Revision 2

Intervention

Several activities have taken place in preparation for the implementation of the

intervention. First of all, there was a selection of the mental health clinic, followed by a signed

agreement that authorizes the intervention to be taken place at the clinic site. The proposed

project was presented to the Touro University of Nevada and approved by the DNP project chair

and members. The site administrator and Medical Director of the site were consulted regarding

the enrolment of participants.

The participants have received detailed information on their role and participation in the

project to reach the end goal.

The activities are expected to take place at the mental health clinic during regular office

hours. The clinic administrator will be in charge of selecting medical assistants whose role will

be to identify the Latinx immigrant, ethnicity which will be evaluated through the patient

demographic intake form at the clinic. Patients that require community resources and assist the

providers with a resource list for them. The project lead will be available to assist the medical

providers with any questions about the LICCT tool, as well as the specifics of each of the

resources within the tool. I will also be available with questions and guidance for the medical

assistants regarding documentation of resources provided to patient. In the event that I am not

available on grounds; a telephone and email contact will be provided to all participants for quick

access. The intervention will take place on November 4, 2020 through December 1, 2020. The

following is a weekly timeline of the implementation.

Week 1: During the beginning of this week the medical providers will take part in

educational training. The training will be presented in a power point and the IAPCCR-R pre-test

and post-test evaluation will be provided to all medical providers prior to the presentation. The

presentation will include a detailed explanation of the resource tool. During the second half of

this week implementation of the resource tool will begin.

Week 1-4: Implementation of resource to patients during in-office visits. Ongoing

education and support to participants will be available through these weeks. Data collection and

assessment of compliance will be conducted on a weekly basis in order to capture any

opportunities needed for re-training.

Week 5: During this week compiling of data for analysis should be completed and

statistical testing should be performed.

The implementation phase shall commence on November 4, 2020, and end on December

1, 2020. Later, the project lead and the medical providers are expected to have a meeting and

share the final data collected and analysis at the end of the intervention.

Tools

The tools that will be utilized during this DNP project include IAPCC-R, the LICCT,

educational presentation, and chart review tool. The following is an explanation of each tool.

LICCT (Appendix B)

The LICCT tool is composed of several resource assistance organizations with their

address and phone numbers. The five resources included in this tool are food assistance,

clothing, vocational training, employment services, and interpretation services.

The food assistance organizations provide USDA food distribution of canned goods,

fresh products, and groceries. The centers also provide emergency food, breakfast, lunch, and

dinner in different days of the week for those in need.

The clothing assistance organizations clients may obtain free hot showers for men and

women multiple days a week and a free exchange of clean clothing, shoes, and shower programs.

They also provide blankets and accessories to meet the needs of children, victims of crime, and

people affected by poverty, and homelessness.

The vocational training assistance organizations provide the tools and resources

necessary to help minorities to achieve financial stability. The services they offer include

financial coaching and education, credit counseling, free income tax preparation, and income tax

return, job training, interviewing skills and resume building, job orientation and training, resume

writing, vocational training, and job placement.

Employment services provide job placement referrals in addition to various course and

training through community programs.

Interpretation services will be available to assist the patient with translation of

documents, onsite interpretation, and telephonic interpretation.

IAPCC-R (Appendix C)

The Inventory for Assessing the Process of Cultural Competence Among Healthcare

Professionals-Revised (IAPCC-R) will be used as a pre/post questionnaire before

implementation and after all interventions to assess the providers' knowledge. According to

Transcultural CARE Associates (2015), the IAPCC-R© was developed by Dr. Campinha-Bacote

in 2002. It is a revision of the Inventory for Assessing the Process of Cultural Competence

Among Healthcare Professionals (IAPCC). The IAPCC, which is no longer available for use,

was developed by Campinha-Bacote in 1997 and is based on her cultural competence model, The

Process of Cultural Competence in the Delivery of Healthcare Services (1998). Cronbach's alpha

of the IAPPC© was established at .81 (Wilson, 2003). The IAPCC only measured four of this

model's five constructs (cultural awareness, cultural knowledge, cultural skill, and cultural

encounters) and not the fifth construct of cultural desire. In 2002, Campinha-Bacote revised the

IAPCC by adding five additional questions to measure the fifth construct of cultural desire. This

revision led to the instrument's last name. Further research was conducted on IAPCC-R© to be

used with students, and a student version (IAPCC-SV) is currently available (the IAPCC-R

website). Permission for the use of the (IAPCC-R) to assess the level of cultural competence of 3

mental health providers was granted on August 29, 2020. The total cost was $48 for 6 tools

which will be divided in 3 pre/post questionnaires. The permission only grants administration of

the tool via an onsite pencil and paper method which will be personally hand administered. All

other formats of administration are against contractual agreement.

Educational Presentation (Appendix D)

According to Bhui, Warfa, Edonya, McKenzie, & Bhugra (2007), cultural competency is

considered an essential requirement for medical providers in the specialty of mental health,

providing care to culturally diverse patient groups. Ongoing education and training have proven

to yield improved compliance in medical management and healthcare quality for ethnic groups

(Bhui, Warfa, Edonya, McKenzie, & Bhugra, 2007). Due to the considerable confusion about

what constitutes cultural competence at the organization, the need for competence training is

deemed crucial for the project's success. An educational presentation has been developed by the

project lead using a PowerPoint presentation, pre/post survey, and LICCT handouts. The

training's goal is to provide consistency among the providers of the clinic on how cultural beliefs

and practices of Latino immigrants may affect their perception of mental health illness, health

behaviors, and acceptance of resource assistance. The training will take place at the organization

and will be conducted by the project lead with the medical director and administration's

permission. A three-hour session will be allotted for the educational presentation.

Chart Review Tools

Two chart audit tools have been incorporated in the project. The first tool has been

composed of two sections (Appendix E) to evaluate participant’s knowledge of cultural

competency through educational presentation and pre/post questionnaire. The second tool

(Appendix F) is a scale tool to evaluate the knowledge in cultural competence of the participants

and the need for further education. Both tools have been developed by the project lead and

reviewed for quality by the project team and the stakeholders at the site. In addendum the

participants will also be evaluated for their compliance in providing and discussing the available

resources with the patient and documenting the plan accordingly during the office visit.

Data Collection Procedures

Data collection in the healthcare sector is a sensitive activity. Under the stipulated

nursing and healthcare principles, it must be done avoiding infringing patients' privacy,

confidentiality, or disclosing their essential information to the public and third parties. Data will

be made anonymous for confidentiality by hiding patient identities, locations, and addresses.

This approach will help protect the patient's information and reaching unintended people.

When collecting data, the project lead will undertake both pre- and post-survey results

assessments to profoundly impact the possible statistical analyses' choice to be conducted at the

group level (Alessandri et al., 2017). The data will be stored in digital form to avoid

manipulation by other parties since it may potentially result in incorrect data.

The IAPCC-R survey will be administered as a pre-test to evaluate cultural knowledge by

participants. Immediately after this survey is completed by the providers an educational training

via a power point presentation will be conducted by the project lead delineating the purpose,

goal, and each step of the project. Following the education training all providers will receive the

same survey to evaluate their level of learned competency. Both surveys will be provided to the

participants at the same time before the educational session. Since the surveys are the same, the

lead will label the surveys as Pre-1 for pre-test 1 and Post-1 for post-test as identifiers. Surveys

will be labeled with each participant name but will be entered in the code book with unidentified

initials. Directly after the collection of all pre/post survey questions, the audit tool (Appendix F)

will be completed, and results entered in the codebook. Once medical provider competency has

been established, the intervention will begin, and data will be collected weekly. Data will consist

of whether each Latino immigrant patient seen by a medical provider at the clinic receives the

resource information according to their needs. The medical providers will be required to address

the resources provided in their assessment and plan portion of their progress note. The

compliance of the intervention will be collected weekly by the project lead and entered in the

codebook. Finally, once the four weeks of implementation have ended, data analysis will be

conducted using the appropriate audit tool (appendix E).