TEXAS






 

TEXAS
Office for the Elimination of Health Disparities
Prepared by National Association of State
Offices of Minority Health (NASOMH)
 
Rilwan K. Feyisitan, Jr., Chief
Office of Minority Health
Rhode Island Department of Health
3 Capitol Hill, Room 304
Providence, RI 02908-5097
Phone: (401) 222-5940
Fax: (401) 222-5957
E-mail:
Rilwan.Feyisitan@health.ri.gov
Website: www.health.ri.gov/programs/minorityhealth
 
 
Organizational Structure/History
 
The Texas Office of Minority Health, currently the Office for the Elimination of Health Disparities, was created by the 73rd Texas Legislature in 1993 as part of House Bill 1510 to facilitate an increasing focus on the distinct health care needs of minority populations in Texas. The functions of the office, as promulgated in the bill, were: 1) to assume a leadership role in working with federal, state and private groups and agencies to develop minority health initiatives; and 2) to maximize the use of existing resources for this purpose without duplicating current efforts in this area.
 
With the passage of House Bill 2292, 78th Legislative Regular Session in 2003, the Texas Legislature called for the creation of the Office for the Elimination of Health Disparities (OEHD). OEHD’s primary focus is to optimize the health and wellness of Texas residents by developing and strengthening systems and services to monitor, analyze, and assess the health needs of underserved populations throughout the state. OEHD was established in 2004 to bring greater focus to health disparities statewide across service systems.
 
With the passage of House Bill 1396, during the 80th Legislative Regular Session, the Texas Legislature transferred the Office for the Elimination of Health Disparities (OEHD) from the Texas Department of State Health Services (DSHS) to the Texas Health and Human Services Commission (HHSC). The relocation to HHSC has afforded OEHD the opportunity to apply an integrated approach and to partner with other health and human services agencies. This includesoversight to all HHSC agencies, including the Texas Department of State Health Services (DSHS), the Texas Department of Aging and Disability Services (DADS), the Texas Department of Assistive and Rehabilitative Services (DARS), and the Texas Department of Family and Protective Services (DFPS). 
 
 
Purpose/Mission Statement
 
To provide leadership and guidance throughout HHSC and to assist the state in improving the health status of special and underserved populations.
 
Service Purpose:
To reduce health disparities among special or under-served populations across Texas. This will be achieved by: 
 
▪ Providing technical assistance throughout the Texas Health and Human Services Commission to ensure health disparities are addressed in all agency services;
 
▪ Providing leadership to internal and external partners through the collaborative development of health policies and programs established to eliminate health disparities; and
 
▪ Promoting cultural competency, research, health literacy, and evaluation of health promotion and disease prevention program activities.
 
 
Program Focus/Activities
 
The core functions of the office are to: 1) identify internal and external partners, resources and opportunities for collaboration and coordination of health disparities efforts in Texas; 2) identify “best practices” and work with research and policy institutions to develop and promote evidence-based intervention strategies and research initiatives for addressing health disparities; and 3) provide internal and external consultation, training, education, and technical assistance on health disparities, cultural competency, health literacy, program evaluation and strategic planning. 
OEHD adopted National Association of State Offices of Minority Health’s Guiding Principles (NASOMH) Guiding Principles (established in November 2005) as a tool to guide the actions of the office.
  • Eliminate health disparity for affected communities and nations through vigilant monitoring, regulation, and investigation of the determinants of disease and injury.
  • Build capacity of national, state and local government to develop, implement, monitor and evaluate high quality cultural competence standards in all domains of public health, including policy, funding and programs.
  • Engage and empower affected communities and nations in innovative ways to support individual and community efforts.
With the primary focus of the OEHD optimizing the health and wellness of Texas residents by developing and strengthening internal and external health and human services systems to address the needs of underserved populations throughout the state. With such an ambitious mission, the scope and breadth of office activities is large and varied and is determined by office, commission, and legislative strategic directives along with the amount of resources available. In general, the legislatively-mandated efforts of the office categorizes the NASOMH principles into the following areas: policy development and implementation, educational and training initiatives, program evaluation and monitoring, cultural competency training, capacity building, community engagement and empowerment, and technical and resource assistance.
 
Health Disparities Index Project (HDI)
Health Disparities Index (HDI) is intended to monitor progress toward eliminating the health and human services gaps in ethnic and racial populations in Texas. HDI establishes a baseline for HHSC efforts to eliminate racial and ethnic disparities in health and human services. Although current data are presented by race and ethnicity to describe the status gaps, race/ethnicity alone is not a cause of a particular health condition or status. The HDI project will account for the real causes that affect health and human service disparities.
 
The goal of HDI is to identify relevant public health and social service indicators available from existing Health and Human Services (HHSC) databases that could provide an overall picture of community health. The HDI initiative will stimulate research aimed at reducing health disparities. The HDI initiative incorporates the Community-Based Participatory Research (CBPR) model. The CBPR is a partnership approach designed to answer the question of how community stakeholders are empowered to identify effective and efficient solutions to health problems. To address disparities, and develop stable, mutually beneficial relationships with community-serving agencies, this HDI project will be guided by community participatory principles and will grow directly out of identified recommendations and goals of the community.
 
Local Conversations
Modeled on the National Partnership for Action (NPA) to End Health Disparities Initiative; OEHD has begun a series of community dialogues across Texas. Community dialogues will allow the participants to share their concerns and generate ideas about how to address health disparities in their area. OEHD will use the information gathered in these community dialogues to develop new programs and to strengthen existing HHSC and collaborating partner programs to address health disparities in Texas. Local Conversations will address health disparities experienced
by African Americans, Hispanic Americans, American Indians and other underserved communities in Texas by bringing together community members and leaders.
 
Local Conversations are built around a series of dialogues among community members, health clients, HHS practitioners, and other health stakeholders. Through these dialogues, participants will gain an understanding of the causes and cures for health disparities and build teamwork across communities: generate new models and methods, share most effective approaches and stories of success, and identify next steps to support our common effort.
 
HHSC will use these dialogue sessions to: develop a statewide health disparities strategic plan, increase awareness of health disparities, improve cultural and linguistic competency, health literacy, and outcome evaluations of programs, engage community members to design and implement local projects to eliminate health disparities.
 
 Policy Development and Implementation
OEHD works with internal and external stakeholders to affect federal, state, and local policies to address health and human services. One of the most visible efforts is providing administrative support to the Health Disparities Task Force (HDTF), which makes biennial recommendations on health and human services to the Texas Legislature. Other significant policy initiatives are: efforts to implement culturally and linguistically appropriate standards (CLAS) for care and the collection of appropriate health care data to identify disparities with the Health Disparities Index.
 
OEHD’s Health Disparities Learning Lunch Series
Monthly sessions provide professional, structured training and education regarding “best practices,” as well as guidance on successful application of evidence-based interventions and policies to HHSC staff. Other trainings are available on various health disparities topics, such as Battling Obesity: Adopting Healthy Eating Habits,2-1-1 Texas Information & Referral Network: Your Link to Health & Community Servicesand cultural competency.
 
African American Legislative Health and Human Services Day Summit
A biennial event, to be held at the Texas State Capitol, different summit themes are presented and featuring educational presentations and review of strategic and programs plans addressing health disparities in Texas.    
 
Regional Health Disparities Projects
In addition to staff located in Austin, Texas, OEHD also partners with designated staff located in the eleven Health Service Regions (HSRs). Each fiscal year, OEHD provides financial support and other resources to supplement and direct the work of staff in the regions to conduct activities to address health disparities. These projects are varied and range from coalition building to outreach and education activities; each project is based on the particular needs of the regions and is responsive to community input. 
 
Community Information Network (CIN)
OEHD maintains a database of community-based organizations, researchers and professionals. The database provides an invaluable linkage to share information among stakeholders in minority health in Texas. OEHD utilizes the date base to share information to members about health disparity and minority health issues, statewide meetings, conferences, funding opportunities, and community and advisory board placement opportunities. Since the transfer, the OEHD database has increased by 25,000. This has drastically expanded the number of contacts to whom the office can relay information.
 
Texas Health Disparities Task Force (HDTF)
Created by the Texas Legislature in 2001, the HDTF offers recommendations to assist the HHSC in accomplishing the following goals: 1) eliminate health and health access disparities in Texas among multicultural, disadvantaged, and regional populations; and 2) to reorganize HHSC programs to eliminate those disparities.
 
In accordance with state legislative statute, OEHD provides administrative support to the Health Disparities Task Force (HDTF). The HDTF is an external, nine member advisory group to the Health and Human Services Commission. The HDTF meets quarterly and OEHD staff takes care of the many tasks needed to convene this group, including posting meetings, preparing meeting packets, procuring meeting space, recording and transcribing meeting minutes, responding to any requests associated with the biennial legislative report and other duties. 
 
Outreach and Education Campaign
 
Resource Clearinghouse
An integral part of OEHD’s mission is to provide educational and training resources not only to Health and Human Services (HHS) agencies but also to communities and external partners. One innovative method OEHD employs to meet this requirement, is to provide a central location that is accessible to community members and other employees of HHS agencies, called the OEHD Resource Clearinghouse. The Clearinghouse is located on the fifth floor of the Brown Heatly building and contains educational and informational materials on health disparities, health literacy and cultural competency. Culturally tailored health brochures can be accessed at the Clearinghouse, as well as links to electronic health disparities research information. 
 
Additional Training Initiatives
Cultural Competency- worked with the Texas Medical Foundation Health Quality Institute (TMF) to offer cultural competency training in each region in Texas. Physicians who complete the training are rewarded with Incentive Continuing Medical Education (CME) credits, plaques and other incentives such as English-Spanish dictionaries, language line services, and other cultural competency material.
 
Community Based Participatory Research (CBPR)- providing technical assistance and training in the development and implementation of CBPR projects, through a three phase process: Phase 1- Concept Development and Project Design; Phase II – Partnership Development and Community Engagement; Phase III – Research Design Implementation; and Phase IV. - Data Analysis and Evaluation.   Participants will be able to utilize some or all of project development phases.
 
Logic Models- providing training on understanding the benefits and how to implement them into projects; training on the logical relationship between the program’s objectives, activities, impacts and outcomes. It is a description of what the program will do and how the program will work to improve racial/ethnic minority health and eliminate racial/ethnic minority health disparities.
 
Health Literacy- providing training to assisting patients and providers understand that health literacy is an important issue. The National Academy on an Aging Society reports that more than 90 million adults in the United States have low health-literacy skills. They have difficulty understanding instructions and information on prescriptions or medicine bottles, appointment slips, informed-consent documents, insurance forms, and educational materials. 
 
Technical and Resource Assistance
OEHD provides technical assistance and resources to HHS peers and historically disenfranchised communities to initiate and augment existing efforts to address health and human service disparities at the state, regional, and local levels. OEHD works to locate funds and resources from public and private entities to support local and regional efforts, such as the health disparities projects and activities that are conducted by the Department of State Health Services (DSHS) regional staff. OEHD also provides technical assistance to many HHS programs, such as the Texas Health Steps, HIV/STD Comprehensive Program, Mental Health and Substance Abuse Program, Community Preparedness, Department of Family and Protective Services (DFPS), and others. OEHD provides technical assistance to external community groups as well, such as the Austin/Travis County Mental Health Mental Retardation Center's (MHMR), Central Texas Alliance for African American Health and others.
 
Navigational Guide
OEHD completed and distributed a culturally appropriate navigational guide that provides a comprehensive listing of federal, state health, local and social services that are available in Texas. The tabbed guide has visual and tactile cues for identifying important sections. The guide uses the same imagery from the awareness campaign, reinforcing the same motivational messages. Each page presents a call to action, reminding the reader that they are empowered to seek access to health care. A separate section of the navigational guide specifically focuses on services for HIV and sexually transmitted diseases in Texas. With continued funding, OEHD will update and distribute the Navigational Guide every two years. 
 
 
Eliminating Health Disparities Statewide Initiatives
 
In Texas, reducing and eliminating health disparities requires the efforts of a multidisciplinary team of researchers; public health, substance abuse and mental health staff; and community and organizational stakeholders who can investigate and provide a better understanding of the role of behavioral, biological and socioeconomic variables. No one program and/or project can adequately address every factor that may contribute to health disparities. Investigation will educate OEHD about how these variables intertwine and will lead to informed development of policies and interventions to address health disparities, including those in mental health and substance abuse.
 
To achieve this goal, the Office for the Elimination of Health Disparities (OEHD) at HHSC created and supports a state collaborative of stakeholders addressing health disparities. In addition, OEHD also supports HHSC programs by providing a link between state and local communities to address health disparities, strengthening the infrastructure to address health disparities and emphasizing health promotion and disease prevention. The collaborative program, Texas State Partnership to Address and Eliminate Health Disparities (TPAHD), is a five-year project to reduce health disparities inTexas by strengthening relationships to determine evidence-based policy and prevention program strategies. 
 
TPAHD focuses on the following three core areas: 1) conducting a needs assessment to determine barriers to public health and health care and potential solutions; 2) enhancing and supporting the community-based collaborative to recommend, test, inform and reform proposed strategies, and 3) creating and supporting a process for diffusion of ongoing technical assistance regarding health disparities information, research and strategies. To ensure these outcomes and provide guidance, the project has an external evaluator to: 1) provide an assessment of the process; 2) determine the effectiveness of proposed interventions/policies, and 3) estimate the impact on health disparities in Texas.
 
Regional Roundtables on Diabetes and Health Disparities
OEHD Texas Diabetes Council, Health Disparities Task Force, American Diabetes Association and Texas Health Institute is sponsoring diabetes round tables event to: highlight innovative ways that providers and community organizations are addressing diabetes health disparities in different regions, identify ways existing projects can be expanded and sustained, and develop new collaboration and partnerships across all stakeholder groups
 
TMF Health Quality Institute
OEHD partners with TMF to offer cultural competency training to healthcare providers and diabetes awareness project throughout the state of Texas. This training teaches providers in Texas about patient perspectives, values and behaviors to provide the best care possible for a culturally and racially diverse patient population. Cultural competency has emerged as a strategy to reduce health care disparities by teaching health care professionals how to meet the social, cultural and linguistic needs of their patients. 
 
Level of Funding Sources
(As of August 2009)
 
Year                 Federal              State             Private
           

FY 2007
$287,203
$321,000
None
FY 2008
$159,250
$299,113
None
FY 2009
$117,826
$299,113
None
FY 2010
TBD
TBD
None

 
 
Resources
 
The Office of Elimination of Health Disparities currently has four (4) professional staff: one (1) Director and three (3) Program Specialists. Each of the Program Specialists focuses on one of the following: coordinating TPAHD activities; working with OEHD Regional Staff; or working with the HDTF.
 
The Statewide Health Disparities Task Force operates with nine (9) seats.
 
OEHD Regional staff members throughout the state of Texas coordinate with the Office to conduct health disparity activities and eight (8) regional projects.
 
 
Recent Publications
 
·         The Health Disparities Task Force Legislative Report, 2008
  • OEHD Biennial Report to the 80th Texas Legislature, 2007
·         The Health Disparities Task Force Report to the Texas Legislature, 2006
·         Final Report of Recommendations for Health Disparities Index, Scope and Indicators, 2006
·         Addendum: Compilation of Responses Regarding the Final Report of Recommendations for Health Disparities Index, Scope and Indicators, 2006
·         Health Disparities/Community Electronic Health Record Consensus Meeting Report, 2006