Laurie, thanks so much for your account of the healthcare workforce
opportunitites for adult learners, and the value of preparing more
adults for these career ladders! 

We would love to hear from others (like Boyd) who are working to prepare
learners to access health careers.

Julie

Julie McKinney
Discussion List Moderator
World Education/NCSALL
jmckinney at worlded.org


>>> laurie_sheridan at worlded.org 10/17/06 4:06 PM >>>

Thanks, Sabrina, for bringing up the subject of the health care
workforce.   And thanks, Julie, for opening up this discussion and for
asking a great question!  

I wanted to weigh in as someone who has been working in Workforce
Development and adult education for many years, including with many
health care programs that provide acess to jobs and to career ladders in
the ever-growing health care field.   I currently work at World
Education, working with ABE programs that are interested in helping
their learners prepare for and enter good jobs, including in health
care.  Let me tell you, health care is a really open field for ABE
learners.   They are needed, and there are some good health care jobs. 
And this will help improve the health care system!    

Yes, if we help adult learners break into the health care field and
climb the ladder, it will benefit the workforce, the field and
especially the needs of patients.  There are currently a huge number of
partnerships and programs that do this already, across the country.  I
don't know them all, and I know Massachusetts and Boston best, but it's
already really clear that health care is a place where ABE and ESOL
learners can find jobs, in many cases access career ladders, and develop
productive careers.  Still better, they can find jobs that they love
because they involve caring for people, and also have the potential for
career ladders to higher pay, responsiblity and skill.  Health care
facilities hire entry-level workers with relatively low skills and work
experience, and yet have the potential for advancement.  Plus, with a
few exceptions, few of these jobs are going to be outsourced outside the
U.S. or even the community.  They require hands-on care!  There is a
major labor shortage in health care at all levels, from orderlies,
housekeepers and dietary workers through certified nursing assistants
and home health aides through various technicians (surgical, radiologic,
lab) to nurses and up.  If you look at the demographic data, the health
care workforce is "aging out" and not being replenished fast enough,
while the patient population is also aging and in need of more and more
chronic and acute care.  So, these are good jobs by and large, and hold
lots of potential for ABE learners.    There's also huge potential for
the ABE field to develop more workplace education programs, "pipeline"
programs in the community to prepare people for these careers, and real
lifelong learning that will enable former ABE students to advance on the
educational and career ladders.   There are jobs in home health and
nursing homes, community health centers, doctors' offices, labs, and
hospitals, and virtually all need workers and are going to need more.

Will ABE preparing learners for health care work help increase
diversity in the field, and/or sensitivity to patients' needs?  All the
evidence so far points to it.  Major funders in Boston and around the
country are currently investing in the education of more community
health workers, long-term care workers in nursing homes and home health
agencies, and also in hospitals.  In many cases, the projects are only a
few years old and too new to demonstrate long-term impact yet, but
others are already showing results.  The Massachusetts ECCLI (Extended
Care Career Ladders Initiative) project, which began in 2001, has now
involved about 20% of Massachusetts nursing homes in career ladder
programs for their Certified Nursing Assistants and Home Health Aides.  
Evaluation studies have consistently shown improved patient care,
improved clinical and basic skills of ECCLI participants, and also less
staff turnover and better relationships with patients.   Hospital career
ladder programs have shown similar results, and continue to do so.

Health care and long-term care quality are largely dependent on the
quality of relationships:  communication, caregiving skills, and warm
nurturing.   All these happen best when health care workers have the
skills to do these, and can communicate with patients in the right
language and with cultural competence.  Case studies of individual
nursing homes and hospitals investing in incumbent worker training and
worker skills education show consistent improvement in quality of care. 
Some of this is due to better training, and better education in basic
skills, and some of it is also due to increased cultural competence, and
a more diverse workforce at all levels.    Health care workers are
generally able to interact more effectively with patients if they share
some background and experiences--just as a lot of health literacy
programs have amply demonstrated with community residents.   A lot of
what's movitating this investment is not just growing the health care
workforce, though that's huge and real, but also training people who
reflect better the ethnicity, languages and culture of the patient
population.  Educating a diverse health care workforce, and recruiting
workers from ABE programs and also continuing to educate them on the job
and on the career ladder, helps the health care field better serve the
communities they are in and the residents who live there.   

You can see some of the evidence for what I say on the web sites of
various workforce development organizations that develop and evaluate
health care career ladder and workforce development programs, such as at
Commonwealth Corporation www.commcorp.org, Jobs for the Future
www.jff.org., SkillWorks www.skill-works.org, Working for America
Institute, www.workingforamerica.org, Coalition on Wisconsin Strategy
www.cows.org, and/or Robert Wood Johnson Foundation www.rwjf.org.   
There are many others, too, "too numerous to mention."  

Laurie Sheridan
Workforce Development Coordinator
World Education/SABES Central Resource Center
44 Farnsworth St.
Boston, MA 02210
(617) 482-9485 Ext. 509
lsheridan at worlded.org


>>> julie_mcKinney at worlded.org 10/17/2006 11:56 AM >>>

Thanks, Andrew, for shedding some light on my question about how the
definition affects what we do to address health literacy. If, as you
say, "broader definitions of health literacy will further the
potential
for collaborations between the 'health' camp ...and the 'literacy'
camp,
then I think there is value in that. In my experience, these
collaborations have proven to help further the goals of both camps in
a
very exciting way.

Sabrina's definition adds a new camp: the healthcare workforce. If we,
as she suggests, help adult learners break into the healthcare field
and
climb the ladder, will the resulting workforce be more diverse and
more
attuned to the communication needs of lower literacy patients because
they will have been there themselves?

What do others think?

Julie


Julie McKinney
Discussion List Moderator
World Education/NCSALL
jmckinney at worlded.org 


>>> sabrina_kurtz-rossi at worlded.org 10/16/06 10:19 AM >>>

I've been adding workforce readiness to my working definition of
health
literary.  I include supporting adult learners interested in health
careers and employment as a way of creating a more culturally and
linguistically diverse health care delivery system which I see would
improve the health literacy or health care system's ability to
communicate with an increasingly diverse patient population.  Does
that
make sense to folks.  It's along the lines of health literacy training
for providers but not really.  It's more like health literary training
for community members that increases an individual's  health literacy
skills and workplace readiness skills.   I'm working with the East
Boston Community Health Center to develop a health literacy training
for
community members interested in becoming a Certified Nurse Assistant
(CNA).  The is need for a training focused on health oriented reading
and comprehension, vocabulary and problem solving skills, and the
application of these skills to the CNA training entrance exam and ones
future career.  We're also looking at provide on-going support for
learners as they progress through their CNA training to ensure their
success in getting certified and obtaining a job.  Are others looking
at
health literacy from this angle?  I'd be interested in hearing what
others are doing in this regard.  

- Sabrina

-------------------------------------------------
Sabrina Kurtz-Rossi
World Education
44 Farnsworth Street
Boston, MA  02210
617-482-9485
skurtz at worlded.org 


>>> pleasant at aesop.rutgers.edu 10/12/2006 1:36 PM >>>

Hi all,

Glad to see this topic being addressed.

Definitions matter in sometimes subtle but very important ways. For 
instance, they can directly influence funding streams, and thus 
create research, practice, and publication communities (some call 
these epistemic communities) which work to self-reinforce and often 
'circle the wagons' when encountering new or opposing ideas. That can 
work to slow down, but also possibly validate, progress and 
development of best practices and new solutions.

I keep encountering more and more folks who think this is one of the 
issues the field of health literacy faces. In short,  that the 
emphasis has been unduly placed on the clinical setting and often 
blames patients. Alternatively, a richer definition casts health 
literacy as a multi-dimensional concept that includes public health 
issues and sees (as has been well-expressed in this thread) health 
literacy as an issue for both providers (of information, of health 
care, etc.) and the 'public'(s). This goes far beyond depicting 
health literacy as an important issue only when people are in a 'sick 
role' (a concept from the '50s). I'd argue that this more inclusive 
and less top-down approach to health literacy is not only more robust 
conceptually but will also increase validity and utility of technical 
measures when they begin to reflect the newer definitions being 
advanced.

Additionally, and I believe very importantly, these broader 
definitions of health literacy will further the potential for 
collaborations between the 'health' camp (physicians, nurses, public 
health professionals) and the 'literacy' camp (ABE/ESOL teachers, 
linguists, communication folks for example). Those sorts of 
collaborative projects which will be in a stronger position on the 
ground in communities and in individual's lives to address the role 
of health literacy as a social determinant of health.

as they say online .. fwiw,

Andrew Pleasant






>Thanks, Andres, Cynthia and Bob.

>

>I tend to think that the definition matters less than what we promote

as

>a way to improve the situation, and I think that the Quick Guide that

>Cynthia mentioned is a great step in addressing solutions with health

>care professionals, as are the strategies that Bob mentioned.

>

>However, when we get used to a certain definition, then we tend to

use

>it in ways that narrow our focus of who to target for interventions.

For

>example, when we talk about people as having "high or low health

>literacy", we are talking about patients, and assuming the following

>definition:

>

>"the capacity to obtain, process and understand basic health

information

>and services needed to make appropriate health decisions."

>

>Andres' and Anthony's definitions (below) include the following

>additions that allow us to also talk about health providers and

>educators as having "high or low health literacy."

>

>"...the ability of health workers to create and share health

information

>so that community members can make informed health decisions. " 

-Andres

>

>"...the capacity of professionals and institutions to communicate

>effectively so that community members can make informed decisions and

>take appropriate actions to protect and promote their health."  -

>Anthony (NYC Mayor's Office of Adult Education)

>

>I think we are all on the same page in thinking that we need to

address

>both groups (patients and providers). How important is it to have

this

>dual focus as part of the definition? What do others think?

>

>Please note that I've changed the SUBJECT LINE so people can find

this

>thread in the archives!

>

>Julie

>

>Julie McKinney

>Discussion List Moderator

>World Education/NCSALL

>jmckinney at worlded.org 

>

>>>>  DICKERR2 at ihs.org 10/10/06 6:45 PM >>>

>I've been watching the discussion on the health literacy definition.

I

>would have to agree with Cynthia Baur's comments. We need to be

careful

>when defining health literacy that the definition is not too

limiting.

>We also need to make sure the definition itself is understandable.

>

>While I very much appreciate that Andres is emphasizing the

>multicultural and multilingual aspects of understanding, her

definition

>limits health literacy to communities that are multicultural and

>multilingual. "The capacity of individuals in a multicultural and

>multilingual community...". By having narrowing the definition are we

>going to exclude communities that are homogeneous? People new to

health

>literacy may.

>

>I have had several discussions (e-mail) with a very prominent

physician

>in our state who vehemently argues none of his patients have problems

>with health literacy. He insists they all understand what he tells

them.

>With a definition such as this I can very well see this individual

>making the assumption that health literacy is limited to people who

do

>not speak English and/or come from cultures different than our own.

>

>The HHS definition does not limit health literacy to any one type of

>patient or community.

>

>Creating easy to understand materials and communicating clearly are

>strategies to improve health literacy. The role of the health care

>provider and health worker in doing this, to me has always been

implied.

>In the many presentations I have given on health literacy, difficult

to

>understand materials and poor communication are always things that I

>discuss as contributing to low health literacy and clear

communication.

>Using easy to understand materials are strategies I outline for

>enhancing health literacy. These are essential to a complete

discussion

>of health literacy but do not define it. As such I think it does not

>really fit in the definition of health literacy but is essential to

>enhancing it.

>

>During my presentations I have found people sometimes have difficulty

>clearly understanding the HHS definition of health literacy on the

>initial read. After we talk very briefly about what it is saying they

>have been able to read it and have it make sense. In the true nature

of

>making things easy to understand it truly is not written at an easy

to

>understand level (it is long and has several difficult to understand

>terms). However, it seems to have been universally accepted and as

such

>I would urge caution developing differing definitions. Adding to it

only

>makes it less reader friendly, more difficult to understand and

>potentially limited.

>

>I respect opinions may differ. By having a common definition that is

not

>limited to specific patient populations and clearly identifying and

>employing similar strategies to enhance health literacy we can

present
a

>common front. By creating varying definitions we become too

fragmented

>in what we trying to improve and risk loosing sight of what our aim

is.

>I believe, if I am not mistaken, our aim with health literacy is

>something to the effect of improving communication and

understandability

>of health related information for all people.

>

>Thanks very much,

>Bob

>

>Bob Dickerson, MSHSA, RRT

>Clinical Resource Coordinator, Clinical Quality

>Iowa Health - Des Moines

>Des Moines, Iowa

>Phone: (515) 263-5792

>Fax: (515) 263-5415

>E-mail: DICKERR2 at ihs.org 

>Website: www.ihsdesmoines.org 

>   

>

>-----Original Message-----

>From: healthliteracy-bounces at nifl.gov 

>[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Baur, Cynthia

>(HHS/OPHS)

>Sent: Tuesday, October 10, 2006 1:01 PM

>To: The Health and Literacy Discussion List

>Subject: [HealthLiteracy 441] Re: Your presentation on health

literacy

>

>I appreciate the lively discussion of the meaning of health literacy.

>The HHS Health Literacy Workgroup has always used the broadest

possible

>definition of health literacy, and we already recognize health

>professionals as part of the problem and solution. All types of

health

>professionals work at HHS, and we have always been very clear that

>improving health literacy is everyone's responsibility. For an

>elaboration of the role that we see health professionals playing,

please

>see our Quick Guide to Health Literacy that was developed for HHS

>employees. We have made this available on our web site for anyone to

>use. www.health.gov/communication, in the health literacy section.   



>

>Cynthia Baur, Ph.D.

>Senior Health Communication and e-Health Advisor Office of Disease

>Prevention and Health Promotion U.S. Department of Health and Human

>Services

>1101 Wootton Parkway, LL

>Rockville, MD 20852

>240-453-8262

>Cynthia.Baur at hhs.gov 

>

>

>

>-----Original Message-----

>From: healthliteracy-bounces at nifl.gov 

>[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Muro, Andres

>Sent: Tuesday, October 10, 2006 12:42 PM

>To: The Health and Literacy Discussion List

>Subject: [HealthLiteracy 440] Re: Your presentation on health

literacy

>

>Hey Anthony, that is great. Now, if we can get HHS to adopt the

>definition. Cynthia, are you there ;-)

>

>Andres

>

>-----Original Message-----

>From: healthliteracy-bounces at nifl.gov 

>[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Tassi, Anthony

>Sent: Tuesday, October 10, 2006 9:04 AM

>To: The Health and Literacy Discussion List

>Subject: [HealthLiteracy 439] Re: Your presentation on health

literacy

>

>I agree that Andres has succinctly captured what many of us have been

>thinking for years.  Here in NYC, we have incorporated this approach

in

>the definition that we are using:

>

>http://www.nyc.gov/html/adulted/html/health/health.shtml 

>

>Anthony Tassi

>Director, Adult Education

>Office of the Mayor

>City of New York

>atassi at cityhall.nyc.gov 

>

>

>

>www.nyc.gov/adult-ed 

>

>

>-----Original Message-----

>From: healthliteracy-bounces at nifl.gov 

>[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Julie McKinney

>Sent: Friday, October 06, 2006 1:42 PM

>To: healthliteracy at nifl.gov 

>Subject: [HealthLiteracy 437] Re: Your presentation on health

literacy

>

>Thanks Andres,

>

>I like the way your new definition of health literacy (at the end)

>includes skills for health workers to achieve in order to be health

>literate. It is a new way of looking at it! Please let us know about

the

>response you get from the presentation, if you could.

>

>Thanks again,

>

>Julie

>

>Julie McKinney

>Discussion List Moderator

>World Education/NCSALL

>jmckinney at worlded.org 

>

>>>>  amuro5 at epcc.edu 10/06/06 1:10 PM >>>

>Julie:

>

>

>

>It is my own presentation. However, it is attached. Let me know if

you

>have questions.

>

>

>

>Andres

>

>

>

>________________________________

>

>From: healthliteracy-bounces at nifl.gov 

>[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of

jbaker3439 at aol.com 

>Sent: Friday, October 06, 2006 10:37 AM

>To: healthliteracy at nifl.gov 

>Subject: [HealthLiteracy 434] Your presentation on health literacy

>

>

>

>  Andres,

>

>

>

>Although I would love it, I am not able to attend the Health Literacy

>Conference next week.  However, I was wondering if your presentation

is

>available for those of us who are unable to attend. 

>

>

>

>Are you part of a group from NCES or DOE that is disseminating

>information about NAAL, or is this a presentation that you have

designed

>yourself?

>

>

>

>Thanks for your time.

>

>

>

>Julie Baker

>

>

>

>

>

>Julie N. Baker

>

>Workforce Skills Development

>

>13805 Shaker Blvd., #4A

>

>Cleveland, OH 44120

>

>216-561-1629

>

>jbaker3439 at aol.com <mailto:jbaker3439 at aol.com>

>

>

>

>

>-----Original Message-----

>From: amuro5 at epcc.edu 

>To: healthliteracy at nifl.gov 

>Sent: Thu, 5 Oct 2006 1:08 PM

>Subject: [HealthLiteracy 430] health literacy conference San Antonio

>

>There is a health literacy conference in San Antonio next week. I'll

be

>doing a presentation about NAAL results and other things. The website

is

>listed below,

>

>

>

>http://www.sahealthlit.org/save2006.pdf 

>

>

>

>Andres

>

>________________________________

>

>

>

>----------------------------------------------------

>

>National Institute for Literacy

>

>Health and Literacy mailing list

>

>HealthLiteracy at nifl.gov <mailto:HealthLiteracy%40nifl.gov>

>

>To unsubscribe or change your subscription settings, please go to

>

>http://www.nifl.gov/mailman/listinfo/healthliteracy 

>

>________________________________

>

>size=2 width="100%" align=center>

>

>Check out the new AOL

><http://pr.atwola.com/promoclk/1615326657x4311227241x4298082137/aol?redi




>r=http%3A%2F%2Fwww%2Eaol%2Ecom%2Fnewaol> . Most comprehensive set of

>free safety and security tools, free access to millions of

high-quality

>videos from across the web, free AOL Mail and more.

>

>

>----------------------------------------------------

>National Institute for Literacy

>Health and Literacy mailing list

>HealthLiteracy at nifl.gov 

>To unsubscribe or change your subscription settings, please go to

>http://www.nifl.gov/mailman/listinfo/healthliteracy 

>----------------------------------------------------

>National Institute for Literacy

>Health and Literacy mailing list

>HealthLiteracy at nifl.gov 

>To unsubscribe or change your subscription settings, please go to

>http://www.nifl.gov/mailman/listinfo/healthliteracy 

>----------------------------------------------------

>National Institute for Literacy

>Health and Literacy mailing list

>HealthLiteracy at nifl.gov 

>To unsubscribe or change your subscription settings, please go to

>http://www.nifl.gov/mailman/listinfo/healthliteracy 

>

>

>----------------------------------------------------

>National Institute for Literacy

>Health and Literacy mailing list

>HealthLiteracy at nifl.gov 

>To unsubscribe or change your subscription settings, please go to

>http://www.nifl.gov/mailman/listinfo/healthliteracy 

>          ********************************************

>

>This message and accompanying documents are covered by the

>Electronic Communications Privacy Act, 18 U.S.C. ** 2510-2521,

>and contain information intended for the specified individual(s)

only.

>This information is confidential. If you are not the intended

recipient

>or an agent responsible for delivering it to the intended recipient,

you

>

>are hereby notified that you have received this document in error and

>that any review, dissemination, copying, or the taking of any action

>based on the contents of this information is strictly prohibited. If

you

>

>have received this communication in error, please notify us

immediately

>by e-mail, and delete the original message.

>

>         *********************************************

>

>

>----------------------------------------------------

>National Institute for Literacy

>Health and Literacy mailing list

>HealthLiteracy at nifl.gov 

>To unsubscribe or change your subscription settings, please go to 

>http://www.nifl.gov/mailman/listinfo/healthliteracy 


----------------------------------------------------
National Institute for Literacy
Health and Literacy mailing list
HealthLiteracy at nifl.gov 
To unsubscribe or change your subscription settings, please go to
http://www.nifl.gov/mailman/listinfo/healthliteracy 
----------------------------------------------------
National Institute for Literacy
Health and Literacy mailing list
HealthLiteracy at nifl.gov 
To unsubscribe or change your subscription settings, please go to
http://www.nifl.gov/mailman/listinfo/healthliteracy 

----------------------------------------------------
National Institute for Literacy
Health and Literacy mailing list
HealthLiteracy at nifl.gov
To unsubscribe or change your subscription settings, please go to
http://www.nifl.gov/mailman/listinfo/healthliteracy
----------------------------------------------------
National Institute for Literacy
Health and Literacy mailing list
HealthLiteracy at nifl.gov
To unsubscribe or change your subscription settings, please go to
http://www.nifl.gov/mailman/listinfo/healthliteracy