Close to 15,000 ITHP's from 167
countries have been served by Welcome Back Centers across the Nation.
English Language Proficiency
Participants, educators, and employers alike identified lack of fluency in English as a fundamental obstacle for ITHPs. Participants understood the need to improve their language skills but expressed great frustration with the length and focus of existing “English as a Second Language” (ESL) programs, which typically run from 3 to 5 years and are primarily focused on reading and writing but not on speaking. As a result, the San Francisco Welcome Back Center developed a unique, innovative curriculum (English Health Train) aimed at improving the English communication skills, career potential, and confidence level of immigrants trained as health professionals in their own country.
Sixty-one percent (61%) of the respondents to the WB survey indicated that their level of English has improved since their involvement with WB.
Loss of Professional Identity
Among the most challenging aspects of WB’s work with immigrant health professionals was dealing with the emotional sequela of migration, including losses of country, family, professional identity, networks, and social standing along with the underlying reasons for migrating. Immigrant health professionals often faced the loss of professional identity and associated social standing and the challenge of redefining themselves in a new societal context. The loss of professional identity was compounded by the complexity of the licensure processes. The role of the ECM is essential in helping navigate the licensing process and in identifying new and fulfilling roles in the health sector.
Fifty-four percent (54%) of survey respondents stated that WB had assisted them in improving their self esteem; 98% said it was important or very important to have an opportunity to interact with other ITHPs; and 66% of respondents noted that WB has helped them explore new career options.
Lack of financial resources and time to attend classes were consistently identified as barriers to participation. Individuals often did not have the time to go to school because they held two or three jobs in order to support their families. Therefore, efforts to find the time to go to school frequently implied a significant reduction in income. Structuring the hours of operation of Welcome Back Centers with this issue in mind has enabled the participants to take full advantage of the program’s services. An important role of the ECMs was to assist participants in finding potential sources of financial support, e.g., scholarships, and loan forgiveness programs. In some cases, assistance in finding affordable childcare or housing was identified as a key element for participants to succeed.
With these elements of support in place, the outcomes the participants accomplished are impressive. Data from a sample of program participants at the Los Angeles site shows that, on average, participants’ income has doubled upon completion of the plan they developed with their ECM. Also WB participant survey data shows that 35% of the respondents had slight or significant increase in income since they enrolled in WB.
Commitment to the Safety Net
The intent of the WB program is to strengthen the safety net by contributing to the creation of a health workforce that better reflects the demographics of the nation and is willing to serve medically underserved communities. The program’s activities and classes consistently highlight the issues of disparities in health, barriers to access to health services, and the role of the safety net. While participants are highly motivated to work with their communities of origin, the realities of the marketplace prevail when job opportunities arise: the private sector can and does offer better salaries than the safety net. The broader contextual issues related to the financial viability and structural security of the safety net influence WB’s ability to provide a pipeline of health workers to safety net providers.
The program’s expectation is that as it contributes to increase the pool of culturally and linguistically diverse health workers, both the safety net and the private sector will be able to find qualified staff to deliver services.
Flexible Career Pathways
The program’s approach to developing a career strategy with the participants started by understanding where the participant was in the spectrum of options available to him/her. This flexible pathways approach, is a non-linear, non-“one-size-fits-all” service model featuring a menu of options and client flow pathways. Participants had different needs at different points in time and to be successful, the program was required to be flexible. Our experience demonstrates that to significantly contribute to the diversification of the health workforce, intense, up-front, and flexible investment needs to be made. In the long term, this investment can yield important and long- lasting results creating a stable workforce from and dedicated to the Nation's diverse ethnic communities.
WB has extremely dedicated staff at every center, at every level. Many of these individuals were immigrants themselves and/or had worked with immigrant communities for decades. The staff’s linguistic and cultural competency directly enhanced the centers’ ability to serve a diverse population; it also probably impacted the racial and linguistic mix of participants enrolled in the program. The fact that the Initiative Director was a Mexican, immigrant physician gave a "real" public face to the WB program, particularly for the media and within the policy arena.
Regional Center Variation
Each center evolves somewhat differently because of geographical location, vision of the local leadership, size of the service area, preexisting relationships with local employers and educational institutions, and staffing needs of the regional health sector. Additional information about each center demonstrating these regional variations can be found on each center’s website.