Community-Based Approach to Addressing Mental Health Needs

Mid-Season Farmworker Appreciation Festival

Collaboration within the Health Center and Beyond to Provide Comprehensive Health Services

Integrating Behavioral Health into the Clinical and Outreach Programs

Using Novelas to Address Culturally Sensitive Health Issues

Holiday Dinner Brings Farmworkers Together in Celebration

---

Community-Based Approach to Addressing Mental Health Needs
2007, Watauga Medical Center Farmworker Health Program top

With the help of a local graduate-level intern, Watauga Medical Center Farmworker Health Program (WMCFHP) conducted a community-wide mental health assessment at two large farmworker camps. The assessments involved focus group discussions whose purpose was to understand: 1) cultural perceptions of mental health; 2) experiences of stress around money, migration, and culture; 3) ways to manage stress; 4) what kinds of support farmworkers would like; and, 5) farmworkers’ perceptions of mental health services. Participating farmworker households and camps were offered incentives that would provide healthy “free time” alternatives: sports equipment, Spanish language reading materials, ESL instruction or language exchange, and group stress reduction education.

Since the start of the WMCFHP in 2004, staff have seen a high number of clinic visits related to the physical symptoms of depression, anxiety, and alcohol abuse; for example, stomach and chest pains, insomnia, and liver problems. WMCFHP’s efforts to treat, understand, and address the root causes of these ailments has enabled the program to more effectively and comprehensively address the spectrum of their farmworkers’ health needs that are typically rooted in the circumstances of their farmworker lifestyles.

Findings from the focus group discussions indicated that many of the interviewees experience boredom and anxiety around missing family, dealing with roommates, worrying about money and dealing with language and cultural barriers. In regards to culturally appropriate mental health interventions, WMCFHP learned that: 1) most farmworkers prefer to seek emotional support from people they already know, including providers; 2) they would not seek mental health services unless they were no longer able to fulfill their social and work duties; 3) they are familiar with Alcoholics Anonymous (also present in Mexico) and would be open to joining local Spanish-speaking groups if it was necessary and groups were available; 4) they are interested in group health education on stress reduction; and, 5) reading materials or sports activities would help them to cope more effectively.

Last year’s efforts generated so much insight and interest that WMCFHP plans to expand the project in 2007 to reach a larger number of camps and incorporate more group stress reduction education.


Mid-Season Farmworker Appreciation Festival
2006, Southern Jersey Family Medical Centers, Inc. top

Southern Jersey Family Medical Centers, Inc. organizes an annual farmworker festival that brings together over 1000 farmworkers and provides them with a social outlet in the middle of the busy picking season. The event is advertised as an appreciation day for the hard-working efforts farmworkers contribute to the community. Community organizations such as churches donate money and time and many items such as clothes, bikes, household and spiritual materials to support the festival. They also provide fun games for the children. Medical students conduct health screenings and provide health education while social service organizations distribute information about their services. Local DJs and Mexican folkloric groups provide the entertainment at the event. The biggest draw of all is the soccer tournament, in which prizes are awarded to the winning team.

Since many farmworkers suffer from depression and isolation, this event provides a much-needed opportunity for social interaction outside of the work setting. The festival sensitizes the community to the significant contributions of farmworkers while also mobilizing community members to donate their time, money and talents to express their appreciation for these contributions.


Collaboration within the Health Center and Beyond to Provide Comprehensive Health Services
2005, Tri-County Community Health Center top

Tri-county Community Health Center’s Community Services Department includes a mental health, substance abuse, and HIV/AIDS/STI screening tool as part of their outreach general health assessment. All outreach staff and accompanying medical students or personnel are trained in using the screening tool and familiar with the prevention model used at Tri-County. The tool allows outreach staff and medical students who partner with them to identify farmworkers engaging in high-risk behaviors for HIV/AIDS/STIs, farmworkers with mental health needs, and farmworkers substance abuse issues. Staff may then refer to an inpatient/outpatient bi-lingual substance abuse treatment center for males on-site at Tri-County Community Health Center, to Tri-County Community Health Center behavioral health or psychiatric services, or to additional services outside the health center. Staff may also refer a farmworker for HIV/AIDS/STI testing at the center, or choose to set up on-site mobile HIV/AIDS testing in high-risk camps or areas.

To provide comprehensive health services to farmworkers in their area, Tri-County uses collaborative ties with other departments within the organization, as well as with state and local organizations. Tri-County has the ability to refer farmworkers on-site at the health center to inpatient and outpatient substance abuse treatment, and to behavioral health services and psychiatric care. Tri-County provides free HIV/AIDS testing on-site in the community and farmworker camps by establishing a mobile testing unit on location for a full day, and returning on an established date to provide test results.

Routine screening for mental health needs, substance abuse, and risk behaviors associated with HIV/AIDS/STIs provides comprehensive care to farmworkers in Tri-County’s service area and meets a previously largely unmet need in the farmworker population. Tri-County’s ability to treat farmworker patients on-site at the health center for substance abuse in a bi-lingual and culturally appropriate facility greatly increases farmworker access to substance abuse services. Similarly, the ability to refer farmworkers in need of mental health services to both behavioral health and psychiatric services at the health center minimizes the need for farmworkers to travel to multiple providers to receive treatment and medications, as well as provides continuity of care and culturally and linguistically appropriate services.

Finally, by providing HIV/AIDS testing on-site in the community, Tri-County makes confidential testing much more accessible for farmworkers in the area, while also providing culturally and linguistically appropriate care. By coming to the camps and encouraging everyone to be tested, Tri-County staff members are able to target high-risk areas, work to de-stigmatize testing, and reach more farmworkers with testing services.


Integrating Behavioral Health Into the Clinical and Outreach Programs
2005, Darin M. Camarena Health Centers, Inc. top

The Darin C. Camarena Health Center has successfully integrated behavioral health into their primary health program, including outreach services. Two behavioral health staff members work in the clinic to ensure that patient’s behavioral health issues are addressed, especially regarding chronic health problems such as diabetes. Full-time behavioral staff members are bi-lingual, and part-time staff members are accompanied by interpreters when working with patients in the clinic. Outreach workers promote a behavioral health model in their work with farmworker patients, as well as promote the bilingual behavioral health services available to patients at the health center.

Addressing behavioral health issues is crucial in treating chronic health problems, and is often difficult to provide to farmworker patients, who are less likely to have multiple visits or seek preventive care. Farmworkers, many of whom are newly arrived immigrants, are often overwhelmed by the cultural and linguistic differences they face, and as a result, often feel isolated. Consciously promoting a behavioral health model and having two full-time behavioral health staff members increases the chances that farmworker patients will receive behavioral health counseling and services, and reinforces health education done by outreach workers in the field.


Using Novelas to Address Culturally Sensitive Health Issues
2004, Terry Reilly Health Services top

As part of their outreach activities, outreach workers produced innovative educational materials such as an eight-part radio novela (soap opera) on sexual and physical abuse, Los Secretos del Abuso Sexual/Secrets of Sexual Abuse, and a short video presentation on common mental health situations of farmworkers, Cuentos Del Campo/Stories from the Field.

TRHS collaborated with a local radio station in the production of the radio novela and negotiated free airtime in return for ads placed with the radio station. In addition to using outreach workers, TRHS used specialists on the topics to review the radio novelas before presenting them to the public to ensure that the information provided was correct and clear.

TRHS identified an effective way to reach the farmworker community by using the radio media. Radio novelas are very popular among Hispanic families. Having a radio novela on topics such as sexual abuse or health situations provides health education in a widely accessible, informal and non-threatening way and in a language that can be easily understood by a broad audience.


Holiday Dinner Brings Farmworkers Together in Celebration
2008, Southern Jersey Family Medical Centers top

In December 2003, Southern Jersey Family Medical Centers (SJFMC) hosted its first Farmworker Holiday Dinner. The purpose of the dinner is to provide farmworkers with a fun, social activity full of both treats and necessities around the holiday season. Many farmworker families who stay in isolated camps year round are in need of a celebration; the cold winter season can depress farmworkers who find themselves away from their families during the holidays.

Aside from supporting farmworkers who are alone during the holiday season, the Farmworker Holiday Dinner is also an event in which the general community reaches out to local farmworkers. Community churches and private citizens donate food, gifts, and time to this event to make it special. Church members first clean up for the dinner and then prepare and serve platters of holiday favorites.

Volunteers put “Angel Trees” on display based on a list of farmworker families compiled for them by the outreach department of SJFMC. Church members pick a farmworker family that they would like to sponsor and then provide both presents for the children and general goods for the family under each tree. Single adult farmworkers are also given gifts. Tables of other miscellaneous donated items are set up as well.

In addition to food and gifts, various entertainers volunteer to perform at the dinner. A DJ provides musical entertainment and a clown comes to share treats and play games with the kids. There is even a volunteer Santa Claus who greets the children and distributes small gifts. Farmworker service organizations also come to help out and tell people about their services. The Farmworker Holiday Dinner is a fun night for the whole community at a time when being with others is so important.