By Audrey Nuamah, Center for Health Care Strategies
Minnesota is home to the largest Somali population in the United States. Hennepin Healthcare — a Minneapolis-based safety net health care system — identified mental health access for this population as a priority health need through their community health needs assessment. In particular, Somali patients accessed mental health services at lower rates when compared with other demographic groups. To increase Somali engagement with behavioral health services, the Hennepin Healthcare Population Health team knew it would require a deeper understanding of Somali culture. The team conducted outreach to Somali community members to hear directly about their needs and barriers to using behavioral health care services. They used human-centered design to work with the community to co-identify these barriers and co-design solutions. Hennepin hired four Community Engagement Leaders to serve as liaisons between the Somali community and health care partners.
CHCS recently spoke with two of the Community Engagement Leaders (CEL), Hilal Ibrahim and Jama Abdul, to learn about their experience with this project. Hilal Ibrahim, a daughter of Somali immigrants, is currently a small business owner selling hijabs for Muslim health care workers, and is passionate about health care inequities with dreams of one day becoming a physician. Since immigrating to the United States, Jama Abdul has become an assistant property manager for a residential apartment and volunteers as a STEM tutor in the Somali community. Through his volunteering efforts, he got to know many other Somali immigrants who raised issues around poor mental health and social isolation but did not know how to access help.
Q: What does it mean to you to be a Community Engagement Leader?
A: H. Ibrahim: I’ve always been an advocate who is big on making a difference. I’ve noticed though, that many times, you have a group of intellectual individuals who also want to make a difference but are not necessarily representative of the demographic being served. It’s difficult to help a population that you cannot relate to, do not know what they need, nor what they’ve experienced.
J. Abdul: I am so excited to be a CEL because I like speaking on behalf of my community and sharing what we traditionally believe about mental health. In my community, there’s a lot of stigma about mental health, and families will often try to hide a family member who has mental health issues. I want to be able to share with my people that there is nothing to hide.
Q: Why do you think it’s important for health care organizations to partner with community members to better understand and co-design solutions to the issues facing them? What are some specific strategies Hennepin Healthcare has implemented to accomplish this?
A: H. Ibrahim: Hennepin Healthcare’s patient population is over 60 percent from communities of color, and we know there are already so many preexisting inequities in health care for this group. Therefore, you want to ensure that their health and their well-being are taken care of, that they feel supported and heard, and that there are no gaps in care. These steps improve patient wellness across the board. I think one strategy that I can recommend is honing in on and focusing on building partnerships with community leaders who are already doing the mental health work in the community. These leaders know not only what is needed, but also what has and hasn’t worked. Hennepin Healthcare has done a good job reaching out to those folks in these spaces.
J. Abdul: After talking with health care professionals, they have shared with us that they don’t know how to approach Somali people because they are afraid of offending our culture and religion. Doctors don’t know where to begin because discussing mental health is taboo. Because of the significant stigma around mental illness, the Somali community doesn’t bring it up either, so nobody is talking about it. So as a part of the Community Partnership Pilot project, we tried to tackle this through our first virtual Tea for Understanding event and then an in-person socially distant Eat for Understanding event, so providers and the community could come together to better understand one another
Q: How were you and Hennepin Healthcare able to work together to build a culture of trust and understanding between each other?
The transparency, openness, and intention are critical, otherwise, actions from the health care system can be mistranslated and once you have that fear you cannot get the trust back.
A: H. Ibrahim: There is a great deal of mistrust in the health care system from immigrant and Black communities, and I believe these feelings are 100 percent justified. In order to build trust, the health care system must make their intentions clear and provide transparent communication along the way. There’s this assumption that immigrant communities don’t understand what is being offered to them because of the language barrier, but I very much disagree with this. If anything, they care more to understand because of that barrier. The transparency, openness, and intention are critical, otherwise, actions from the health care system can be mistranslated and once you have that fear you cannot get the trust back.
Hennepin Healthcare did a phenomenal job engaging with us and using the Somali tradition of oral communication. If you want to do outreach, you’re better off doing a phone call rather than email. Once that trust is established, word spreads like wildfire. If someone has a great experience, she’s calling her sister, her aunt, her mom, and the network just continues to grow.
J. Abdul: The Hennepin team gave CELs the opportunity to invite people to join these discussions, and they provided food and transportation. Two of our sessions included actual people seeking treatment who were able to provide input around their experiences and how receiving treatment from Hennepin made a positive impact on their mental health. Hennepin provided a huge opportunity for our voices to be heard.
Q: How did the human-centered design activities create opportunities for community members to honestly share their perspectives?
A: J. Abdul: I had no prior experience doing human-centered design, so I learned a lot about coaching and facilitation, which I can take back to my own community. As the assistant property manager of my apartment, I co-developed an event with the Hennepin team to host a discussion about mental health and where to go to receive services. The Somali residents in my apartment exchanged stories about how we have traditionally treated mental health and the shame that comes with it. I was then able to share resources with them about the types of services Hennepin offers.
Q: How has the COVID-19 pandemic affected the Somali community, and what can health care entities do to lessen the impacts of COVID-19 on those most impacted by health inequities?
People in positions of power, the ones who make decisions about how care is delivered, need to come from the community.
A: J. Abdul: COVID-19 is not allowing us to come together and the Somali community is very touchy-feely — we like to come together and talk closely and passionately with one another and this cannot happen now. As we pivot to more virtual communication, it is important to remember many older adults don’t have access to certain technologies or the internet. Another challenge is that some religious members of the community, especially women, do not like their faces on video, which makes telehealth visits difficult. Doctors may not have the cultural awareness to understand why and in order to not offend, do not ask more questions. Hennepin and other health care organizations need to keep these things in mind when engaging with members of the Somali community.
H. Ibrahim: You look at the people most impacted by COVID-19 — communities of color, particularly the Black community and immigrant communities — the Somali community falls in both of those categories. Health care systems need to have leadership that is representative of their patient population. I don’t just mean increase the number of Somali nurses or physicians. People in positions of power — the ones who make decisions about how care is delivered — need to come from the community.