know that as you begin to implement this program in your community we are a resource for you. To address any issues or answer any questions that you may have, and again thanks to everyone, I want to thank you for your work and for the difference you are making in so many lives. Thank you, and I will turn the call back over to Lydia.

Thank you, Dr. Gracia, for those very informative remarks. Our next speaker is Ken Johnson. Ken is a senior public advisor at the HHS Office of Minority Health. Welcome, Ken.

Thank you very much, Lydia. As many of you know, I joined OMH in February, and prior to that I was at the HHS Office for Civil Rights. At OCR, one of my primary responsibilities was working with Dr. Gracia and other members of the OMH senior staff on the implementation of the HHS Action Plan to Reduce Racial and Ethnic Health Disparities. The action plan, the first of its kind by the department, touched forth an ambitious vision, a nation free of disparities in health and healthcare.

1. Transform healthcare

2. Strengthen the nation's health and human services infrastructure and workforce

3. Advance the health and safety and wellbeing of the American people.

4. Advance scientific knowledge and innovation.

5. Increase the efficiency, transparency, and accountability of HHS programs.

To implement goal two, that's the workforce goal, the action plan sets forth strategy to be one, and this is the part for us. We committed to increase the use of promotores to promote participation, health education, behavioral health education, prevention, and health insurance programs.

This initiative includes establishing a national steering committee for promotores, developing a national training curriculum and uniform national recognition, creating a national database system to facilitate recruitment and track training and certification, and supporting and linking promotores networks across the nation. I am very excited that today HHS is keeping its commitment from that action plan and launching this promotores national training curriculum. Promoting Healthy Choices is not the [audio cuts out] e-learning program for promoters; however, it is a unique e-learning program in that it provides promotores with the tools to advocate for community change and to empower people to create change in their own communities. The curriculum gives a number of examples to show how this process might work.

First, to address the issue of unhealthy eating in fast food restaurants the e-learning program features the story of a promotores and her friends, they start to buy more groceries, they prepare healthy dishes and they hold community potlucks. This is more than a discussion of diet; it's a discussion of community building. To address the issues faced by community members who do not exercise outdoors because they do not have safe space to exercise. The e-learning program encourages the promotora to lead exercise groups, to help members of their community organize, and to seek funding to rehabilitate existing parks or to build new parks.

The e-learning curriculum also provides advice for those communities who live in food deserts or in areas where there are no grocery stores that carry affordable fresh fruits, vegetables or other healthy foods. In this case, the promotora is empowered to help members of her community organize farmer's markets and plant community gardens. So what's the impact of the national promotores de salud initiative and the Promoting Healthy Choices e-learning curriculum? Our intention is that the initiative and the e-learning course will increase the knowledge and skills of promotores who are serving as cultural brokers and civil rights advocates for access to healthcare, language assisted services, as well as social services including WIC, school breakfast, and school lunch programs which are available to all low income women and children regardless of immigration status. Our intention is that this initiative and the e-learning course will increase the tools available to promotores who are actively providing their communities with culturally and linguistically appropriate health outreach, education, screening, links to care, and navigation through the new marketplace system. Finally, our intention is that this curriculum will augment the ability of promotores to maximize affordable care act enrollment in Latino communities.

Before I close, I'd like to share some good news. Since the start of the first open enrollment period of the affordable care act to March of 2015, the uninsured rate among Latinos dropped by 29% with 4.2 million adults gaining coverage. People believe that this drop is due in part to enrollment assistant provided by promotores. With the support of the HHS initiative and the healthy choices e-learning program, we know that promotores will continue in this good work.

Thank you, Ken. Again, thank you for those very insightful and instructive remarks. Our next speaker today is Liliana Rañ She's the associate director for Asian American, Pacific Islander and Latino affairs, HHS office of Intergovernmental and External affairs, welcome Liliana.

Thank you so much, Lydia, and good afternoon everyone. As Lydia mentioned my name is Liliana Rañ I am the associate director for Asian American and Pacific Islanders and Latinos at the Office of Intergovernmental and External Affairs at the US Department of Health and Human Services. And I'm really happy to be joining you today as well as very thankful to the Office of Minority Health for inviting me to partake on today's call, at this very important moment, as OMH introduces this bilingual e-curriculum Promoting Health Choices and Community Changes.

The launch of this bilingual curriculum is especially significant for the Latino community because it focuses on empowering and building the capacity of a key community asset, promotores de salud. Promotores de salud has not only been our eyes, ears, and boots on the ground when it comes to understanding the health needs of the Latino community, but understanding the cultural needs of the community you're working in, speaking the language of the populations we serve, and the personalized one on one and our small group approach to outreach all contribute to transforming the health of Latino communities.

Promotores has been a key component of our work as a department in building healthier Latino communities that are more educated and empowered to make better choices when it comes to their and their families' health. An example of the direct impact that promotores had on carrying out the departmental priority to increase access to quality and affordable healthcare to Latinos was during both open enrollment periods for the health insurance marketplace created by the affordable care act. Before I provide you with more details on that example and how promotores have been able to impact the way of which Latinos have been able to gain insurance coverage, I will discuss what we know about Latinos and their healthcare, and I will highlight the important role of meeting Latinos where they are, and then working with trusted community messengers.

We know that Latinos are the highest, excuse me, largest ethnic or racial minority group in the US. As of July 1st 2013, Latinos accounted for roughly 54 million individuals, and comprising about 17% of the US population. We know that Latinos have much lower rates of health insurance than Whites, prior to the ACA over a third of Latinos did not have health insurance, while only about one in eight Whites lacked health insurance. We know that Latinos have disproportionate health needs. Latinos experience higher rates of disease such as obesity, diabetes, HIV, and cancer. We know that Latinos have had lower access to healthcare. In fact, Latinos were half as likely as whites to have a regular source of care, such as a primary care provider medical home.

Latinos were less likely to receive routine care and prevention, making them more likely to end up in an emergency department or a hospital. Low-income Latino children had gone a year or more without a health care visit. At a rate three times that of high income Whites, without routine care and prevention, diseases are more likely to progress to more serious conditions and we know that Latinos didn't have access to routine care and prevention, so this disproportionately impacts them. Improperly managing diabetes can result in kidney disease and full amputation, which is also much more likely to happen among Latinos. As you can see, health insurance is vital to Latinos as there continue to be disparities in their health and healthcare.

However, since the start of the first open enrollment period, Latinos have made enormous gains in increasing health insurance coverage, and these gains are likely to increase as we continue with the next open enrollment period. As Ken mentioned, 4.2 million Latinos were able to gain coverage sine the start of the open enrollment in October 2013. In the first year of open enrollment, coverage increases were particularly high for young Latino adults between the ages of 19-34. Insurance raised almost half for this group, coverage increases also occurred for Latinos who primarily or solely speak Spanish, a group who has historically had the highest uninsured rate.

This department is committed to reaching out to the Latino community to make sure they have the information they need to get covered, renew their coverage, get people to use their coverage, and to make better decisions when it comes to theirs and their families' health. We always anticipated that reaching the Latino community would require a unique approach that included more than having a Spanish website and offering bilingual support at the call center. Because of this, we took steps to utilize what we know are trusted messengers in the Latino community, including Spanish language media outlets and working with community partners to provide as much in person assistance to help educate and enroll the Latino community.

Research tells us that in person assistance is an important factor in getting Latinos enrolled in health coverage. As you can see, promotores are vital to ensuring we are reaching Latino communities with messages that are culturally and linguistically appropriate, and that resonate with the population we are trying to reach. Their cultural competence and the role they play as trusted messengers are so important to ensuring health information and reaching the public where they are, where they live, work, play and go to school. This bilingual curriculum is another important resource for our community, to be able to get educated and to take action to create and lead healthier lives.

In order for the department to ensure we are having the intended impact, and that we are reaching the communities that most need our services and programs, we need your input, we need your ideas and we need your ongoing engagement, especially as we roll out this curriculum, to ensure that it gets into the hands of the promotores, and the community that will benefit from these bilingual materials. Thanks so much, and with that I will turn it back to you Lydia.

Great, thank you so much, Lily. And next, our presenter is Brendaly Rodríez. And Brendaly is manager of community engagement and cultural diversity programs at the University of Miami Clinical and Translational Science Institute. She is also the cochair here at the Florida community health for the coalition and we are proud to say that she is a member of the HHS promotores de salud initiative steering committee. Welcome, Brendaly.

Yes, thank you Lydia and good afternoon, buenas tardes everyone. Yes, my name is Brendaly Rodríez and I am a member of the advisory committee that helped develop this e-learning program. Therefore, that is why I am so excited to share some information about it with you. Promoting Healthy Choices and Community Changes are to teach Promotores de salud how to number one, facilitate individual level healthy choices and behavior changes. And number two, to facilitate community level changes that promote those healthy choices. This e-learning program seeks to build the capacity of promotores de salud, to empower people in their own communities, to make those changes at the individual levels, and also to reach out to community levels.

The promotores de salud who take this program now would be able to employ some of those strategies, to strengthen the community work in which they are already engaged- for example, in nutrition outreach, cancer prevention awareness, diabetes screening and chronic disease management. This is intended for any promotores de salud, the community health worker, whether he or she is new to the job, or has many years of experience. We encourage any promotores de salud to take this program, whether you're doing work related to cancer, or women's health, nutrition, or any other health related topic. Promotores de salud already has valuable knowledge about issues of health within the communities, and it is our hope that this e-learning program further equips them to make a difference in their communities.

Let me tell you a little bit more about it. This e-learning program is divided into four units, unit A and B are about individual level changes. Unit C and D are about community level changes. Now, let me give you a little background about how this all came about. and I will be explaining a little bit more about the corresponding website. The e-learning program was developed from 2011 to 2015 and it was all done in collaboration between the project team, comprised by the Health Determinants & Disparities Practice, all done with OMH contractor which is SRA international, and the work of an advisory committee, which is when I come into the picture. The development process also included, and this is very important, focus groups, the promotores de salud community health workers from across our nation.

So, in the advisory committee, we are a group of 16 experts in community health, representatives of community organizations, academic institutions, and federal agencies. We also received feedback from that promotores de salud initiative steering committee. Then we took it to the streets through our focus groups and we pilot tested at five locations early last year, in Georgia, Minnesota, Alabama, California, and Florida. Those focus groups were conducted completely in Spanish, and there we talked to around 45 promotores de salud who participated. And they all came from a diverse background, socioeconomic categories, different countries of birth, and a variety that showed the diversity of our Hispanic Latino population. The feedback from the promotores de salud was invaluable in helping us ensure that the content of the program was engaging, was culturally relevant, and linguistically appropriate to accounting for many varieties of Spanish language vocabulary and ways of saying things.

And also, they gave feedback about the website, for it to be simple to navigate. The project team developed also a marketing and implementation plan, and also an evaluation plan. Now that the e-learning program has launched, the promotional and evaluation activities will be ongoing. The website for the e-learning program is to be engaging, culturally relevant, and simple to navigate. We were mindful that the general literacy and computer literacy of those who might be taking the program varies greatly. That is why we have aimed for the content to be written at a first grade reading level. To access the e-learning program you will be creating a profile like with any other website. Promotores de salud will register for the program and create a login. This allows participants to complete a unit, and in multiple sittings and return to exactly where they left off each time.

So this helps participants to complete the e-learning program on their own schedule, it's a feature I like. Another feature I like is that each unit contains several opportunities for reflection in a section that is called "What do you think?" This feature possesses questions that participants may think about or even journal about and discuss with all the promotores. If they are in a group setting, they may be a focus for our group discussions. We also have case studies that illustrate and reinforce the content that is presented, that's another feature I like, that participants can choose to listen to those case studies instead of just reading them, so it can be used and integrated into group discussion.

Most of the case studies throughout the program allow to follow the story of Maria and Rosa. Maria is the amfitriona or the MC who is a promotores de salud who works with a woman, a client, named Rosa to help her make healthier choices about food, for example. Participants at the end will receive a certificate of completion. They may print it out to show their documentation to the people they work with that they took the unit and they have learned certain objectives. Those learning objectives are listed on the certificate, that's also a feature I like, especially for helping with certification at different states across the nation.

But why focus on promotores de salud? Because, if you're listening to this call you know that or want to know more about this, but promotores de salud are culturally and linguistically, competent liaison, messengers, advocates, educators and that is so because of the intimate knowledge of the community culture and needs. As a result, they are very well positioned to influence positive health changes in their communities, that is why we are so excited about the potential of this program to include health in our communities. Research indicates that the communication and cultural barriers often limit the abilities of Hispanic and Latino individuals to access health services or even to receive quality care. These communication and cultural barriers at times can create distrust between community members and health professionals.

This is why we urge promotores de salud to follow and continue their education and equip themselves. Because promotores are in their communities and we do hope that this e-learning program serves as an important tool to facilitate that important work you already do. Several studies have demonstrated that positive behavioral changes and improved health often can take place if effective training and support systems are in place, and that's why we are equipping promotores de salud as agents of change that work to help improve the health of their communities, and to help reduce health disparities within the US. We hope that promotores de salud will use this e-learning program as a tool among the many others that exist to improve the health of their community members.

And with that, I lead you to Lydia.

Thank you Brendaly for those very, very instructive and again insightful remarks. And now we will prepare to take questions from the call participants, but as we prepare to do so I just want to remind everyone that the call is being recorded and it is not open for press or press attributions. And with that, we will request the operator to open the call for questions.

All right, thank you, at this time we are ready to begin a question and answer session, if you would like to ask a question please press the *1 and please record your name. To withdraw your question, press *2. Once again, press *1 to ask a question, one moment please.

Okay, our first question comes from Don Proulx. You may ask your question, sir.

Thank you, I wanted to first of all congratulate the program being launched now, after about two years of advising with it. And I wanted to just clarify that this is a program that can be taken as a group in a group setting or individually I believe, because some promotores or other community health workers by other titles may not have ease of access to available computers. So is this not one of the advantages of the program?

Yes, that is the case, the program is designed so that both individuals can enroll in the course, and also groups can enroll in the course with a group leader.

And that was a response by Ken Johnson.

Thank you.

Next question comes from Erica Munoz. Erica, you're live if you have a question. We'll go now to the next question, Josephine Mercado.

Good afternoon everyone, I'm calling from Central Florida and my question relates specifically to the learning hours that our community health workers need in order to be certified as community health workers. They are required to provide proof that they participated in how many hours they participated in whatever training program they are doing, will you be able to provide such a certificate or documentation that they actually participated?

This is Ken Johnson again, yes, when the participates in the e-learning program complete a module of the course, they will receive a certificate of that module, and then if they complete all four modules, I think it's A, B, C and D they receive a certificate indicating that they've completed all four modules. And then they can take that certificate and submit it to their certifying agency as evidence that they've completed the program.

Wonderful, thank you.

Next question comes from Carla Briseno.

Hi, this is Carla Briseno from Bexel, thank you very much for holding this call and congratulations for creating this wonderful product for the community. I was just wanting to get more feedback on the details around HHS's involvement support for developing a national certification program for aopromotores, and I'm wondering if you could comment on that if you have any details that you can share.

Hi, this is Ken Johnson, I think it's important for us to recognize that the HHS promotores initiative is not changing the structure in place for state certification for promotores. I think Texas is one of the leaders in that effort, there are other states who have certification programs, some of the programs are specifically titled for promotores, other programs are titled for community health worker. HHS is not going to change or affect that state certification process. What individuals who have completed our e-learning program will have to do is to submit their certificates to their state certification agency for approval.

Okay, thank you.

And next question comes from Janet Bladen.

Hi, I'm a staff nurse with the family health partnership clinic in Illinois, and this question doesn't have to do directly to the e-learning program but I was wondering how much progress has been made in reducing health disparities in the last 20 years and what have you found is most effective?

Hi, this is Dr. Gracia with the Office of Minority Health, thank you for that question and actually the timeliness of that question for many of you on the call you may be aware that this year is the 30th anniversary of the report of the secretary's task force on black and minority health which is commonly known as the Heckler Report. It was a report released in 1985 under the leadership of Health and Human services secretary Margaret Heckler, it was the first time that the US government had convened a group of health experts to do a comprehensive study of the health status of racial and ethnic minorities and found the significant disparities that exist in minority communities, and it lead to, as one of the significant outcomes the establishment of the Office of Minority Health and to help with implementing the recommendations of the report and working with partners across the department as well as across the nation in addressing health disparities.

This year we've been commemorating that anniversary of that landmark report, in April we held a health equity summit, that featured not only secretary Heckler but our current health and human services secretary, Sylvia Burwell, as well as other leading pioneers in health equity. We have made important progress, when we look at areas such as closing gaps in childhood immunizations; we have made progress, for example, with regards to gaps in life expectancy and important progress in cancer rates. However, health disparities persist and significantly impact communities of color and this program, this e-learning program, as an opportunity to empower promotores de salud with information and resources and tools and strategies to be able to effect both individual level and community level change to promote health and wellness is a key part in how we can continue our efforts towards reducing health disparities and advancing health equity in our nation.

Thank you.

Next question comes from Julie St. John.

Hi, I'm calling from West Texas and I have kind of a two part question, so one is kind of a follow up to the earlier question at the hours -- I apologize I joined in about ten minutes late and you might have covered it. I was just kind of curious the time frame. you found that the course takes, and a follow up as a question to that is, id this course designed for new promotores or is it designed as more of a continued education, or is it both and just kind of curious kind of what the focus is of the course?

I'm going to ask Brendaly to take that question.

Yes, with promotores de salud and we have done the... work with a national and state and in those up front and we have received a lot of feedback and we aim to continue work on those activities.

Brendaly, I think there was a question about the length of time that it takes to go through a unit.

With several examples we have in this case we did about a year of curriculum and of development and you can actually have the modules targeted to your organizational needs. You can expand by adding lots of interactive activities to the modules and group discussions as we know promotores de salud work better in those interactive and adult learning activities. Whether journaling, discussions, mentoring, observation of the activities, and feedback within that process or you can also go in a very condensed time frame to kind of get them on board and ready to go to get them through the door and work on the activities they need to, but of course always with the opportunity to go back and receive feedback from peers or their supervisors. So the flexibility in this curriculum that we're putting together and that we encourage promotores de salud to join is there to work on a more extensive platform or to work on more detailed, one on one mentorship with all of the promotores.

This is Ken Johnson from the Office of Minority Health, I just wanted to add that I think we found that when participants take the course, each module takes about 45 minutes to an hour to complete, and also we recommend the course for all promotores. I think it's appropriate for both beginning, intermediate and advanced levels.

Thank you.

Our next question is from Jesse Marquez

Yes, I'm from the big island in Hawaii and I was wondering is there a cost attached to this e-learning program?

This is Ken Johnson again from OMH, the courses are free, and in addition all of the courses on the Think Cultural Health website are free.

And would you happen to -- can we have the website?

Yes, it's ThinkCulturalHealth.org.

Okay, thank you.

Just to correct, the website is ThinkCulturalCealth.hhs.gov. To get specifically to the promotores curriculum, it's Promotores.ThinkCulturalHealth.hhs.gov. You can also type in Google, Think Cultural Health it will get you there. You can go to the Office of Minority Health, you can Google that as well and will get the links to it, but directly it's ThinkCulturalHealth.hhs.gov

Thank you very much, we're just starting a community health workers program that does have e-learning as well as book lectures and is for nine months, so I'm very eager to hear about your program.

We're thrilled to have you on from Hawaii, thank you.

You're welcome.

Thank you and our next question comes from Raquel Castro.

Hi, well I think somebody asked a question about when -- how soon it would be up and running. Can we access the modules at this time?

Yes, it's up and running today.

Okay good, and I have a second question, do you have a mechanism for compiling the experiences of the promotores as they use these modules?

Well at the beginning of each module there is a registration process where it asks for name, email address, identifying information and also the background. And then later in the module there's an opportunity to comment.

Okay thank you

This question is from Alma Olives.

Good morning this is Alma from Albuquerque, New Mexico and its morning still here. Somebody had asked a question about the cost, I was concerned about the cost and the other thing is. there are four modules and 45 minutes each, is that correct?

Yes it is, and the cost is free.

And those modules consist of what topics?

It's healthy choices, understanding healthy choices, and then the last two modules are on community changes. So Unit A is Understanding Healthy Choices, Unit B is Helping People Make Healthy Choices, Unit C is Understanding Community Change, and Unit D is Helping People Make Community Changes.

And this is only based on health, correct? It doesn't have anything about systems change as well, or systems, not only healthy?

Well I think as I indicated what makes the program unique is that there is an example of a promotora, and I think Brendaly also talked about this in her comments, and her work with a friend, and the friend is addressing around healthy eating. And so some of the solutions that they talk about are shopping more at the grocery store, eating out less, and those are more on the personal level. The other solutions that they talk about are more on the systems level. Especially given the example of one of the problems that the community has is that people don't have a safe place to exercise. So they talk about seeking funding and working together as a community to either rehabilitate existing parks or build new parks so that people really do have a safe place to exercise and the built environment supports them making healthier choices around food and increasing physical activity.

And the question you made during -- in response to that question, we made a conscious decision to include these discussion items under this rubric of social determinates of health. We may not have the rubric, the name, the title, but the conversations about nutrition or increasing physical activity and making healthy choices around those points of discussion we vote about what we all know of social determinates of health, the environment, the physical context, and economic and social factors that influence our choices.

Right, and the reason that I was asking that question is because one of the biggest, as a community health worker that I am, one of the biggest concern is what you've mentioned, social determinates but also making changes in the systems. Like for example, let's say somebody goes to a division and they have a sign saying do not come up to the window unless you're being called and it's only in English. What is that system going to change? Like for example, I live in the south valley here in Albuquerque and we live with most Hispanic and Latino community and at our, one of our sites which is federal, our post office said we do not have Spanish speakers. We were like wait a minute, you're federal funded, by law you have to have somebody interpretation, not only in Spanish but all of the languages.

How dare you put that? So the community, we got together and made a complaint about how can you have this type of message? So that's why I was asking what type of training besides medical do you guys add because if you have somebody that doesn't have the food and is on food stamps, even if they try to buy the quality food, if they don't have the food stamps they're not going to be able to eat and access the quality food. If you don't train community health workers on how to, work the systems to, in order for community to have quality access or equality access to those systems.

This is Ken Johnson from the Office of Minority Health. The e-learning program, the healthy choices program does outline for promotores the different resources available to help people make healthy choices around food, including food stamps, and WIC, and school breakfast and school lunch. Correct me if I'm wrong, but I think what I heard you saying was that there was a social service agency which did not have appropriate signage directing individuals whose primary language is Spanish to the place where they needed to go to get services. Usually the first step in that process is whether that particular agency has an internal grievance process, and sometimes the issue can be resolved at that level. But if that's not the case then that individual could file a complaint with the office for Civil Rights here at HHS.

And it's important, I always try and note that sometimes individuals don't want to file a complaint for fear of retribution or because they don't want the spotlight to be on them. Advocates can file a complaint on behalf of an individual, who is adversely affected, and certainly the absence of signage or the absence of language assistant services by either healthcare organizations or human services organizations that receives federal financial assistance from HHS, we would be the appropriate place to file a complaint. However, if the problem is happening around food stamps, then the Office for Civil Rights at the Department of Agriculture would be the appropriate place.

But my question was in this training then this module, do, is there a training to teach community health workers how to navigate or how to process that complaint for that person that's not willing to do it?

I think that the e-learning course is limited to training promotores to provide individual consumers with the options of social services available to support healthy choices around food and exercise. I think that you've raised a valid point, there is a need for more discussion about how to file a complaint, how to advocate for services, but that's not specific to this module or this training.

Yes, because here in Albuquerque we do have a program called pathways, and it, again, because most -- everybody, the whole nation is concerned about healthy eating, healthy food, healthy exercising, healthy this, but what we saw in our curriculum was that we only target health, well great, but how about the systems? If you have a family member that has no food and can't qualify for the public assistance because that administration lost the paperwork, then of course that person is not going to get healthy and that's why we combine both healthcare and systems changes together. And in order for things, for family members to be able to access those healthy choices. So hopefully your curriculum, in the future, can have that added, and this is the reason that I wanted -- I was interested of this call to see how the curriculum looked like and if I could add to my curriculum other choices. And like I said, I'm going to review it, I'm going to see it, I'm going to take it because training is always good, but I think that in the future it needs to be added, systems change.

Alma, this is Liliana, thank you so much for your comment. It's a really important conversation and it would be great to be able to continue this conversation with you, the Office of Minority Health and others that are part of these conversations on a regular basis to see what can be done, because a systems conversation is a much larger one that goes beyond the curriculum, so thank you again. We do have five minutes left and in order for us to just keep in line with our 3:00PM finish we're going to go ahead and move on but it would be great to get your contact information after the call and just see how we may be able to help and work together with you.

Thank you.

Thank you. Our next question is from Jade Durham. Please unmute your line. Okay, we'll go onto the next question, Fernando Pinera.

Hi, this is Fernando in Denver, Colorado working in Career Result. My question has already been asked so I'm just going to submit my comment to congratulate the team that worked on this and also great to hear from colleagues that I haven't talked to in a while, Dr. Nadine and Brendaly it's great to hear from you and congratulations we look forward to get the team of promotores engaged with this new effort, it's so great to hear that it's live now and we will be getting people registered and get the process going, so we look forward to keep the conversation going about how new developments are occurring and as one other person said before what new and things can be considering in adding and just make it great and now being available and it's great to hear that the English, and the Spanish and everything is working, so congratulations and no questions. Thank you.

We have time for one more call.

Next one is from Norma Marti.

Thank you so much, the question has already been answered and again I appreciate all of your efforts at creating some kind of standardization for all of us to follow, thanks.

Did you want to take one more question?

One more question, yes.

Nelly Ayala.

Hello, this is Nelly Ayala from the state of Alaska, and thank you so much for introducing the promotores program and I have -- while everybody was asking questions I went really quickly through the units that I was interested in and here in Alaska we have a very diverse group of Latinos, they are Mexican, Puerto Rican, a lot of Salvadorians, people from Honduras, Panama, and most of them have a problem with diabetes in particular. Nutrition, but not necessarily in terms of they don't know how to make the healthy choices it's just that they don't know how to use their community resources because they're new to Alaska, and there's a lot of things that are not available in Spanish here.

So I was looking through your site and I really like that it's focused on the socio economic model of public health and there's a lot of really good information in terms of theory from the unit D in terms of helping people make community changes. The only feedback just in like a quick look that I made. I think I understand that it's basically for Latinos and so that's why it starts out in Spanish but I would have just liked it to start out in English and then make a selection to Spanish rather than the other way around. Since most of the promotores that we have here are actually -- their first language is English and their second language in Spanish or they are born here in the states but their background is Hispanic. And I also wanted to find out if you were thinking about making more modules in regards to systems change like the person from Albuquerque stated or, doing more in terms of community changes as well as how to get used to the medical or how to get use to being a transfer into the US if they just came here and making those community linkages.

We'll have Ken Johnson respond to the final question before we conclude the call.

All of our classes on the Think Cultural Health website are on a schedule four revision. I think right now there's a banner on the website that indicates that the physician's course has recently been revised and updated and certainly the promotores course will go on a similar schedule. I also just wanted to let you know that if you click on one button you'll get Spanish and if you click on another button you'll get English, so the entire course is available in English and the entire course is available in Spanish.

Yes, I was just thinking in case the person didn't really was - they can talk in Spanish but they can't really read in Spanish. That little button says click aqui, that's in Spanish so, it was just a little bit difficult to get that, so that's all.

Thank you for your comments and thank you very much for all of our callers.

Again, thank you so this concludes this portion of the stakeholder call today and again I want to remind everyone that the call will be available through the Office of Minority Health website later this week and you can access the call for the next thirty days at Minorityhealth.hhs.gov or the Think Cultural Health website at ThinkCulturalHealth.hhs.gov, and if you can't remember either one of those you can just Google Think Cultural Health and we will also posting press information in English and Spanish today on the Office of Minority Health website, again, thank you all for joining us today.

Thank you, this concludes today's conference, you may disconnect at this time.