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I can still remember the first time I saw my byline in print. After years of writing articles, essays and short stories, I’d finally sold one—and had the magazine to prove it. A writer is a person who uses written words in various styles and ques to communicate their ideas. Writers produce various forms of literary art and creative writing such as novels, short stories, poetry, plays, screenplays, and essays as well as various reports and news articles that may be of interest to the public.

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An annotation is more than just a brief summary of an article, book, Web site or other type of publication. An annotation should give enough information to make a reader decide whether to read the complete work. An annotated bibliography is a kind of a research based on literature review on a given theme. The process of writing an annotated bibliography assumes that a student should create an alphabetical list containing research sources.

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There are a plethora of job boards on the web, and we have selected our favorites who have been providing services for some time. ESL Job Feed provides many updated daily feeds of English job listings from regions and countries worldwide. is one of the biggest job boards for English teachers. Most serious teachers and long-term professionals are constantly learning about their field of choice, and these online and print publications discuss a variety of subjects and issues of interest. ELGazette is a digital magazine designed for all people involved in English teaching. English Teaching Professional is an online resource and offers a paid magazine subscription to teaching professionals. Forums are a great place to have your questions answered and to research countries, recruiting agencies, jobs, and sometimes even living conditions. They are the best place to get independent verification about a particular job, and there are always experts willing to share their knowledge and experience. ESL Café Job Discussion Forum has a very busy forum with many experts and experienced members sharing valuable advice about jobs abroad, broken down by the most popular regions and countries. ESL Café Teacher Training Forum is a mixed threaded message forum where members discuss the advantages of different certifications necessary to teach English. When you find a job it is always good to have lesson plans and other resources to help you teach your students, especially if the school you work for does not provide them, or if you work as a freelancer or just plain want to be creative. We have selected some websites offering such materials. Boggle's World ESL Article ESL There are some primary resources all teachers should check out or follow at some point in order to find jobs and other useful information. We have listed some primary sites we prefer which should serve as great departures for research into your dream job. ESL Café has information about teaching English as a second language, either internationally or in the U. The forums offer in-depth discussions on a variety of issues and on a variety of countries worldwide. A recommended resource for anyone interested in teaching English abroad. TESOL International Association is the website of a global association that serves the needs of 13,000 English language teaching professionals representing over 140 countries. An essential resource for both ESL and EFL educators. offers a teacher forum, ESL lesson planning, TEFL Resources, teacher training, ESL jobs and other valuable resources for teaching English as a foreign or second language. Total ESL is a portal offering everything from articles on a variety of issues relating to teaching English, links to an extensive job board updated daily, discussion forums, lesson plans, and much more. University of Michigan, International Center’s Overseas Opportunities Office hosts articles and provides resources on Teaching Work Abroad. Fulbright English Teaching Assistantships are programs for recent university graduates. MA or doctoral candidates, or young professionals to serve as English Teaching Assistants in countries worldwide, with a large number of offerings in Brazil, Germany, Malaysia, Korea, Spain, Turkey, and more funded by the host country. It provides some of the best-paid teaching opportunities in less-wealthy regions such as Africa, Latin America, South and Southeast Asia, and even Eastern Europe and the former Soviet Block. Peace Corps is sometimes overlooked because of its designation as a volunteer program, but is one of the largest work-abroad programs for U. In this Toolkit, you will find supports for writing a grant application for funding. Part I gives a step-by-step overview of the grantwriting process. Part II provides a general template for writing a grant application. Completing Part II will give you a solid proposal that can be adapted to meet specific grant opportunities and review criteria for specific funders. Additional tools can be found at the end of the section. 2506 Crestline Circle Lawrence, KS 66047 People for Universal Health Care September 22, 2000 Kansas State Health Department Attn: Grant Committee 618 N. Bay Country Topeka, KS 67525 Dear Sir or Madam: The mission of our organization is to improve the health and well-being of children in Marshall County, Kansas through education and improved community programs. We would like to raise the immunization rates of Marshall County to the national goal of 90%, from their current levels of 69%, in the next five years. We are interested in immunization rates in Marshall County because there is little or no system to ensure that the children of that community receive proper immunizations. Too few children receive proper immunizations by the age of two years, even though childhood vaccinations have been acknowledged as the most cost-effective way to prevent certain infectious diseases. Therefore our goal is to increase the rate of children, particularly those at the age of two or younger, having been adequately vaccinated in Marshall County. We believe that we have the capacity to carry out this initiative because we have a strong history of success in child and youth services, as well as health and wellness services. Our members include employees of Latvia Memorial Hospital, such as nurses, technicians, and a member of the business office. Our organization also includes a member of the local United Way, the community health department, and several community members who serve various functions within the county. Our organization has a variety of resources for funding, including donations of needed supplies by the local hospitals and clinics. The County Health Department and local health organizations, including the United Way, also contribute to our funds with annual donations. Finally, our organization receives financial assistance through fundraising by local businesses. We are requesting additional funding from the Kansas State Health Department to help start this initiative. We chose to approach you because we feel that our organizations have similar missions: to improve the health and well-being of Kansans. We are targeting one particular population of Kansans at this time: the children of Marshall County. Sincerely, Julie Vu Executive Director STATEMENT OF THE COMMUNITY PROBLEM OR CONCERN State the community problem or concern to be addressed. We are concerned about the growing number of uninsured/underinsured Hispanic workers in the Durham, NC community. This community has issues of access related to language barriers, the lack of health insurance, and the lack of transportation to the clinics currently available in the area. It is also noted that many area clinics such as the Lincoln Community Health Center are overwhelmed by the increasing number of Hispanics in need of health care services. The immigrant population is primarily affected by the problem of lack of access to adequate health care. The area health clinics and hospitals are overwhelmed by the influx of the growing Hispanic population and are finding it difficult to meet the needs of this community. DESCRIPTION OF THE COMMUNITY Describe the geographic area that defines the community including the location and physical boundaries, total population, and other relevant characteristics. Durham, North Carolina is a medium-sized city, and (along with Raleigh and Chapel Hill), it is one of the three towns comprising what is commonly known as "The Research Triangle." Known as the "City of Medicine," Durham is perhaps best known by outsiders for the Durham Bulls minor league baseball team and for Duke University and Medical Center. Durham is also home to two other colleges, North Carolina Central University (the nation's first publicly supported liberal arts college for African-Americans), and Durham Technical Community College. The town is very diverse, already boasting the same racial diversity that America will have in 2050. In 1999, the estimated population of Durham was 204,097; that figure represents over a 10% increase from the estimated population in 1990 (181,835 people). While the town was founded primarily with money from tobacco over a hundred years ago, it is now a major center for research and development, with major corporations such as IBM and Glaxo Wellcome having a home in Research Triangle Park, most of which is a part of the city of Durham. Indeed, trying to cope with the booming growth that has hit the area is one of the largest challenges facing area planners. Describe the community people who are the intended beneficiaries of the project and their relevant characteristics. Our project is being developed to serve the needs of Hispanic residents of Durham County, including those who have come to this country illegally. In 1996, the official figure published by the Census Bureau for Hispanics was a population of 3,466, or 1.8% of the population. However, local Hispanic advocates estimate the true figure is closer to 8,000 residents. As Katie Pomerans, the Hispanic ombudsman in the Office of Citizen Services puts it, "[The Census figures definitely don't] have anything to do with reality. They're grossly undercounting, and it makes no sense." Any way you count it, the number of Hispanics in the county is on the rise. The Census Bureau states that the Hispanic population of Durham grew by 11% from 1995 -- 1996, and the number of Hispanic children in schools jumped by 25% during the same time period. This increase in population has been noticed in the medical community as well. Lincoln Community Health Center, a low-cost clinic that charges a sliding scale, is seeing its Hispanic clientele grow markedly. For example, in just the two years from 19, the percentage of the patient population that was Hispanic tripled, from 2.7% to 7.1% of the clinic's visitors. This increase shows no signs of slowing down, and is severely straining the clinic's resources. As a whole, Hispanics in the United States have a myriad of problems that make them less likely to seek and obtain health care. Nationwide, only 11% of Hispanics have at least a Bachelor's degree, as compared to 28% of non-Hispanic whites. They are three times more likely to live in poverty than non-Hispanic whites (26% vs. Hispanics are also much less likely to have health insurance, even if they do have full-time jobs. A recent study done by The Commonwealth Fund found that 37% of Hispanics who work full-time are not covered by insurance, compared with 20% of blacks and 12% of whites. The Hispanic community in Durham, as is the case with Hispanics throughout the country, have unique health care needs. Not the least of these is actually having the resources to get them in the door of a medical office. As The News and Observer, one of the local newspapers, reported last summer, "The number of immigrant Latinos seeking medical attention is growing, but several barriers -- including a language gap and lack of transportation -- haven't made it an easy trip to the doctor's office." Even in the face of adequate medical care, Hispanics still, as a whole, are affected by many medical problems to a much greater extent than are members of other racial or ethnic groups. For example, high blood pressure, diabetes, obesity, and tuberculosis are all health concerns which occur in Hispanics more frequently than in other populations. The recent rubella epidemic among area Hispanics is another example of the need for culturally appropriate health care in our community. Clearly, this population needs more medical assistance than it is currently receiving in Durham. ANALYSIS OF THE PROBLEM OR SITUATION Identify the basic conditions or root causes that may contribute to the problem or concern. Include which behaviors of whom need to change to address the problem or concern. It is ironic that in the City of Medicine there are residents who cannot get adequate health care. Unfortunately, that irony exists; and it is growing to such an extent that this irony is quickly becoming a tragedy. The booming Hispanic population is at the root of this problem. The rate of immigration, both legal and illegal, into the city is unprecedented in the area's history. Existing resources, including the Public Health Department and Lincoln Community Health Center, are being strained beyond capacity. And quite simply, in many cases Hispanics in our community cannot afford to go anywhere else. In Durham in 1990, for example, 285 households headed by Hispanics had incomes below , 999; and 157 had incomes below ,999. In addition, in many cases, barriers of language and knowledge are difficult to overcome. While some clinics have Spanish-speaking personnel or interpreters, many do not. Additionally, the very people who do not regularly seek medical care in the community are the same people who are unaware of the resources already available in the community (for example, STD hotlines in Spanish and disaster assistance). ORGANIZATIONAL CAPACITY TO CONDUCT THE PROJECT Describe the nature, depth and continuity of the organization's leadership. Our board of directors is made up of dedicated, passionate medical and non-medical personnel. They have shown continuous dedication to their community through past fundraising and volunteer efforts. Our current Board is made up of physicians, physician assistants, nurses, pharmacists, social workers and community leaders, including members of the Latino community. Important posts in the clinic will be filled as follows. Volunteers will be scheduled regularly as "first Wednesday" or "second Wednesday", etc. Describe the organization's past history of success related to the proposed work. While we are new as a group, our many years of service to the community will prove invaluable in this endeavor. Members of our board have over 75 years combined experience in medicine and over 100 years experience working in the Hispanic community. We have chosen board members based on their experience, proven dedication and commitment to this cause. Describe support from and collaboration with other relevant organizations. Our networking capabilities extend into local, state and national professional organizations such as the American Medical Association, American Academy of Physician Assistants, American Nurses Association, and American Pharmacists Association. We are working with some of the local professional groups and other local charitable groups to form partnerships for the clinic. Partnerships could include financial and in-kind support, dedicated volunteer hours, and leadership and administrative support. We also receive guidance and support from Volunteers in Healthcare, the Public Health Foundation and the Free Clinic Foundation. VISION AND MISSION State the positive vision for the community related to the problem or concern. Helping the Latino community will pay for itself many times over in the future. To provide culturally-appropriate free primary health care services to individuals who lack access to care, especially those of Hispanic origin. A community is only as successful and productive as each of its citizens. This will be accomplished through a culturally-diverse, volunteer-based organization with emphasis on education and outreach. OBJECTIVES State the overall objective(s) for the community project or initiative. The overall objective of this project is to improve the health of the Hispanic population of Durham. TARGETS OF CHANGE AND HOW REACH THEM Identify primary targets of change. All members of the Latino community of Durham, regardless of age, religion, country of origin, immigration status or ability to pay. Indicate how targets will be reached by the intervention. Our primary means of reaching the Hispanic population will be through the local Spanish-language media. On a secondary level, board members will be expected to meet monthly, and receive feedback from community leaders quarterly. Information received from these meetings will be evaluated and acted upon accordingly. MOBILIZING HUMAN AND MATERIAL RESOURCES Describe the people who could potentially help address the problem or concern, the assets they could contribute, and how they might be engaged in addressing the problem. Any members of the community who are willing to donate their time and help improve the health status of the Latino community. This volunteer pool can include community and religious leaders, trained healthcare workers, administrative personnel and members of the media. Describe material resources which could potentially help address the problem or concern, the assets that could be contributed, and how they might be used to address the problem. We will be looking for in-kind donations of new and used medical equipment including exam tables, medical supplies and pharmaceuticals. We will also be in need of office and record-keeping materials. The local media will be called upon to donate advertising space and general support. Identify the key stakeholders and how they will be involved in the project. There are many people who will be affected by this project. Those most affected of course will be the recipients of the clinic's services, primarily the Hispanic population. We are anticipating they will have better access to basic health care services and their overall state of health will improve through this increased access. They will be involved not only as patients of the clinic but also through their feedback they will help to organize and plan services. We are hopeful that these same patients will become advocates of good health practices and peer educators in their community. Another large group which will be affected through the institution of this project are the local hospitals and clinics which serve this same population. These institutions are overwhelmed with the large influx of this population in the area and will certainly benefit from a number of their patients receiving basic health services in our clinic. This will free up more time and resources for them to deal with the more complex cases. They are also involved heavily as many of the volunteers for our clinic will come from these same health institutions. Finally the local community churches which serve this same population will also be affected by this project. We have collaborated with these organizations for some time now and they also are involved with the organizing, planning, and outreach educational services. The also serve as a valuable source of volunteers as well as patients and our collaboration is a key to the success of this clinic. TARGETS, BEHAVIORS, AND STRATEGIES FOR INTERVENTION Outline the key targets of change, key behaviors that need to change, and the strategies or intervention components to be used to change behavior. There are several groups we see as key targets of change. Broadly, the Durham health care community needs to address this overwhelming problem of the migrant Hispanic population’s difficult access to healthcare as a separate and more comprehensive issue. Though each individual institution has taken steps to address the issues on an individual level, the numbers of these patients are becoming overwhelming and need to be addressed on the community level. Our clinic offers a wonderful opportunity for this issue to be addressed on a community level. Also this clinic tackles the issues of language barriers, the lack of health insurance, and the lack of transportation to the other health services currently available in the area. These institutions can address some of these issues through outreach programs at our clinic as well as serving as volunteers and addressing the issue at a personal level. Secondly, the Hispanic migrant community itself must change. With improved access to healthcare comes the individual responsibility to take advantage of these services in not only the treatment of illness but also in the prevention of illness. Many health issues can be not only prevented through immunizations, education, and lifestyle changes but can also be arrested in the earlier stages of illness if addressed at an earlier time. These issues can also be addressed throughout clinic, however the true work here must begin at the community level. Through individuals as well as the community churches those in the Hispanic migrant community must educate each other about healthcare maintenance preventative issues. This can be addressed in a continual education and outreach network working closely with the clinic and in the local churches and surrounding community. OVERALL EVALUATION Describe what "success" will look like for the project or initiative. Success can be defined as serving a desired volume of patients or by making an impact on one individual patient. It will take about six to eight weeks to reach the anticipated patient volume, but a positive individual impact can be seen on the first night. We expect to see 500 patients in the first six months. As we are a new project, our original goals for "success" are modest. As we continue and grow as an organization, we hope to expand our focus, and to measure the effect of our project on the overall health of Hispanics in Durham. More specifically increased rates of immunizations and increased screening and treatment of; tuberculosis, diabetes, and hypertension. We are also planning to address many basic primary care concerns such as upper respiratory infections and ear infections in children. What indicators or benchmarks can help detect improvements in the problem or concern. As addressed above one simple indicator we can follow in order to evaluate the success of our program is the immunization rates of both children and adults. It is also possible to measure or compare screening rates for tuberculosis, diabetes, and hypertension through percentages within those at risk in the patient population. Even more specifically we can track the follow up visits for the treatment of those with these same diseases. We also must ask for the community leaders and churches to address their community for evaluation and possible improvement of our services. PROCESS EVALUATION Indicate how implementation of the intervention will be monitored. Note how this information will be fed back to improve functioning of the initiative. The indicators mentioned above will be monitored on a monthly basis. Also monitored will be the number of new and return patients. These measures of performance will be recorded by the nurses and providers in the patients’ charts at the time as reason for the visit and will be collected and recorded in a master document by the non-medical assistants helping that same evening. For at least the first year following the implementation of the project the Board will meet monthly to discuss any problems as well as the progress of the clinic. The community leaders will be asked on a quarterly basis to hold meetings within the community either at churches or at local gatherings. This will be for both informing the people of the services available to them as well as requesting feedback from the community, which will be presented at monthly Board meetings for evaluation and possible implementation. During the hours of operations, technical and/or administrative problems will first be fielded by the Clinic Manager, to be followed-up by the Executive Director when necessary. Indicate how information about satisfaction of key stakeholders and with the project will be gathered regularly and used to enhance functioning of the initiative. As discussed above there will be monthly Board meetings to discuss any problems encountered as well as progress of the clinic on a monthly basis for at least the first year of operation. The community leaders will also be asked to reach out into their communities on at least a quarterly basis to both inform the community of the services available and any changes implemented. Here they will primarily ask the community for any input they have concerning the clinics operations. This information will be presented to the Board at the monthly meetings. Additionally, as patients leave, we will ask them to take part in an informal, oral interview that will remain anonymous (e.g., their names will not be attached to their answers). Those surveyed will be asked a short list of open-ended questions that have been reviewed by an expert in Hispanic studies and an epidemiologist. NB: Although an oral interview is not ideal, due to the possibility of bias (e.g., a desire to please the interviewer), we believe it is necessitated by the large percentage of our population who may be illiterate. Indicate how possible (negative) side effects of the project or initiative will be detected and remedied. Note how this information will be used to minimize those side effects? Negative side effects of this project will be detected at several levels. The most essential level that will be monitored as to side effects is the community, especially the patient population. Information from these oral interviews mentioned above, both positive and negative, will be reviewed by our Board of Directors on a monthly basis, and adjustments will be made accordingly. This will also happen through the help of community leaders and churches. Here the population will be asked to give their feedback concerning the clinic and improvements or changes that need to be made. This information will be channeled back to the Board, which will try to implement as many changes as possible to improve services. Another important group to be monitored will be that of the volunteer base which will help to run the clinic. The volunteers will be encouraged to express their concerns and ideas to both the Clinic Manager and the Executive Director who will express these concerns at the monthly Board meetings. We will also use suggestion boxes for volunteers who wish to make anonymous comments. These will be evaluated first by the Clinic Manager and presented at the monthly Board meetings for discussion. OUTCOME EVALUATION Indicate how community-level indicators will be used to determine whether the effort made a difference with the community problem or concern. Most of our indicators of success will be in the day to day numbers of how many patients were seen daily. We will also track specific major public health issues, such as: We will also work with other community health centers, most notably Lincoln Community Health Center and the Durham Public Health department, and attempt to determine if there is a difference in their utilization due to our clinic. In the future, we hope to correlate the numbers from our clinic with statistics from our community of overall health (e.g., the rate of STD's; the rate of immunization in the community, et cetera). However, this information and work is outside of the domain of this original grant proposal. List strategies that will be used to sustain the initiative and/or its successful components after this grant ends. While the startup grant which we are applying for today is crucial to get our program on our feet, it is our goal that the program will eventually be entirely sustained through the use of local resources. To that end, our financial sustainability plan includes all of the following: In one paragraph, state WHY this project should be done: a) at all, b) in this community, c) at this time, and d) by this organization. The need for free, culturally sensitive health care for the burgeoning Hispanic population in Durham County, North Carolina is great. By all accounts, it will grow substantially in the coming decade. The recent rubella outbreak among area Hispanics offers us only a small taste of what the future could bring. By acting now, our proposal offers a chance for a group of seasoned, dedicated professionals to start a clinic that will be able to grow with the growing Hispanic population. We hope our clinic will contribute to a thriving, diverse, Father Mark O'Reilly Our Lady of Guadeloupe Catholic Church 123 Guess Road Durham, North Carolina 27704 Telephone (919) 477-6789 E-mail: [email protected] 4, 2000 Dear friends: I am writing this letter in support of the new free Hispanic health care center that has been proposed in our community. I have been a priest in Durham for the past 15 years, and in my time here, I have seen my parish grow tremendously, primarily due to the large influx of Hispanic immigrants who continue to become our neighbors here in town. As a priest, I am privy to many of their difficulties, and it strikes me time and again how many of these problems are due to a lack of adequate health care. Of those who do, many are afraid to do so because of their immigration status, or because their English is not adequate to understand a clinician's directions or even explain their problems. Many of these people I have accompanied to local clinics and served as their translator; but if I did this for every person who needed this in my parish, I would no longer have time for anything else. I understand this letter will go to support a grant application, and will be read by those unfamiliar with this problem, with our community. Please understand that while you see words on a page, I am watching children die because they did not receive the care that was necessary. The need is urgent, and the time to act upon it is now. I have the highest confidence in those who are running this new clinic. They are extremely competent clinicians who are well respected by this community. Most importantly, they are passionately dedicated to this cause. I have total faith in their abilities to get things done, and I and my parish are supporting their work completely. We have offered them a modest stipend of 0 annually (the amount our parish could afford), and many of our parishioners will be volunteering at the clinic. If I can be of any further service, please do not hesitate to let me know. Yours in Christ, Father Mark Julie Nielson Human Relations Department Big Drug Corporation Research Triangle Park, North Carolina [email protected] 29, 2000 To Whom It May Concern: We are writing in support of the new free clinic that is being proposed in our area. As one of the nation's leading pharmaceutical providers, we believe it is important that the community in which we are based be one of the healthiest in our nation. It is to that end that we have pledged our support to this new clinic. It is part of our mission to "give something back" to the community that graciously houses us. Although we have not yet finalized the specifics of our donation to the new clinic, we hope to be a regular benefactor, probably through donations of our products. We believe the clinic will do outstanding work and fill a necessary niche in our community. We hope that you will join us in supporting this worthy endeavor. If you have any questions, please feel free to contact our office at (919) 383-1234. Nielson Human Relations Associate Big Drug Corporation Appendix B: Documentation of the growing Hispanic population in Durham December 21, 1997 The News & Observer Estimate alarms Hispanic advocates By NED GLASCOCK; STAFF WRITER RALEIGH -- The U. Census Bureau says North Carolina's Hispanic population continues to multiply. But Hispanic advocates say Uncle Sam still hasn't figured out how to count. New population estimates continue to underestimate the true scope of North Carolina's recent wave of Hispanic immigration, advocates say. They worry that the apparent underestimation could mislead policy-makers about the level of state and local resources needed to address the influx. The Census Bureau estimates that 134,384 Hispanics lived in the state in July 1996, an 11 percent increase over 1995 and 73 percent more than in the 1990 census. However, the new figure falls far below the estimate of 205,000 made by state health officials in 1996, said Katie Pomerans, Hispanic ombudsman in the Office of Citizen Services, a wing of the state Department of Health and Human Services. "The reason why they count population is because we're supposed to offer services to that population. You plan for growth that way - for the number of schools you need, the number of parking spaces you need. But nobody knows the actual figure, even after they count it." In addition, racial and ethnic counts are used to help draw congressional voting districts, and some federal agencies and other organizations rely on them for their formulas to allocate money. In the Triangle, the apparent discrepancy between official figures and reality is pronounced in Durham, where estimates by local Hispanic groups put the population about 8,000. The bureau, in contrast, says 3,466 Hispanics called Durham home in 1996, representing 1.8 percent of the county's population. "It definitely doesn't have anything to do with reality," Pomerans said. "They're grossly undercounting there, and it makes no sense." Although the Census Bureau says Durham's Hispanic population grew by 11 percent from 1995 to 1996, the number of Hispanic children in the Durham public schools jumped by 25 percent over the same time frame, from 562 to 705, she said. Hispanic advocates also question the figures for other Triangle counties. The Census Bureau reported: - 11,227 Hispanics in Wake County, or 2.1 percent of the county's population. That figure is a 15 percent increase from the year before and a 103 percent rise since 1990. 2,508 Hispanics in Orange County, or 2.3 percent of the population. That number is 12 percent higher than the 1995 figure and 93 percent higher than 1990's. Overall, Hispanics make up a tiny fraction of the state's population - 1.8 percent of the state's 7.3 million residents in 1996, according to the bureau. Still, even that percentage is on the increase: In 1990, Hispanics made up 1.2 percent of North Carolina's population. Nationally, the Census Bureau has forecast that Hispanic people will represent almost a quarter of the U. population by the year 2050, up from one-tenth currently. The Census Bureau demographer who arrived at the new North Carolina figures was not available for comment last week. Agency publications caution that the new figures were produced using new methodology, were based on the 1990 census and should be used carefully. "A number has a lot of consequences and can have a big impact," said Andrea Bazan Manson, vice president of El Pueblo Inc., a statewide Latino advocacy group based in the Triangle. Manson said the group often uses estimates of 250,000 to 300,000 for Hispanics in the state. "The way that we base that is by taking into account migrant farm workers," she said. "[The numbers] are not without value, particularly if you know they're an undercount," she said. For years, Hispanic advocates across the country have complained about what they regard as undercounting Whether the census data for North Carolina are accurate or not, the trend of growth in Hispanic numbers is undeniable and can still help guide policy-makers, said Susan Brock, a migrant health coordinator with the nonprofit N. "I don't know that any data [are] perfect." Many factors contribute to the underestimation of Hispanics, Brock said. Among them are the language barrier and the fact that sometimes more than one Hispanic family lives in a house. Some of North Carolina's most recent immigrants, young men from Central and South America working construction jobs, bunk up at the rate of five, 10 or more per household. In addition, undocumented immigrants are reluctant to come forward and be counted. Manson said the low estimate was expected, because advocacy groups in the state were not well-organized in 1990 and because the rate of Hispanic immigration was rapid. "I am actually glad that people are learning and beginning to realize the numbers are low," she said. "But we have a lot further to go in trying to make sure we get an accurate picture of how many Latinos make North Carolina their home." Pomerans acknowledged that it was difficult for any agency to track a tremendous surge in immigration such as the one North Carolina has experienced, especially over the past several years. "We have to just hope that with the next census, it's better done," she said. "A lot of that depends on the help of the community and educating people about the importance of responding to the census." February 22, 1998 The News & Observer Spanish lessons (Part A) (First of two parts) By Ruth Sheehan and Ned Glascock; Staff Writers Lured by the prospect of good jobs in a humming economy, Latino immigrants have flocked to the Tar Heel State in record numbers this decade, literally helping build the new North Carolina as they forge new lives. But this historic demographic shift is placing a large burden on state and local governments - a burden for which nearly every agency and branch of government is ill-prepared and under equipped. Although Latinos remain a small fraction of North Carolina's overall population - about 2 percent - the U. Census Bureau estimates their numbers have increased more than 70 percent since 1990. Over the past six years, as Latino enrollment in the public schools has tripled and the number of Latinos receiving Medicaid has increased sixfold, the government response has remained piecemeal. We are behind the curve, well behind the curve on this one." Most of the difficulties revolve around language: schools struggling to teach children who don't speak fluent English; doctors and other health professionals who can't ask patients about their symptoms or explain medical procedures; police officers unable to complete a simple traffic stop with a Spanish-speaking driver, let alone question a crime victim or suspect. Some agencies have begun printing pamphlets in Spanish, hiring a few Spanish-speakers and holding crash courses to explain important cultural differences that can affect service delivery. "It is not as if this wave of immigration is some big surprise at this point," says Katie Pomerans, a liaison for the Spanish-speaking community with the state Department of Health and Human Services. Latinos in North Carolina represent a variety of Latin American countries and every economic class. But it is the wave of working-class migration mainly from poor areas of Mexico and Central America - and even other parts of the United States - that poses the biggest challenges for government. Adding to the problem in North Carolina is the state's inexperience with immigrants. Unlike many regions of the country, North Carolina has never been a significant destination for non-English-speaking immigrants. And the answers for how to deal with this unprecedented influx of new residents - some legal, some not - have proved elusive. Government agencies in North Carolina are playing catch-up, says Aura Camacho Maas, a member of the state Human Relations Commission and founder of the Latin American Resource Center in Raleigh. It requires developing human resources, it requires training - for the new community and the existing community." Government's struggle to match the rapid pace of change plays out in the classroom, the courthouse and the health clinic in nearly every community in North Carolina. "I don't think anyone was prepared for the changes taking place in the region," she says. Here is a collection of snapshots from the front lines. "The first reaction from many different sectors was to ignore it. Among schoolchildren: Mary Mason's specialty is language. As coordinator of the English as a Second Language program at Athens Drive High School in Raleigh, Mason sees the demand arcing upward in what is perhaps the most crucial interface between new Latino immigrants and the state: the public schools. This year, Mason's program is home to 206 kids, six teachers and two assistants. Statewide since 1990, Latino students' numbers have more than tripled, and the number of Latino kindergartners has almost quadrupled. The Wake County public schools have nearly doubled their ESL teaching positions in the past year, and the pace is so frantic that some new ESL teachers are sent into the classroom while they're still training for certification. "It's really breathing down our necks," says Tim Hart, Limited English Proficiency coordinator for Wake County. "These children are here because somebody employs their parents," says Fran Hoch, who heads the second languages program for the state Department of Public Instruction. And they're not the children of migrants, she says. "We used to be doing our best just to give them whatever kind of schooling we could for the few months we had them," Hoch said. If we don't serve them, they become part of our dropout rate." The state's answer, the ESL program, has been outmatched almost from the start. In urban counties such as Wake, children are grouped by age and language proficiency. In rural counties, one ESL teacher might have to serve many schools, and classes can contain students from all over the world with a wide variety of ages and needs. The younger the child, the easier it is to pick up English - and the easier to learn a new language in a normal classroom environment. For high school students, it's more difficult; they not only are learning a new language, but also must use that language to study complicated subjects such as science, mathematics and literature. Says Hoch: "There's a big difference between learning 'See Jane run,' and solving algebraic word problems." The state does not track dropout rates for ESL students. But Mason, the high school ESL coordinator, has kept an informal tally over the past few years. Of the last 26 she's taught, only two had graduated by May. "The prospects are not good for these kids," she says. Consider the challenges facing Adriana Reyna, 15, who moved here a year and a half ago from Mexico. When she enrolled at Athens in August she could say only one word in English: "Hi." Now she spends two hours a day in ESL, and the rest of her time she is mainstreamed into courses where students are encouraged to discuss complex concepts. Reyna has no idea what her classmates are talking about. "I only listen." On the job: Inside the cramped, concrete-block duplex in Durham, Tom O'Connor listens intently to the Honduran woman with the long brown hair. Occupational Safety and Health Project, O'Connor's job is to be an advocate for ill-treated workers. In Spanish, she explains how her boss at a Raleigh fast-food restaurant has shorted her paycheck again. More and more, his cases involve workers from Mexico and other countries south of the border. And although she's a full-time worker, she receives no health benefits. But truth be told, neither O'Connor nor the state labor department has a handle of this segment of the work force. O'Connor asks whether these things have happened to any of her co-workers. "Creo que es que somos hispanos." I think it's because we're Hispanics. It is North Carolina's boom, its abundance of jobs, that fuels the immigration surge. Her face creases with an expression that's part grin and part grimace. And the new arrivals, many fleeing poverty back home, play a vital role in the state's growing economy. Anyone driving past a construction site need only look to confirm that Hispanics make up a large and growing percentage of the workers erecting the new subdivisions, office buildings and shopping malls that mark North Carolina as a player in the New South. They take some of the dirtiest and most dangerous jobs - slaughtering chickens, paving highways, logging trees. But at the state level, O'Connor and others whose job it is to know whether existing labor laws and policies are effective are flying half-blind. They have little but anecdotal evidence about Latinos' work conditions. State University researchers - teaming up with O'Connor's advocacy organization, the state Department of Labor, labor activists and others - are undertaking an ambitious study of the state's Hispanic work force. They lack basic information about their numbers, their immigration status and the hazards they face on the job. The preliminary results raise as many questions as they answer, says Jeffrey Leiter, a professor of sociology and anthropology at NCSU, who is helping lead the research. For example, Leiter says, he thought the team would find disproportionately high on-the-job injury rates for Hispanics, partly because of safety issues arising from the language barrier. But an unexpected pattern emerged from the information on large work sites the team pieced together from federal and state databases: In certain job categories, a surprisingly low percentage of Latino employees reported workplace injuries. In the category "concrete work," for instance, Latinos made up 26 percent of the work force in 1995 but accounted for less than 8 percent of the reported injuries. "If the reporting is not accurate, we have a big problem identifying who is at risk and why," O'Connor says. "We can't understand what the problems are and how to reduce injuries. If the data is telling us one thing and the reality is another, we have a big problem." Leiter's team of students and researchers will soon conduct field interviews to determine whether Hispanic workers are less likely to report injuries. Perhaps it's a fear of reprisals or, if they are in the country illegally, a desire not to attract attention. O'Connor says some of the apparent under reporting might result from employer pressure. Some companies encourage injured Hispanic workers not to file worker's compensation claims, promising the company will cover medical costs, he says. Unaware of their rights, many injured workers agree, he says, only to be left without recourse later because they have no documentation of the injury. Appendix C: Documentation of health problems that face the Hispanic population May 10, 1996 The News & Observer Rubella outbreak hits Latinos hard Illness, fear twin foes in Chatham By Ben Stocking; Staff Writer Page: A1 SILER CITY - An outbreak of rubella - a disease that had been nearly eradicated in the United States - has spread with remarkable speed among Latin American immigrants in Chatham County. Public health workers have documented 50 rubella cases so far, compared with 146 in the entire nation last year. To contain the outbreak, health workers have been going from home to home, business to business trying to persuade immigrants to be immunized. Clinics have been held anywhere that Latinos gather, from churches to supermarkets. "Gaining their trust has been hard," said Maria Rangel-Sharpless, an epidemiologist with the state Division of Maternal and Child Health. "We've had to overcome a lot of obstacles." Nearly four weeks into the outbreak, state and county health officials are confident that it is almost contained. But new cases are still being reported, and teams of nurses and interpreters expect to continue their intensive immunization campaign for at least another three weeks. Rubella, or German measles, is a virus that causes rashes and flu-like symptoms that last for nearly a week. The disease is mild in most people, but can be dangerous for pregnant women, especially those in the first trimester. Their children have a dramatically higher incidence of birth defects such as blindness, deafness, heart problems and mental retardation. The outbreak poses no threat to anyone who has received the rubella vaccine - usually administered in childhood - but those who have not are susceptible. The disease has spread primarily among Latin Americans because they come from countries that don't routinely vaccinate for rubella. Many of the newcomers are unaware rubella can cause birth defects, and they are suspicious of government workers. Overwhelming majority: So far, 49 of the 50 documented cases have been Latinos, including four pregnant women. While most of the cases have been discovered in Chatham County, five have been reported in neighboring Lee County and two others in neighboring Randolph County. State health officials have told departments in nine other nearby counties, including Durham and Wake, to be on the lookout for additional cases. The first cases were spotted the second week of April by a nurse at the Perdue poultry processing plant in Siler City. She noticed that two plant employees had developed rashes. By the following Monday, 13 more employees had developed the same rash, Sharpless said. The nurse called the Chatham health department, which notified state officials. They ordered blood tests that showed the workers had rubella. Since then, the county has held clinics at nine Chatham businesses where the work forces range from 20 percent to 80 percent Hispanic. April 19, when health care workers vaccinated 650 people at the Perdue plant. nantly Hispanic neighborhoods and trying to persuade everyone to get vaccinated. Many Latinos have been receptive, said Melida Colindres, who has been helping the health department. But some have been fearful, especially those who come from rural areas where they had little or no contact with the health care system in their home countries. "We have had to go to their houses two or three times and really convince them that this is a health issue and that they needed the vaccine and that their children needed the vaccine," Colindres said. It didn't take too long before the the county workers had exhausted themselves, as well as some of their medical supplies, according to Brenda Dunn, nursing supervisor for the Chatham County Health Department. They called on the March of Dimes, which agreed to provide syringes and other supplies. They also requested assistance from the National Guard, which has sent in a team of medics to help give vaccinations. 8,000 vaccinations: The state is paying for the immunizations, which cost each, according to Stefanie Groot, a spokeswoman for the state Division of Maternal and Child Health. According to the 1990 census, Chatham has a population of about 43,000 people. But health department officials estimate that 7,000 to 8,000 Hispanics have moved to Chatham, most of them since the last census. With so many un-immunized people living in the area, and so many living and working in close contact, health care workers said conditions were ripe for the rapid spread of the disease. Rubella passes through casual contact, as easily as a cold. "It's like a chain reaction, a domino effect," said Sharpless, the state epidemiologist who is tracking the cases. "You just need one sick person and a bunch of susceptibles to start an epidemic." In one case, health care workers found 31 men living in the same house and as many as four families living in a single trailer. In such conditions, disease can spread very quickly. Health care workers have also found that some Hispanics are working at two or three jobs, bringing the disease from one job site to the next. Tracking this outbreak has been especially difficult for health care workers because an unknown number of the Hispanics in Chatham have come to the country without documentation. Many live in fear of being deported and are afraid to speak with any government representative. Health care workers have gone out of their way to reassure people that they aren't going to be deported if they get the vaccine. "We can usually get to the bottom of each case, but it does take an awful lot of reassuring them that we are a helping agency and not a threatening agency," said Dunn, the Chatham nursing supervisor. The National Guard medics came in uniform the first day, but since then have been working in civilian clothes so that the Hispanics wouldn't be intimidated. Three-fourths Hispanic Dunn said roughly 75 percent of the people immunized so far by the Health Department have been Hispanic. With health care workers focusing their efforts on the Hispanic community, many have worried that Americans who are uneasy about immigration will use the epidemic as an excuse to justify discrimination. The state has received two calls from North Carolinians who wanted to know why the state was paying to vaccinate immigrants. Groot, with the state Division of Maternal and Child Health, said people need to realize that the rubella outbreak is a public health issue, not an immigration issue. "We're here to serve anyone who needs medical assistance," she said. "Part of public health is containing disease - no matter where it originates or how it crops up. We need to contain it to protect everyone." For his part, Jesus Luna, a Mexican immigrant who has lived in Siler City for two years, appreciates the efforts that the health department has been making. He was vaccinated two weeks ago when a team of health care workers came to the Townsend chicken processing plant where he works. "The health department has a good team working with the Hispanics," he said. "They told us it was very important to get vaccinated. October 12, 1997 The News & Observer Minority health concerns heard By CATHERINE CLABBY; STAFF WRITER More than 300 people took state officials up on their offer Saturday and came to Raleigh to propose ways to improve the health of North Carolina's racial minority residents. Instead, in heated discussions in sterile meeting rooms at a Raleigh conference center they spoke long and loud about the social, economic and spiritual threats to people's well-being. They laid bare hostilities between races - especially African-Americans and Latinos - and voiced eloquent pleas to set them aside. "If they don't, we can reiterate them." Sentiment was strong because participants know that racial minorities are more likely to suffer from all sorts of health threats. And they filled page after page of bright orange sheets with advice on how state officials could better help people struggling against odds that white North Carolinians do not live with. "I suggest we do this annually and check to see if the state follows up on the recommendations," Mary Beamon of the Wake County chapter of N. Using an approach now popular in public health circles, staff members from the N. Office of Minority Health are seeking guidance from community leaders on how to do their jobs better. Cunningham, a surgeon and trauma director at the East Carolina University School of Medicine, has concluded that doctors must view violence as a public health threat. The men and women who arrived before breakfast at the Jane S. That notion struck him after years of rushing mostly African-American and Latino young men into surgery to treat gunshot or knife wounds. Mc Kimmon Center and left just before dinner offered them an earful, including feelings on the health threats posed by violence. Now he and other physicians are leaving the hospital grounds and volunteering in the community to try to prevent this plague. "We had failed." Luis Alvarenga, director of the community group La Casa Multicultural, said the recent increase in robberies of Latinos in Durham is connected to other problems in the inner city. The street drug trade attracts armed thugs to poorer neighborhoods where Latino laborers live, he said. "In every single neighborhood there is drug dealing going on," he said. Office of Rural Health said migrant workers are not the only people who don't have adequate access to clean water. "That is bringing this viciousness in." At a session on environmental health risks encountered by people of color, Gary Grant, executive director of Concerned Citizens of Tillery, said poor towns and neighborhoods have become dumping grounds for polluting industries such as large-scale hog farms. Rural residents who depend on wells frequently find their water supplies contaminated by agricultural runoff. "Not all of them can afford to buy water every month," she said. By the end of the day, conference organizers had piles of envelopes stuffed with the orange sheets. Participants, who came from across the state, suggested everything from eliminating the food tax to putting counseling stations next to police substations in poor neighborhoods. Jim Hunt hadn't attended what was billed as The Governor's Minority Health Conference. Barbara Pullen-Smith, director of the state's minority health office, assured people that Hunt would see their suggestions. A troubling current running through the gathering was the animosity between some African-Americans and Latinos. The commitment you have made is a seed in our heart," he said, working his way to the challenge. We don't do this for ourselves but for the future." Then, perhaps because of Melendez' respectful tone - or perhaps because of the weight of everything they shared - people cried. Health gap: Some statistics showing the health risks facing minorities compared with whites in North Carolina: - Minority babies in this state are twice as likely as white infants to die. Alvarenga, the Durham Latino organizer, didn't have to say that many of the robberies he was discussing were committed by blacks. Ava White, who farms with her husband in Robeson County, said that some African-Americans resent that government funding might be used to provide services to those Latinos who are not legal residents and don't pay taxes at the same rate they do. Appendix D: Documentation of the lack of access to appropriate health care faced by the Hispanic population in Durham March 24, 2000 The News & Observer Access to health care unequal in N. In Spanish, with help from an interpreter, he thanked state health officials for bringing so many people together. Carolina By Ned Glascock; STAFF WRITER Page: A8 In North Carolina, the report from the Centers for Disease Control pointed to disparities among whites, blacks and Hispanics in access to health care in 1997. For instance, 12.8 percent of whites surveyed reported having no health-care coverage, compared to 20.4 percent of blacks and 21.4 percent for Hispanics. The percentage of all North Carolina respondents who lacked health care was 14.7 percent, slightly above the national median of 12 percent. The report also painted a portrait of Tar Heel health. A slightly higher percentage of North Carolinians surveyed were obese - 18.4 percent - than the national median, 16.6 percent. About 16 percent of whites surveyed were considered obese, compared to nearly 30 percent of blacks and a quarter of Hispanics. Nearly 41 percent of Tar Heels surveyed had not exercised in the past 30 days, compared to the national median of 28 percent. Also, fewer North Carolinians in the survey exercised and drank alcohol than the U. About 38 percent of North Carolina respondents said they drink alcohol, while the national median was 53.5 percent. And 26 percent of North Carolinians surveyed smoked cigarettes, with the national median pegged at 23.3 percent. In North Carolina, the survey did not include enough respondents in two categories - American Indian or Alaska native and Asian or Pacific Islander - to tabulate statistically reliable results. For Hispanics, a category of ethnic origin that includes people of any race, only 82 respondents were contacted in North Carolina, just above the cutoff of 50 required by the survey. August 22, 1999 The News & Observer FINAL WORD Page: A32 Falling through the cracks: We used to be able to access the School Health Fund occasionally for certain medical needs of Hispanic children without Medicaid. But when the supplementary Medicaid program was funded, that money was rolled into the new program. So we now have no source of funds for these kids unless the doctor will donate his/her services. But it is very hard to get dental care, glasses, lab tests this way. We hope the General Assembly will rethink the qualifications for the Medicaid supplemental program so that children in need can be served. Rose Gallagher Migrant outreach worker Edgecombe County Schools January 9, 1991 The News & Observer Report says Hispanics lacking in health care By The Associated Press Page: A11 CHICAGO -- Hispanics lack medical coverage more than any other U. ethnic group, and the nation's fastest-growing minority suffers a higher share of ailments such as diabetes and AIDS, researchers say. Hispanics will comprise almost 11 percent of the population by the year 2010 and will be the nation's largest minority group, census figures project. "Hypertension appears to be more prevalent," they said. Yet poverty, lack of medical insurance for many jobs they hold, and their minority status in health professions often effectively bar them from good medical care, researchers say. "Hispanic children suffer disproportionately from lead poisoning and measles. The situation gets even more bleak as Hispanics adopt U. culture -- including its smoking and eating patterns, said a report today in the Journal of the American Medical Association. Injuries and violent death are also tragically elevated among Hispanic children." Certain cancers also strike Hispanics at higher rates than non-Hispanic whites, as do tuberculosis, alcoholism, cirrhosis and infection with the AIDS virus, according to the editorial and a report by the AMA's Council on Scientific Affairs. The issue is devoted entirely to the topic of Hispanic health. "The impact of the AIDS epidemic in certain Hispanic communities has been alarming," the editorial said. "Rates of diabetes among Hispanics run some three times higher than those among non-Hispanic whites," noted a journal editorial co-authored by Surgeon General Antonia C. "Although representing only 8 percent of the total U. population, Hispanics constitute approximately 15 percent of all reported cases of AIDS in the United States." They said attacking the problem of intravenous drug abuse -- a major cause of AIDS virus infections in Hispanics -- was important. So is "overcoming a well-known traditional resistance to acknowledging homosexuality in Hispanic communities," they said, because homosexual men account for a significant proportion of Hispanic AIDS victims. Also recommended were developing cooperative efforts on the U. S.-Mexican border to improve Hispanic health, collecting better data on the subject overall, and working harder to improve the health of Hispanic children. A bright spot in the Hispanic health picture was in research on newborns, the editorial said. Despite relatively low family incomes, poor health insurance coverage, and low use of prenatal care, Mexican-American newborns have relatively low rates of death and of low-birth-weights when compared to non-Hispanic whites and to blacks. July 24, 1999 The News & Observer Latinos face health obstacles By JEN GOMEZ; STAFF WRITER DURHAM -- The number of immigrant Latinos seeking medical attention is growing, but several barriers - including a language gap and lack of transportation - haven't made it an easy trip to the doctor's office. "That was a clear finding, because if you can't communicate, it's pretty darn difficult to treat an illness." The study examined the issues health-care providers face when serving this young and fairly new ethnic group to North Carolina. "The key issue is the language barrier," said Mike Mc Laughlin, who conducted a study on Hispanic/Latino Health Issues through the N. Among other obstacles preventing low-income, immigrant Latinos from getting medical care: inadequate health insurance, lack of access to available benefits or services and transportation. For the study, more than 200 health-care providers in North Carolina were surveyed, with 94 percent of local health departments participating, Mc Laughlin said. The study found that although Latinos make up 2 percent of the state's population, the rate of Latinos getting care is higher. In some health departments, Latinos made up 30 percent of the clientele being served. In 1997-1998, Latinos comprised 22.6 percent of the total caseload at the Durham County Health Department. Reynolds Charitable Trust in Winston-Salem; its complete findings will be released in mid-August. Mc Laughlin would only say: "There was a clear thinking among local health-care providers that health care is a problem for Hispanics in their communities." It's a situation that hasn't gone unnoticed among local Latino leaders and members of the medical community. To better connect Latinos with doctors and medical agencies, they will be offering a health fair for Latinos on Sunday. More than 50 agencies and health-care providers will be there. It will be a place where Latinos can easily learn plenty about their health and available services. "Health is a great concern for the Latino population," said Katie Pomerans, the Hispanic ombudsman for the state Department of Health and Human Services. "Of the calls I get, I would say more than half of them are health-related." The fair will be from 3 to 6 p.m. in the gym and parking lot at Immaculate Conception Catholic Church, 810 W. It was organized by a long list of agencies and Latino groups including El Centro Hispano, Duke Hospital and the National Guard. A slew of services and information will be offered. Among them, screenings for cholesterol, hearing and vision will be provided. Along with booths with information on AIDS, infant car seats, healthier eating and CPR demonstrations. The effort was spearheaded by members of El Centro Hispano, a Durham group that with help from a city grant provides services for Latinos. Ivan Parra, director of El Centro, who regularly handles Latinos' questions about health care, said he hopes the fair will reach a large portion of the community. "Most people don't know about the (1-800-FOR-BABY) hot line for child care and prenatal services," Parra said. "Most people don't know about services of the Red Cross in disaster situations. "Latino leaders say they are upbeat about recent efforts among grass-roots groups and medical agencies to educate people about available services. "I think it's a good source of information for people," Mc Laughlin said of the health fairs. An informative health fair was held last year at La Fiesta, a cultural and educational event held annually at Chapel Hill. "Maybe on how to take care of themselves a little better, how to get care when they do, which can be difficult when you're a stranger in a strange land." Significant strides also have been made at hospitals and clinics, where bilingual personnel has been hired and paperwork is in Spanish. Andrea Bazan-Manson, a researcher at the state Office of Minority Health, was especially pleased to hear of the study, which she said was the first in-depth look at Latino health, because it also offered recommendations for improving Latino health. "I think the health-care systems in North Carolina have realized that this is a community that is growing and we need to start focusing on," Bazan-Manson said. "A lot of them don't know what kind of services they can get. The Latino community is becoming aware of the services and using them and also paying for them." April 27, 1999 The News & Observer Hispanics less likely to have insurance, study finds By THE WASHINGTON POST Minority workers, and especially Hispanic workers, are significantly less likely to have employer- provided health insurance than other workers in the same fields, according to a study from The Commonwealth Fund. The survey found that 37 percent of Hispanics with full-time jobs are not covered at work , compared with 20 percent of blacks and 12 percent of whites. "Perhaps the most important lesson learned from the analysis is that having a job does not equalize chances of obtaining health insurance coverage for minority workers," the report concludes. "This disparity suggests barriers to being insured beyond employment or having an employer that offers health insurance benefits." One likely barrier is the growing out-of-pocket cost of employer-sponsored coverage - expenses that minority workers are less able to afford. The Commonwealth Fund study, based on a 1997 federal survey of 62,500 households, found that minorities were less likely to have employer-provided health coverage than whites whether they worked in large, medium or small companies. Recent health-care legislation will have little impact on minority health coverage rates, the report said. "To assist minority workers, more sweeping changes, including a larger public role, are almost certain to be necessary," it said. August 13, 1999 The News & Observer North Carolina is experiencing a wave of Hispanic immigration that shows no signs of cresting and creates new challenges for public services, including health care. This week, The News & Observer has teamed up with WRAL-TV and the N. Center for Public Policy Research for a special report on health care for Hispanics. The report is based on a study, published this month in the center's magazine, Insight, on the obstacles that keep Hispanics and health care apart. for "30 Minutes," a weekly news magazine with host David Crabtree. Appendix D: Time Chart of Activities Needed to Implement the Intervention Personal names and addresses were removed at the project's request. Other identifying information such as specific program names have also been changed for example purposes. COVER SHEET Title: Rural Community Recreation Project (RCRP) Grant application to: The Community Foundation Assistive Technology Program Contact person: Executive Director Applicant organization: Assistive Technology Partnership (ATP) 501 (c) (3) organization Recreation Education/Training Information access The mission of the Assistive Technology Partnership is to increase knowledge about and access to assistive technology and information technology for people with disabilities. People with disabilities, families, and providers that serve people with disabilities Project title: Rural Community Recreation Project Project summary: The Rural Community Recreation Project will address barriers to recreation participation faced by adults with disabilities. Assistive Technology Partnerships, in collaboration with multiple organizations, will promote inclusion, access, and availability of assistive technology used for recreation in two rural communities. Project activities will include community mapping of local recreation resources, training related to assistive technology use, provision of assistive technology devices to community recreation sites, and information dissemination. Time frame: January 1, 2004 - December 31, 2005 Requested funds: 4,738 Recreation is an important and desired aspect of life for people with and without disabilities, but people with disabilities often face barriers to participation. The lack of knowledge about existing resources, inaccessible facilities, lack of training by community recreation providers, and a lack of appropriate adaptive recreation equipment are significant barriers to desired recreation and community participation. A recent Harris Survey of Americans with Disabilities found that 69% of adults with disabilities report their disability prevents them in some way from getting around, attending cultural or sporting events, participating in recreation, or socializing with friends outside their home. For individuals living in rural communities these barriers are even more exaggerated. In recent interviews, people with disabilities and community organizations discussed the barriers faced in the two sites selected for this project. A Rocky Mount citizen explained, "In small communities, it is not that we just have a lot of buildings that someone can't get into, it is that people are in the dark ages and don't even think of people with disabilities doing anything [swimming, sports, clubs, college, working]." Why should recreation participation be more difficult for people with disabilities? Why are there often few existing adaptive recreation programs that provide accessible and inclusive facilities and even fewer facilities that have the assistive technology often required for many individuals with disabilities to participate in specific self-determined recreation activities? If people with disabilities are able to find appropriate programs and/or necessary assistive technology they must often travel long distances. By focusing efforts on increasing access to existing community resources, people with disabilities will not have to seek out specialized programs outside their home community - they can participate in their neighborhoods with family and friends. This project seeks to equip consumers and recreation providers with access to assistive technology and the training necessary to achieve quality community recreation participation. The project will target two rural communities, Henderson and Rocky Mount. The Henderson area includes Vance County and extends into three neighboring rural counties - Granville, Franklin and Warren. Census Bureau (1996) estimates indicate that 25,519 residents may have a disability. Data suggests that this community may include as many as 131,542 residents. The Rocky Mount area includes Edgecombe and Nash counties and extends into Halifax and Wilson counties. For this community state data shows 267,063 residents and U. Census Bureau estimates 51,809 residents with a disability. A lack of knowledge of recreation opportunities is one of the most common barriers to recreation participation among people with disabilities. Many people with disabilities simply don't know where to look for recreation opportunities, how to ask about accessibility or programs and when and how to assert their rights. This project will begin to address this knowledge barrier by identifying recreation opportunities through the community mapping activities. Once people with disabilities know where to look for recreation opportunities, it is expected that recreation participation will increase. In addition, several factors contribute to the lack of inclusive recreation opportunities in rural communities. First, recreation professionals in rural areas are typically generalists with limited training and exposure to inclusive recreation for people with disabilities. Though it may seem that these professionals show less initiative to address the needs of people with disabilities and include them in community programs, it is often a lack of training and awareness of these needs that is the barrier. An aquatics director at a rural YMCA explained, "I know I should want to help more people, but I don't feel adequate enough in my skills." Similarly, a superintendent at a state park near Henderson showed surprise when first learning about assistive fishing gear and noting that he previously assumed that their 0,000 accessible fishing pier was sufficient. Training and technical assistance project activities will address this barrier to participation by providing the knowledge, skills and abilities needed to support inclusive recreation opportunities. Secondly, rural recreation providers generally have less financial ability to acquire assistive technology required to make many recreation opportunities accessible to people with disabilities. Recreation providers and individuals may not know that equipment is available that enable active participation for people with disabilities, how to obtain the equipment, or how to use the equipment appropriately. Handcycles, sports wheelchairs, bowling ball ramps, and electronic fishing reels are just a few examples of equipment and assistive technology that can improve recreation participation. Funds provided by this project will bring the financial resources into these rural communities to purchase assistive technology for recreation that they would not otherwise be able to afford. This equipment will remain in the community and benefit the community for years to come. The vision of the Rural Community Recreation Project is to increase recreation participation among people with disabilities. The mission of the Rural Community Recreation Project is to eliminate barriers to recreation participation for adults with disabilities living in Henderson and Rocky Mount and surrounding areas by increasing awareness and access to recreation through assistive technology and training. Overall objectives for the project include the following: An increase in the awareness of existing community resources and the benefits associated with participation in traditional and nontraditional recreational opportunities and increased participation rates; An increase in the number of community recreational opportunities that are accessible, inclusive and have necessary adaptive equipment from which residents with disabilities may choose; An increase of knowledge by community recreation providers, resulting in more responsive and inclusive service provision to consumers with disabilities; An increase in the availability of assistive technology for recreation activities with increased recreation participation by individuals with disabilities; The development of community commitment to sustain project outcomes through the maintenance of assistive technology at community sites and website. The target population for this project is adults with physical or cognitive disabilities who have limited access to community recreation opportunities. Mobilizing human and material resources The human and material resources are gained primarily from the lead project organization, the project staff and collaborators. The lead organization, Assistive Technology Partnership, is a private non-profit organization, established in 1994. Board members include individuals with disabilities, parents of children with disabilities in addition to representatives from state agencies, businesses, and the medical and education community. Having provided services in 100 counties, ATP has state-wide reach. ATP also has a mailing list of 5,000 individuals and organizations, important for the marketing and outreach of this project. ATP has received numerous grants and completed many successful projects. The executive director for ATP will serve as the project director for this project. Responsibilities will include budget oversight; hiring of inventory surveyors; marketing of the project including preparation of PSAs, newsletter articles, and presentations; coordination of site trainings; liaison with community network groups; oversight of contract employees; dissemination of information and reports; preparation of required reports; and coordination and oversight of AT mini grants. The community mapping coordinator will be responsible for the community mapping process including the training of surveyors, developing the survey instrument, developing format for the community resource web page, oversight of the programmer, data entry and web developer. The third member of the project staff is the training coordinator. Responsibilities of the training coordinator include identification of training needs based on community mapping results, identification of potential trainers, assisting with specific and generic training, reviewing training materials and serving as a liaison with existing community recreation providers. Numerous key stakeholders have been identified as collaborators in the project. Much of the success and sustainability of the project depends on these collaborators. An initial list of collaborators and their role in the project is as follows: Kerr Lake State Park has already begun building accessible facilities and has agreed to be a pilot site for training and placement of assistive technology. Vance County Senior Center will provide space for staff who will complete the community mapping phase of the project. Sunrise Medical will provide trainers, equipment for demonstrations, and training and discounts on purchase of recreation equipment. Governor's Council on Physical Fitness and Health will provide in kind staff support, involvement of local fitness councils and financial support through matching funds. Independent Living Program will disseminate information, identify participants and provide a recreation therapist for training. Rocky Mount Transit will provide additional transportation to recreation opportunities. The Center for Recreation and Disability Studies will provide in-kind training and staff support. Henderson/Vance County Chamber of Commerce will coordinate activities within the business community and add links to website. The project activities will take place in four phases with each building upon the other to achieve the project goals. Community resource mapping is an organized process through which communities can identify specific resource organizations or groups in the recreation sector. Approximately 50 resources will be identified in each community. Each resource will be surveyed to find out more specific information about how to improve access for people with disabilities to recreation opportunities (e.g., through training, modifications and assistive technology). The surveyors will be community citizens, three at each site, who will be hired and trained to collect information from identified recreation providers. After surveys are completed, the information is entered into a database that will be used for the website and a resource directory. Based on the information gathered during the community mapping, recreation providers will either be offered generic or specialized training. Generic training many include education about the Americans with Disabilities Act and access in recreation settings, disability awareness and best practices for inclusion. Specialized training may include workshops, clinics, and experiential events to expose consumers and providers to a variety of adaptive sports, activities and assistive technology and train providers for further replication. Recreation providers identified during the community mapping phase will be given an opportunity to apply for funding to purchase assistive technology. Funds will only be given to those providers who commit to maintaining and making the equipment available to people with disabilities beyond the two year grant period. Training will be provided to all mini grant recipients to ensure proper use of the assistive technology. Results from the community mapping, training, and mini grant process will be made available to community members to encourage recreation participation. A searchable database containing community recreation information will be placed on a website and a computer will be placed in each community in a central, accessible location. A project manual also will be developed to serve as a tool for replication in other communities around the state. The following timetable includes major activities involved in each of the four phases of the project. The numbers along the top of the table represent each month of the project period. The evaluation process will be initiated at the onset of the project and conducted throughout the two-year period to measure: (1) the effectiveness of project methods, (2) timeliness of services, (3) consumer satisfaction, (4) accomplishment of specific outcomes, and (5) replication potential. Several evaluation strategies will be used including choice response and open-ended questionnaires in pre/post evaluation at all trainings, log of website usage, quarterly evaluation of use of assistive technology after community placement, and a review of record keeping. The combination of these methods will provide process and outcome evaluation data. Plan for financial sustainability The involvement of collaborating organizations, specifically the involvement of the Governor's Council on Physical Fitness and Health, is the long-term plan for sustainability and replication of the project. The project fits within the long range goals of the Council and its plan to increase funding to support similar projects. Staff and fringe benefits are for the Project Director (calculated at .40 FTE). Responsibilities include budget oversight; hiring of inventory surveyors; marketing of the project including preparation of PSAs, newsletter articles, and presentations to diverse audiences; coordination of site trainings; serving as a liaison with community network groups, overseeing contract employees, dissemination of information and reports, preparation of required reports, coordination and oversight of AT mini grants and consumer and family stipends. Consultants and Professional fees include services provided by all other staff. This includes the community mapping coordinator and evaluator who will work 300 hours in year 1 and 200 hours in year 2 at a rate of per hour. Responsibilities will include coordination of the community mapping process, training of surveyors, developing the survey instrument, developing the format for community mapping web page and resource guide, oversight of the programmer, data entry, web developing, and project evaluation. The training coordinator will work 400 hours in year 1 and 2 at a rate of .50 per hour. Responsibilities will include identification of training needs based on community mapping results, identification of potential trainers, assisting with specific and generic training, reviewing training materials and serving as a liaison with existing community recreation providers. The community mapping surveyors include 6 individuals, 3 at each site, working 10 hours a week for a total of 12 weeks at a rate of .00 per hour. The web developer's rate is .00 per hour for a total of 50 hours in year 1 and 20 hours in year 2. Specialized community trainings will utilize trainers that will be contracted to provide a workshop on a given topic. The cost will be 0 per training for a total of 20 trainings in year 1 and 2. Travel is calculated at $ 0.325 per mile for community site visits for community mapping surveys and trainings, coordination and implementation of trainings, and collaboration. Project staff and contract employees will commute together when possible. Equipment is for the purchase of "high cost" assistive technology items. Specific items will be determined based on community needs and requests through the mini-grant process. A computer also will be purchased and placed at each site so consumers and families will have increased access to the project website and Internet resources. Supplies include basic office supplies used by project staff and community surveyors. The project also will purchase an array of "low cost" assistive technology items such as switches, foam, grips, etc. for use in each community as determined by specific needs. Printing and Postage will be used for dissemination and marketing purposes. Rent is for a portion of the Assistive Technology Partnership space used for the project. Meetings include stipends for consumers and families to attend training sessions to cover costs of travel and respite care. This amount also covers costs of refreshments at training sessions. Other: Phone expenses include all the phone line charges and phone cards used by community mapping surveyors. Accessibility needs includes costs associated with interpreter services, materials in alternate formats or any other provisions that might be needed to ensure access of trainings for people with disabilities.

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How do you judge if an intervention is effective when you hear about it in the media? One earlier round of “miracle cure” publicity was so bizarre that Nasa, which is quite busy making spacecraft, was forced to issue a press release refuting claims in the Independent and New Scientist that Dore used special Nasa space technology and exercises in the treatment (Dore denies involvement in these claims). You might have noticed the Dore “miracle cure” for dyslexia, invented by millionaire paint entrepreneur Wynford Dore. In fact just recently you may have seen “Strictly Come Dancing” star Kenny Logan – a rugby superhero, with 70 caps in 13 years – promoting the Dore Dyslexia Program with his own personal testimonials on the Jeremy Vine Show, Channel Five News, Radio Five Live, BBC London, ITV Central, ITV Yorkshire, in the Daily Mail, the Daily Record, Scotland on Sunday, and many, many more. And we should remember that the published scientific evidence for Dore consists of an infamous research study (published in two papers) on the “miracle cure”, filled with fascinating methodological holes so serious that there were five resignations from the editorial board of the journal Dyslexia in protest at its publication, and an unprecedented nine critical commentaries from academics (here and here). But in the media you will only ever see Dore being promoted intensely, glowingly, uncritically, with intimate personal testimonies which many, understandably, consider to constitute evidence. Ofcom found Dore’s TV advertisement to be in breach of its rules on evidence, “assessment of medical claims”, and “impressions of professional advice and support”. With repetition, after all, they can start to feel eerily quantitative. 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You will never hear a negative Dore anecdote in the media. I spoke with three patients who felt the £2,000 programme didn’t work for them. It’s a fairly modest claim about their own experience, and you’d have thought the company might simply wear it. They asked for the names to discuss the cases specifically. In a letter to these patients asking for permission to talk about their cases they mentioned libel in a way that can only be described as threatening. She thinks, incidentally, that the Dore Programme made her son’s seizures and headaches worse. I make no comment on that, as it is simply one mother’s story (but if Dore wants to live by extreme anecdotes, then that is one for them to think about). The other felt he dared not take the risk of speaking out – of simply saying “it didn’t work for me” – as he felt so threatened, he does not have the resources to protect himself legally. 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I think the most fascinating thing about this story is that the mainstream media has been so fawning, encouraging people to part with their cash even as the programme was going under, while the bloggers have been dissecting the scientific evidence, even dissecting the accounts, predicting the financial problems, and reporting on events as they happen. This very week, even as everyday folk in Australia were wondering if they would ever see their money again, Radio 4’s supposedly investigative consumer programme You and Yours was promoting the Dore programme. So far – and I think I should start keeping a proper score here – that’s mainstream media 0, bloggers 10. Most amazing is that Dore UK seem also now to have gone under, or rather, into administration. Appointments have been cancelled, and staff sent home. This came in just too late for my column, but no worry: it will be fascinating to see how it is covered by the media. However misguided I feel it was, I sincerely hope their investment is safe. Perhaps You and Yours could reimburse the people they encouraged into the program this week, in the face of the evidence, and after the program was clearly in dire straits. If you like what I do, and you want me to do more, you can: buy my books Bad Science and Bad Pharma, give them to your friends, put them on your reading list, employ me to do a talk, or tweet this article to your friends. This idea was sent to me by someone who works in a newsroom and said, “My editor looked at me like I was crazy for asking if I’m going to get in trouble for keeping a machete at my desk.” …followed by this excellent suggestion: “Could we have an open thread sometime of things that are chill in your industry that would be extremely not chill elsewhere? What flies in your industry that you’re pretty sure would not fly somewhere else?

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