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n i n e Cultural Sensitivity or Cultural Innovation? A Review of Interventions to Improve Enrollment of Latino Immigrant Children in Public Insurance Programs A d e l a d e l a T o r r e , J e s s ic a N u ñ e z d e Yb a r r a , M a r i s o l C o r t e z , a n d E m i l y P r i e t o In their study of the ways in which managed care plans in California have adapted their services to meet the health needs of the state’s diverse populations, Coye and Alvarez (1999) introduce the idea of cultural competency by distinguishing it from cultural sensitivity. According to the definitions they provide, cultural sensitivity refers to an awareness on the part of health care providers of the impact that racial, ethnic, and linguistic variations can have on patient health. Coye and Alvarez distinguish this from cultural competency, which they define according to its functionality; cultural competency is “the ability to provide services [to diverse groups] that yield the desired clinical outcomes combined with a high degree of patient satisfaction.” Given this emphasis on functionality, cultural competency is less a capacity for relating to others and more a set of practices or interventions that have concrete 268 Cultural Sensitivity or Cultural Innovation? ■ 269 and measurable implications for health outcomes, cost-effectiveness, and level of patient satisfaction. Although the ideal measure of cultural competency with respect to Latinos would be an improvement in health outcomes, very little of the existing literature attempts to investigate the effects of culturally competent interventions or practices on Latino health status. Most of the available literature is descriptive, focusing not on the effects of particular practices or interventions, but on the need for providers to adapt services to the particular needs of the populations they serve. In the case of Latinos, this most often amounts to studies that demonstrate the need for linguistic adaptations such as provision of interpreter services (Doty 2003), availability of bilingual and bicultural health workers (Center for Mental Health Services 2001), and Spanish translations of program information (Coye and Alvarez 1999). Other adaptations described in the literature include the establishment of community advisory committees that providers can consult to assess the changing needs of enrollees (Bureau of Primary Health Care 1999) and the inclusion of Latino cultural issues as part of the curriculum of U.S. medical schools (Flores et al. 2002). However, when referring to increasing health care access to insurance , it might be more useful to define cultural competency here as the interventions or practices that are best able to reduce the gap between the number of Latinos eligible for public insurance and the number actually enrolled and utilizing available services. Thus the question becomes : Why do Latinos remain under-enrolled in Medicaid and SCHIP despite high levels of eligibility, and despite measures such as eligibility expansions and established methods of outreach? In answering this question, it is important to explore how culture influences behavior when an individual accesses health care. Culturally competent practices are those that are able to address and remedy the specifically cultural or non-financial reasons for Latino under-enrollment and under-­ utilization. This chapter will therefore focus on what we term “culturally innovative interventions”—methods shown to effectively reduce the gap between Latinos’ eligibility and their enrollment in and utilization of services—by examining recent literature that documents the effects of outreach practices on Latinos specifically, or whose results can 270 ■ De La Torre, De Ybarra, Cortez, and Prieto be applied to Latinos. However, in order to examine the culturally innovative interventions that have been most successful with Latino populations, it will be useful to first briefly review the general literature on outreach strategies in order to provide some basis for comparison. Outreach Literature: General Overview When lawmakers signed SCHIP into existence in August 1997, federal legislation recognized outreach to be a central part of the newly created program. As defined by SCHIP legislation, outreach entails “activities to inform families of available coverage and to assist them in enrolling” (Westpfahl 1999). Title XXI mandated that states not only include such activities as a central component of their SCHIP program,1 but that they also submit a description of outreach plans to the federal government for review (Moore 1999). Further recognizing the centrality of outreach to the successful operation of SCHIP, the Health Resources and Services Administration...

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