The Spanish-Speaking Women's Cancer Initiative (2001-2004)
After reports indicated that uninsured Latinas in Contra Costa County had particularly high mortality rates in a county that already had a high incidence of cancer, the Community Health Fund worked with community organizations to build a multi-agency collaborative to help Latinas get earlier detection and treatment for breast and cervical cancer. From 2001 through 2004 the Community Health Fund provided $1.6 million - which includes $600,000 that the CHF obtained in a grant from the California Endowment - to support planning, implementation and evaluation of the initiative.
The September 2004 evaluation by the Center for Applied Local Research found that LaClínica's Promotoras de Salud program had provided cancer information to between 2,800 and 4,000 Latinos annually in central and east Contra Costa County. From 2001 -2004, Patient Navigators from the county had provided navigation to 6,742 Spanish-speaking patients for pap smears and breast examinations. Collectively, the SSWCI's continuum of culturally and linguistically appropriate medical care and coordinated services had supported 85 -120 Latino women annually, who had been diagnosed with cancer. Services included transportation to appointments, 40 different support groups, case management services, in-hospital and in-home support, multiple cancer education workshops, and hospice care. Focus groups found patient satisfaction with the services to be extremely high.
To this day, the program (now known as the Latino Collaborative of Contra Costa County [LC4]) provides a continuum of services to help monolingual Spanish-speaking women live with, through, and beyond cancer. From September 2004 through February 2009, outreach efforts reached over 14,000 individuals; almost 20,000 more received screening, navigation, and translation services, with nearly 6,000 of those receiving screenings and referrals for mammograms at community clinics. Thousands more in those same five years received case management, support services during treatment, health education, and help obtaining health insurance or treatment referrals.
The Health Issue
In the late '90's, health indicators pointed to a high incidence of cancer in Contra Costa County, with uninsured Latinas experiencing higher mortality rates. Evidence indicated that barriers in the healthcare system and poorer screening rates contributed to later detection and thus poorer treatment outcomes for Latino women.
The Health Improvement Strategy
After considerable discussion, the proposed partners - the American Cancer Society, Anna's Program of Hospice of the East Bay, the Contra Costa Health Services Department Patient Navigator Program, La Clínica de La Raza, Cancer Support Community, and the Women's Cancer Resource Center - decided to focus their efforts on earlier detection and treatment for breast and cervical cancer in the Latina community. To prevent late diagnosis, the collaborative - with the leadership of La Clínica - conducts outreach and education to motivate women to seek regular screening. La Clínica and the County provide primary care and screening, as well as referrals to diagnostic services. The County Patient Navigators help monolingual patients access services through the county system.
Then the organizations work together to further meet the needs of these patients. The American Cancer Society, for example, provides transportation to appointments and helps with wigs, turbans, and prostheses. If a woman has emergency financial needs or requires emotional support at the hospital, the Women's Cancer Resource Center is available to help. For therapeutic support, Cancer Support Community provides the only cancer support groups in Spanish in the county. Finally, Anna's Program and Hospice provides care for those with advanced cancer.
The initiative has been an unqualified success. A formal, outside evaluation found that the initiative: