AUGUSTA — An independent review of the Maine Center for Disease Control and Prevention found, among other things, that the agency makes it difficult for staff members in different departments to work together, that it needs to better train its workers to deal with diverse groups of people and that some staff members feel managers bully minority employees.

It recommended changes.

The Maine CDC Cultural Competence Assessment was done in late 2012 and the full report was presented to CDC officials in June 2013. The report was made public last week as part of a Freedom of Access Act request by the Sun Journal.    

A CDC spokesman said agency leaders acknowledge the report’s findings and are making changes.

“The information is valuable and we appreciate the participation of our staff,” spokesman John Martins said in an email. “We are currently working to implement many of the recommendations associated with the report.”

The CDC is seeking national accreditation from the Public Health Accreditation Board. Agencies must address cultural and communication competency to earn accreditation, according to the report.

As part of the assessment, 229 CDC staff members completed an online survey and 31 were interviewed in person. The process took several months to complete. 

At the end, the assessment team delivered a 122-page report.

The report’s findings include: 

* Staff members were divided about whether the CDC gave them the resources needed to communicate with the public across cultures, languages and literacy levels. Several said they needed better support from leadership, including one person who said, “The attitude is to blame those who ask for help.”

* Staff members disagreed about whether the CDC welcomes different cultures and recruits and retains diverse employees. Comments ranged from, “In my office, everyone is like family. … It’s fun to learn everyone’s different cultures,” to, “I have been present when people of color have been yelled at, treated unfairly, and made fun of.”

* CDC staff members struggle to engage tribal members, refugees, the elderly, the poor and other vulnerable populations in part because the CDC lacks protocols and there are delays for workers to get permission from management.

* Nearly two-thirds of respondents didn’t know how to get a professional interpreter for someone who is deaf. Many knew foreign language interpreters were available but didn’t know how to access them. “We have a list (of interpreters), but none of them are actually available,” one person said.

* Better data are needed to identify the disparities in health and health care for different populations.

The report made a number of recommendations, including that the CDC revisit its nondiscrimination policies and monitor trends in its hiring and retaining of diverse staff, give workers more training on accessing interpreter services, develop a plan to engage vulnerable populations and develop a council to identify and propose strategies to address health disparities.

It also recommended that the CDC hold agency-wide “town halls” at least once a year to allow staff to raise concerns — and offer solutions — about collaboration problems among divisions. However, Martins said the CDC was doing that before the report.

“In addition, we have created Ideas Teams that include representatives from across our agency to identify better ways to do our work together,” he said. “We know that many of the best solutions come from front-line personnel.”

Martins said the CDC has taken the assessment and its recommendations seriously.

“The core of public health is to meet the needs of all people, especially those most at risk,” he said. “Our state is becoming more diverse each year, with many people speaking languages other than English. Maine CDC has promoted for years the importance of both organizational and individual self-assessments in order to determine where we have areas for improvement and to identify our strengths.”

Using grant money, the agency in January hired a contractor to help implement the report’s recommendations. It is also developing a translation policy, identifying data system improvements for race, ethnicity and language data and forming a council for addressing health disparities.

It is updating its policy on the use of interpreters because nearly two-thirds of respondents didn’t know how to get a professional interpreter for someone who is deaf and many didn’t know how to get a foreign language interpreter.

“This assessment clearly indicated the need to refresh and remind staff on how to access resources that are available,” Martins said.

In places, the report noted issues with leadership and staff members’ different opinions about the treatment of diverse employees. Martins said the agency anticipated a range of responses to the survey and “we appreciate all responses received.”

“As assessments are useful quality improvement tools, the report offers us an opportunity to address some identified areas,” he said. “It is very important to CDC leadership that all staff members understand the importance of sharing any incident where any staff member is treated in an unprofessional and inappropriate manner.”

Over the past year, some CDC officials have been accused of harassing and intimidating employees. A former CDC division director has filed a federal whistle-blower lawsuit against the agency and the state’s Office of Program Evaluation and Government Accountability plans to look into management behavior and the treatment of employees at the Department of Health and Human Services, which oversees the CDC.

The Cultural Competence Assessment was done by a small, independent team that included Stefanie Trice Gill, a cross-cultural systems consultant based in Maine. The state paid her $44,000 for the assessment and report.

ltice@sunjournal.com

The Maine CDC Cultural Competence Assessment’s findings include:

* Staff members were divided about whether the CDC gave them the resources needed to communicate with the public across cultures, languages and literacy levels. Several said they needed better support from leadership, including one who said, “The attitude is to blame those who ask for help.”

* Staff members disagreed about whether the CDC welcomes different cultures and recruits and retains diverse employees. Comments ranged from, “In my office, everyone is like family. … It’s fun to learn everyone’s different cultures,” to, “I have been present when people of color have been yelled at, treated unfairly, and made fun of.”

* CDC makes it difficult for staff in different programs and divisions to work together.

* CDC staff members struggle to engage tribal members, refugees, the elderly, the poor and other vulnerable populations in part because the CDC lacks protocols and there are delays in getting permission from management.

* Nearly two-thirds of respondents didn’t know how to get a professional interpreter for someone who is deaf. Many knew foreign language interpreters were available but didn’t know how to access them. “We have a list (of interpreters), but none of them are actually available,” one person said.

* Most respondents said they didn’t feel responsible for identifying health disparities — the gaps in health and health care for different populations — and said that responsibility rested with their supervisors, others in their program or the Office of Health Equity.

* Multiple employees said the Office of Health Equity had provided helpful training on health disparities. Others said they were aware the office existed but didn’t know its role.

* Policies related to cultural competence and health equity are not understood or implemented because of a lack of training and orientation.

* Although a tribal liaison exists, there is no standard operating procedure to outline how CDC leaders might facilitate information sharing between the state and tribal government.

* Better data are needed to identify disparities and set priorities.

Among the report’s recommendations:

* Develop a senior-level health equity council to identify and propose strategies to address health disparities.

* Ensure that all program managers and staff members who work with the public have in-person, hands-on training on accessing interpreter services.

* Develop hands-on workshops and support for staff in all divisions who work with public health data to learn how to identify and address disparities.

* Monitor trends in hiring and retention of diverse staff.

* Revisit nondiscrimination policies and procedures and make them easily available to all staff.

* Hold CDC-wide “town halls” at least once a year so staff can raise concerns and solutions about collaboration among divisions.

* Issue an annual CDC Vulnerable Population Demographic Profile that highlights growth trends in vulnerable populations by demographic and lists the top 10 languages spoken.

* Release an annual Maine Public Health Equity Profile that highlights the health disparities of vulnerable populations across Maine and make that profile available (updated annually) on the state CDC website in various languages.

* Ensure that each division is developing its own health equity profile to be updated annually.

* Ensure that all workers and contractors are collecting data uniformly.

* Ensure that staff can anonymously report concerns regarding the validity of data collection to the Maine CDC Health Equity Council.

* Establish clear protocols for engaging with vulnerable populations to limit lag time and ensure all staff can engage.

* Develop a policy and outreach plan to engage vulnerable populations, encourage outreach and publish a public health equity report every year.

* Develop policies and procedures to ensure culturally appropriate communication.

* Monitor trends in the use of interpreters. Issue an annual report that looks at usage and notes top languages and any gaps.

* Evaluate interpreter services being used to ensure they’re effective, timely and easily accessible.

* Evaluate protocols and resources for the translation of materials into other languages. Establish new protocols to ensure ready access and reduce waiting times.

* Develop internal procedures for plain-language reviews of written communication and for cross-cultural/language review for documents targeted to diverse populations.