“Do you really think that these children who have been exposed to this violence believe that there is a future for them?” asked Sen. Marilyn Moore, D-Bridgeport.
Days after a 3-year-old child and a 16-year-old boy were killed in separate shootings in Hartford, Sens. Marilyn Moore, Gary Winfield and Doug McCrory demanded Wednesday that the state fund community programs that stop cycles of violence and trauma in Connecticut’s cities.
“What we are seeing in our cities is a slow, banal mass killing,” said Winfield, D-New Haven. “And this state is doing almost nothing about it.”
Winfield and other members of the legislature’s Black and Puerto Rican Caucus rejected the notion that Connecticut doesn’t have enough money to tackle the problem, pointing to President Joe Biden’s proposal to allocate $5 billion to anti-violence groups dedicated to reducing gun violence and to the money that would flow into state coffers if lawmakers vote to legalize marijuana and sports betting this year.
“We’re going to find a funding stream,” said McCrory, D-Hartford.
Gov. Ned Lamont’s spokesperson Max Reiss said federal and state funding addressing youth gun violence in Connecticut totaled $6.6 million across 2020 and 2021.
“The administration has made a commitment to supporting nonprofits and fighting gun violence in the past and will continue to do so.” Reiss said. “The administration is ready and willing to engage on new ideas on how to address this issue.”
There were no calls to allocate more money to police. Instead, legislators pushed for increased funding for community-based organizations that work to prevent violence and provide mental health services for traumatized youth. Those organizations, the legislators said, know their communities, and all their complexities and challenges, best.
“Historically, government’s approach has been to give the money to police departments [and] governmental agencies. That is the wrong approach,” said Moore, D-Bridgeport. “It should not be going to a police department, it should not be going to OPM [the state’s budget office], it should be going to the communities, and they should be leading the charge.”
Hartford, Bridgeport and New Haven all saw an uptick in shootings and gun violence in 2020. Statewide, there were 161 criminal homicides last year, a 25% increase from 2019, according to data obtained by the CT Mirror.
Legislators at the news conference noted that Black and brown people living in the state’s cities disproportionately suffer from gun violence. The schools in those communities, the lawmakers said, are under-resourced and serve children with complex trauma. The communities are similarly under-resourced, lawmakers said, and lack a robust system of well-funded anti-violence programs and social services.
Youth anti-violence programs have received state funding in the past. Between the 2019 and 2021 fiscal years, Hartford, Bridgeport, New Haven, Meriden, Waterbury and West Haven received a combined $1.7 million to address youth gun violence.
But often, discussions about gun violence center on punitive actions, such as ensuring those who fire the shots are arrested and serve time in prison, said Winfield, the co-chair of the Judiciary Committee.
“If we want to fix the things that we see, it’s not just more gun laws,” Winfield said. “If we want to fix the things that we see, we have to first admit that policy has built us to this place.”
Ten people spoke at Wednesday’s news conference, half of whom were legislators. The others represented groups that work to reduce violence in Hartford, Bridgeport and New Haven. Compass Youth Collaborative’s Jacqueline Santiago talked about the work her organization does, going into hospitals after a shooting to support victims and get information to ensure there isn’t retaliation.
That work, Santiago said, is done every day on a “shoe-string budget.”
Others spoke of the need to treat young people’s trauma. Andrew Woods, from Hartford Communities That Care, said the majority of survivors of gun violence are repeat victims.
“Boys and men of color are at significant risk in every urban community in this nation,” Woods said. “But interestingly, they’re the ones who get the least support, the least empathy, but they are victims of violent crime in their communities where they are just trying to get up, go to work, go to school.”
Leonard Jahad, executive director of the Connecticut Violence Intervention Program, talked about the importance of restorative justice programs that can heal both victims and perpetrators of crimes.
Jahad, a former probation officer and correction officer in the state Department of Correction, said people regularly come out of incarceration “with old beef.” Or, crime victims or perpetrators are unaware that the other has been working on themselves, taking steps to improve their lives.
“They’re going to arm themselves,” Jahad said. “Just because you don’t have a damn conversation.”
Acknowledging the momentum that occurred last summer, when legislators passed a police accountability bill during a special legislative session in the wake of George Floyd’s death, McCrory said the state must address gun violence differently than it has in the past, lest it experience a false sense of security that the problem has been addressed.
“We fell back into the trap because we passed one piece of legislation, and we got comfortable again,” McCrory said.
“As a Black person, we have learned how to survive in this country,” he added. “We’re not interested in survival anymore. We want to thrive.”
Data on race, ethnicity and language is critical to making real healthcare progress
There are significant disparities in health status based upon race, ethnicity, and other factors that deprive many Connecticut residents of an equal opportunity to enjoy good health and well-being. That some Connecticut residents live without proper treatment of illness and injury due to disparities in health care access, affordability, and outcomes based upon race, ethnicity, and language (REL) is self-evident to many but not to all.
Without raw data and the resulting ability to quantify and track them, we cannot make clear the pervasive inequities and health disparities in Connecticut. It is critical that we have necessary data to address and mitigate root causes of healthcare disparities and assess the effectiveness of our solutions to resolve them.
Legislation pending this session would provide patients with a voluntary option to share REL data with providers who participate in the independent, non-profit, health information exchange. The objective is to advance health equity and reduce health disparities driven by data specific to those inequities and disparities.
This initiative is meant to address existing racism experienced in Connecticut in different ways by different demographic groups. Without the data generated by this initiative, this inherent racism in our systems remains invisible.
Without question, there is a sense of urgency about the issue to be addressed by this legislation, which has been in process for several years already. Chronic conditions like diabetes and asthma –-now amplified by COVID-19 –-disproportionately impact populations based upon racial, ethnic and language demographics.
This pending legislation would bring Connecticut in line with data collection standards endorsed and engaged by analysts at the U.S. Department of Health and Human Services and the state’s Community and Clinical Integration Program, which included the collection of data to identify and prioritize opportunities to reduce health disparities.
It also aligns Connecticut with a federal minimum data collection requirement from the Office of Management and Budget (OMB) and the more detailed Centers for Disease Control standards related to healthcare funding.
Several hospitals and providers successfully started collecting detailed REL data as a part of Connecticut’s Community and Clinical Integration Program. Going forward it will be important that all Connecticut providers, hospitals, and agencies collect REL data in a consistent and standard way to gain insight into health disparities in clinical outcomes and other areas across the state.
The statewide Health Information Exchange is a system for sharing data across systems and networks to inform better care coordination, clinical decision-making, lower health care costs, and access to real-time information about community health. Including REL data will mean that this information can be used to identify and address the consequences of systemic racism.
No one will be forced to provide REL information in order to access health care. It has been and always will be voluntary.
Health care providers already collect self-reported REL data. Doing so in a uniform manner just makes the data more useful. Some providers already engage in training to ensure the data is collected in a culturally appropriate manner. Others may need to do so to ensure providers and patients understand why the data is collected and how it is used and protected. This is a challenge that can be met if we commit now to the need to collect these data.
Analysts will have access to these data only at an aggregate level, protecting and ensuring privacy and confidentiality regarding all patient data. REL data is collected to identify trends in health disparities by race, ethnicity, and language. This improves our understanding of inequities in health outcomes and which efforts to address them are working.
With standardized REL data, providers and policymakers will be better equipped to provide targeted interventions to improve health and wellbeing among all residents, particularly those most impacted by health disparities so obvious to us all after the past year of living through the COVID pandemic.
Connecticut can do better for all its residents and spend healthcare dollars more wisely and effectively in the process. Pending legislation will help provide the data to show the way.
Vicki Veltri is the Executive Director of the CT Office of Health Strategy; Tekisha Everette is the Executive Director of Health Equity Solutions. Matt McDermott is the lead organizer of Congregations Organized for a New Connecticut.
Is CRC the new standard of care?
Alistair Gardiner, April 14, 2021
The data is clear: Racial disparities plague the US healthcare system.
“Get it right, and you can build trust with a diverse American that ripples out into the local community. Neglect cultural sensitivity, and the opposite effect occurs,”
What is CRC? Or Culturally Sensitive Care or Culturally Competent Care?
In short, culturally relevant care is a tool physicians can use to build greater connections with diverse and underserved Americans, with the goal of overcoming systemic challenges that lead to worse outcomes in these groups. Other monikers for this concept in the past have included “culturally competent care” or “culturally sensitive care.”
In light of glaring racial disparities in the US healthcare system, some physicians are starting to embrace a more culturally sensitive approach to providing care to their patients.
COVID-19 has brought this issue into sharp relief. According to data released by the US Department of Health and Human Services (HHS) in March, racial and ethnic minorities not only experienced higher rates of coronavirus infection but also higher rates of hospitalization and death from COVID-19. And now that vaccinations are rolling out, early evidence suggests that minority groups are being vaccinated at a proportionally lower rate compared with White Americans, as well, according to the HHS.
With systemic solutions lacking, some physicians are taking it upon themselves to try to overcome health disparities using a concept known as “culturally relevant care” or CRC. But many doctors don’t know what CRC is or what it entails. Here’s an overview of CRC, how it can help doctors provide care that respects patients’ unique cultural needs, and how this strategy can benefit patient outcomes.
Evidence for CRC’s efficacy
Examples of CRC can be found in the aforementioned PLoS One review.
The researchers examined 67 articles, which outlined several approaches implemented in different healthcare settings, measuring their effectiveness.
One article showed that the availability of a bilingual Russian internist at the Denver Medical Center resulted in a reduction in diastolic blood pressure and cholesterol among Russian diabetes patients. The authors also cited a study carried out at Boston’s Martha Eliot Health Center, which focused on the outcomes for Latinx patients with anxiety participating in an allocentric relaxation intervention, a culturally relevant therapy in Latin culture. The study found that long-term rates of major depression in these patients decreased from 25% to 14%.
Other articles cited found that providing an avenue for more involvement from patients’ family members resulted in patients from African American, Latinx, or Asian backgrounds feeling that they were better able to treat their disease, more comfortable talking about their diabetes with their families and friends, and more confident and in control of their lives.
Other studies in the review arrived at similarly encouraging results. The installment of a sweat lodge at one hospital saw admissions from Native American patients increase from 4.7% to 7.5%.
In another study, the implementation of Community Health Workers (who would educate patients during home or clinic visits) led to increases in rates of cancer screenings among Chinese and Hispanic patients.
Another study found that the employment of Black or Latinx “health navigators” at a breast cancer clinic helped lower stress for patients and providers
1.“through improved communication,
2. increased safety of treatment,
3. improved understanding,
4. trust and connectedness,
which in turn [led] to higher efficacy of treatment and greater improvements in applying health recommendations.”
Study authors concluded that some, but not all, of these strategies, appeared to result in “moderate effects on patient outcomes.” More research is needed because the efficacy of many strategies could not be confirmed due to a lack of a control group and other study limitations. Researchers also pointed to several outstanding strategies that weren’t implemented in any of the studies analyzed, including the use of telemedicine, other outreach methods, and the creation of community health networks.
Putting CRC in practice
In his blog post, Bakhru cites two real-world examples where the method proves vital in proper care delivery. “In primary care settings, physicians often emphasize the importance of cervical cancer screening for female patients. For most women, this is a simple subject to discuss. But for trans men, such conversations require a high degree of cultural sensitivity and mutual understanding.
Get it right, and you can build trust with a diverse American that ripples out into the local community. Neglect cultural sensitivity, and the opposite effect occurs,” Bakhru explained.
Here’s the second example: “In late April, a Muslim patient whose chart shows a long history of healthy blood pressure presents with hypertension. Cultural sensitivity in this scenario requires an awareness that Ramadan occurs in the spring, meaning your patient’s vitals may be affected by their religious observation of that holiday, which can include fasting. It’s important to acknowledge that a patient may have short-term elevated blood pressure before pursuing therapeutic strategies for a reading that amounts to a brief anomaly in their chart,” Bakhru said.
While further research is required to establish clinically proven strategies for the implementation of CRC, physicians should nonetheless explore ways to adopt the approach as a first step to addressing America’s healthcare inequities. After all, as Bakhru argues, it [CRC] could become the new standard of care.