African-American Outreach Programs Require Planning, Sensitivity

NEW YORK—Developing and implementing cancer outreach programs for African-Americans takes planning and sensitivity, said Robin L. Hurdle, CSW, a social worker in charge of the African-American Outreach Program at Cancer Care, Inc., the New York-based program that provides emotional support, information, and practical help to people with cancer and their loved ones free of charge.

The key to building successful programs is what Ms. Hurdle calls “the parallel process,” ie, the planning that should go on 2 years before a program opens its doors.

“When you talk about underutiliza-tion, when you talk about people walking out and not coming back, being wary of even coming into your program, it is because the parallel process has not been thought through,” Ms. Hurdle told a group of oncology social workers from hospital outreach programs in the New York metropolitan area at a seminar sponsored by Cancer Care.

Often administrators get side tracked looking for money, space, and staff, Ms. Hurdle said, and do not think enough about the makeup of the community, what its members want and need, or what the staff and the facility itself should convey to them.

To aide those developing cancer support outreach programs for African-Americans, Ms. Hurdle and Anita Redrick McFarlane, MPH, CHES, outreach manager of the Cancer Information Service, Memorial Sloan-Kettering Cancer Center, have developed a series of questions known as the Community Needs Assessment Tool (see table).

The Community Needs Assessment Tool

What are the most pressing health issues in the neighborhood? Prioritize those issues.

What other issues are specific to the neighborhood?

What is the community’s financial base?

Who or what represents the community’s political base?

What are the community’s resources—hospitals, home care agencies, clinics/primary care centers, volunteer ambulance corps, businesses, civic organizations, etc?

What are the neighborhood’s demographics—languages, age ranges, etc?

How much assistance do outside businesses put back into the community?

 Are there facilities and/or personnel in the community knowledgeable about cancer issues? Can partnerships be formed with these groups?

What is the neighborhood’s system of communication, formal and informal?

 Identify a potential volunteer base.

Identify the cost of transportation and the frequency of service.

 Identify potential community spaces that can be rented for health fairs

The outreach facility in its appearance should incorporate cultural representations, photos, paintings, or other elements of interior design that reflect the cultural identity of the community. Special holidays such as Black Solidarity Day should be kept in mind when schedules are planned.

The program’s staff, in addition to providing information about the program, should also be able to communicate its knowledge of the culture of the community and be mindful of the community’s socioeconomic status.

“In many cases, people in these communities are going from crisis to crisis, basically just surviving,” Ms. Hurdle said. “Our staff has to be respectful, to be able to understand and help them address their concrete issues and some of their psycho-social issues.”

The person who walks in the door is not just a possible breast cancer patient, but may be a mother of three, the single head of a household, struggling not only to keep her children in school but to put food on the table.

“On some level, the program that you strive to create has to address some of these issues,” Ms. Hurdle commented. “During your parallel process, if you know your program can only do cancer screening and medical referral, then build alliances with other organizations that can help in other ways.”

Church pantries, for example, may provide lunch to clients, she said. Social agencies may be able to provide money for transportation to the program’s facility. The National Cancer Institute’s Cancer Information Service is available to answer general medical questions.

During the parallel process, thought should also be given to how clients will be able to find the actual location of the outreach program.

“If prospective clients have to ask five or six different people on the street for the outreach program for ovarian cancer, many of them will give up before ever getting there,” Ms. Hurdle said. “People get very hyper quickly when they can’t find things.” She suggested that planners “think about how you will make yourself known. You may be able to get the hospital or organization you are affiliated with to give you signs you can put up in the neighborhood.”

Though money may be limited, there may be ways to supplement it, Ms. Hurdle suggested. Toy manufacturers could give small grants to create playrooms in the outreach facility for children whose mothers are being screened. Local bakeries might be willing to donate day-old baked goods for clients to snack on. In return, the outreach program could offer cooperating merchants on-site health education and screening, she said.

Although members of the community might not be able to donate money to the outreach program, they might be able to donate time. A young woman with some extra time on her hands could take care of the children in the playroom. Some people in the community might be able to give out flyers letting the community know about the facility. Others might know about low-cost or no-cost spaces in the area the program could occupy.

Though funding for outreach programs is often low at first, administrators should not lose heart, Ms. Hurdle said. “You must be willing to take those lemons and turn them into lemonade. You have to be able to start small and grow.”