Coordinator Addresses More than Farmworkers’ Health Needs

Training All Outreach Specialists as Medical Interpreters

Incorporating Clinical Case Management into Outreach

Administration and Reading of PPDs in the Field by Trained Outreach Workers

Providing Comprehensive Diabetes Care in One Locatio

Assessing and Reassessing Farmworker Needs throughout the Season

Post-Natal Program for Farmworker Families

Integrating the Outreach Department into the Health Center

Provider and Caseworker Team Visits to Housing Camps

Using MiVia and Telemedicine Technology to Increase Access to Specialty Care

Creating a Safety Net for Homeless Farmworkers

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Coordinator Addresses More than Farmworkers’ Health Needs
2006, Family Health Services top

Family Health Services (FHS) employs a Community Services Coordinator (CSC) to assist farmworker patients at FHS’s eight sites, including its mobile unit. The patients referred to the CSC for case management are primarily individuals with needs outside of the scope of medical, dental or behavioral health treatment, such as financial assistance, employment, services for the elderly and Medicaid. The CSC travels to each site on a weekly basis to obtain referrals and to contact patients by phone or in person. Patients are provided with information on community resources, what verification or documentation they will need to provide to successfully receive help, and instructions on how to make appropriate appointments. The CSC thoroughly documents her interaction with each patient and this information is then routed to the referring provider and the patient’s medical record.

Family Health Services makes a point not to limit services to farmworkers because their needs are so unique and FHS wants to be as responsive as possible. The role of the Community Services Coordinator at FHS expands the reach of case management beyond the health center’s services. The CSC keeps abreast of all available programs and resources in the communities where FHS operates, to ensure that patients receive comprehensive and detailed information on different types of assistance. The CSC’s services are so well known that she is often contacted for assistance by individuals who are not yet patients at FHS but who have heard of her services through friends and family. If they so desire, these individuals have the opportunity to establish patient care at FHS in addition to receiving information about community resources and services.


Training All Outreach Specialists as Medical Interpreters
2006, Bluegrass Farmworker Health Center top

At Bluegrass Farmworker Health Center, all Outreach Specialists are trained in medical interpretation as part of the integrated clinical case management model. Outreach Specialists serve as interpreters and accompany any BFHC patient referred to a specialty physician. The Outreach Specialist is able to help clients navigate all aspects of the referral process from arranging transportation, to discussing payment options to scheduling follow-up visits in the home. The outcome of this effort has been better patient compliance and improved relationships between the health center and referral providers.

Much like the clinical case management model, this practice has expanded the role and usefulness of outreach within the whole of the organization while also ensuring better care for patients. The specialty providers greatly appreciate the interpretation services. As a result, they have become more flexible in scheduling BFHC’s patients on short notice and have become more willing to arrange lower fees and better payment plans.


Incorporating Clinical Case Management into Outreach
2006, Bluegrass Farmworker Health Center top

Bluegrass Farmworker Health Center has expanded the role of outreach to include clinical case management. This transition included moving the Clinical Case Manager under the umbrella of the outreach department while training Outreach Specialists on basic clinical case management skills. By creating specific guidelines regarding the Outreach Specialist’s role as case worker and incorporating home visits into clinical tracking and follow-up procedures, outreach staff are now an integral part of the clinical process. Patients who need follow-up but have not responded to phone calls and mailings receive home visits from Outreach Specialists before their case is closed. Patient compliance has greatly improved, especially among chronic disease patients.

This new approach to clinical case management is unique because it expands the role of the outreach worker, a role which did not traditionally include clinical case management. It also alters the traditional context of case management given that few programs send caseworkers out of the office setting directly to where patients live. By integrating case management and outreach, BFHC has been able to minimize many barriers to care while elevating the importance of outreach to clinical staff members who now see more concrete results from outreach efforts.


Administration and Reading of PPDs in the Field by Trained Outreach Workers
2005, Elaville Primary Medicine Center top

Ellaville Primary Medicine Center’s outreach workers conducted tuberculosis screenings with farmworkers in their service area and were able to follow-up with and read PPDs for 88% of those screened. While no active cases of tuberculosis were found, of the 32 farmworkers with positive PPDs, 23 were given copies of their PPD record, chest X-rays, and lab work upon returning to their home bases in Mexico, and five completed a treatment regimen. Two were advised to stop treatment for medical reasons. Prior to beginning the project, outreach workers received training in tuberculosis education and testing, and were able to provide culturally and linguistically appropriate health education and case management services to all those screened. Those with positive PPDs received free chest X-rays and lab work, as well as their choice of pick-up location – the local health department or the Ellaville Primary Medicine Center – for monthly prescription refills.

Ellaville Primary Medicine Center set up a tuberculosis screening program that meets individual farmworker needs by administering and reading PPDs in the field, working with patients to determine where they will be when the PPD needs to be read, and then coordinating with growers and crew leaders to assure access to workers in the field. Ellaville staff also provided culturally and linguistically appropriate health education about tuberculosis and the testing process prior to administering all PPDs, as well as provided X-rays, lab work, and antibiotics free of charge to all farmworkers with positive results, and offered a choice of medication pick-up locations. Each of these practices worked together to foster a high return rate for PPDs readings, as well as high compliance with follow-up care.


Providing Comprehensive Diabetes Care in One Location
2005, Migrant Health Service, Inc. top
Migrant Health Service, Inc., (MHSI) in conjunction with providers from the surrounding community, holds “Diabetes Cluster Clinics” seven times during peak season in which farmworkers are able to access a multidisciplinary diabetes team consisting of lay health educators, outreach workers, a diabetes educator, a nutritionist, an ophthalmologist, a hygienist, a physician or mid-level nurse specializing in podiatry, MHSI clinical staff, and a phlebotomist. At locations throughout the service area in Minnesota and North Dakota, patients are able to cycle through what would normally take up to eleven outreach and clinical office visits in 3-4 hours time, addressing issues such as nutrition, diet, exercise, eye and foot care. At the final station, patients meet with a nurse who reviews the patient’s overall findings and makes any necessary referrals for further care.

By holding the Diabetes Cluster Clinics, Migrant Health Service, Inc. has successfully made services more accessible to farmworkers in an area of particular health concern, diabetes. This practice meets the needs of farmworkers who may not have time for more than one office visit, and also allows farmworkers and MHSI to save on medical costs by cutting down on the need for multiple appointments. The practice has also successfully integrated services offered through MHSI with those of area practitioners to the benefit of farmworker patients.


Assessing and Reassessing Farmworker Needs Throughout the Season
2005, Greene County Health Care, Inc. top

Greene County Health Care, Inc. conducts a needs assessment with farmworkers at housing camps across their service area at the start of each season, and then revisits the results of that assessment mid-way through the season to determine if they continue to accurately represent needs among farmworkers in the area. The initial needs assessment is conducted through focus groups with farmworkers at an average of 15-20 camps and is followed by a planning meeting with outreach staff to determine where the greatest needs lie and how to address them. The follow-up assessment mid-way through the season is done using individual patient health assessments and case management intake forms, which are filled out by all farmworkers seen by outreach staff. If a discrepancy is found, appropriate changes in services are made.

Conducting a needs assessment each year is an important mechanism for insuring that services offered meet real needs in the farmworker community. Greene County Health Care, Inc. has improved upon the practice of a yearly needs assessment by reassessing results mid-season through a review of patient health and case management assessments. By conducting planning based on needs assessment results at the start of each season and making adjustments mid-season based on updated data about diagnoses and needs, Greene County Health Care, Inc. is providing responsive services to a population whose needs can change in the course of a growing season.


Post-Natal Program for Farmworker Families
2005, Golden Valley Health Centers top

The Puentes Program at Golden Valley Health Centers (GVHC) provides post-natal care to new mothers, and enrolls many farmworker mothers. The Puentes Program starts working with new mothers in the hospital immediately after birth, where they are registered for the program and offered health education and breastfeeding advice. A few days after the mother and baby come home, a GVHC nurse will visit the home and conduct a well-assessment of the child. If the child does not have any health issues that need attention from a doctor or nurse, an outreach health educator will visit the home and work with the mother throughout the course of the program. The program curriculum includes breastfeeding and parenting skills as well as screenings for post-partum depression and domestic violence. The Puentes program sometimes serves as a bridge to geographically and culturally isolated farmworker moms, and is an important way for GVHC outreach and Puentes Program staff to access farmworker women and children.

While many health centers have pre-natal programs, Golden Valley Health Center has an additional program that focuses intensively on post-partum care. The program provides much needed services to families in the area, and provides a very important link between the health center and farmworker women and children. The program builds trust and relationships between farmworker families and the health center through home visits and access to outreach health educators. In addition to the care given in the clinics and in home visits, mothers can also use a “warm line” to reach their health educator by phone for any questions or concerns. Golden Valley works in a tight collaboration with WIC, the Public Health Department, and the Office of Education to provide comprehensive services to program participants.


Integrating the Outreach Department into the Health Center
2004, Farmworker Health Center, Union/Jackson Labor Camp top

The philosophy of the Farmworker Health Center is one of shared governance: the office manager, outreach coordinator and clinical supervisor all work very closely to make sure the clinic is managed appropriately. Goals, objectives, and activities are determined in a cooperative manner by the SHSDC, the Board of Directors, the Farmworker Health Center, and outreach staff members.

SHSDC recognizes that an outreach program is an essential component of health care delivery for farmworkers. This philosophy, coupled with the inclusion of former farmworkers or adult farmworker children both on the Board of Directors and among the outreach staff members, demonstrates integration of the outreach program within the rest of the organization. SHSDC further integrates the outreach program within the health center to meet the basic health care needs of the farmworker population by sharing information between the outreach department and other health center departments. The clinic staff members meet with the outreach team every week to conduct case management for the clinic clients. Together, clinic and outreach staff members review cases and conduct general planning for the operation of the health center. They seek to identify migrant and seasonal farmworkers that need to be brought into to the health center for care.


Provider and Caseworker Team Visits to Housing Camps
2008, Finger Lakes Migrant Health Care Project, Inc. top

Finger Lakes Migrant Health Care Project, Inc. (FLMHCP) has contracted with a voucher site provider to visit migrant housing camps in the counties that they would normally serve in private practice. The clinical provider sees patients in their homes, observes their living conditions, and meets their family members in order to get a more holistic understanding of the factors influencing the patients’ health. On such visits, the provider is accompanied by a FLMHCP bilingual/bicultural case manager to provide assistance and serve as a patient advocate. The case manager organizes follow-up care including making arrangements for and covering the costs of transportation for patients to be seen in a clinical setting if necessary.

This program gives clinical providers a rare opportunity to experience first hand what the farmworker deals with at work and home. The case manager provides a constant link for the patients so that wherever seen, there is a familiar face. In addition, patients receive care without needing to travel. This is especially important for routine screenings that may not seem worth a trip to the clinic but which often uncover more serious diseases such as diabetes, hypertension, and hepatitis.

Though providing medical services in isolated areas is difficult because doctors often lack access to their patients’ prior medical histories, in this program, a medical chart is created for each patient using MiVia software. MiVia is a secure, web-based, and patient-driven Electronic Health Record program that allows patients to go anywhere in the world and give any provider access to their health records. The in-camp providers bring internet-accessible laptops, in order to look up patients’ previous medical care. This approach prevents the duplication of services, such as blood work and immunizations, that may have occurred at other clinics and it also allows for the tracking of medications.


Using MiVia and Telemedicine Technology to Increase Access to Specialty Care 2008, Finger Lakes Migrant Health Care Project, Inc. top

Finger Lakes Migrant Health Care Project, Inc. (FLMHCP) has teamed up with a major regional hospital to provide access to a variety of healthcare specialists for migrant and seasonal farmworkers using both telemedicine equipment and MiVia software.

Prior to an appointment, a FLMHCP clinical provider enters all of a patient’s vital information as well as notes on past interactions. On the day of the visit, the patient is accompanied by a bilingual case manager into the clinic the farmworker normally visits. By then, the off-site specialist has already accessed the patient’s record using MiVia, and is aware of the patient’s health concerns and important medical information. Using telemedicine cameras and digital diagnostic instruments such as otoscopes, stethoscopes, and cameras, the visit is conducted just as if the specialist were in the room with the patient except that a trained nurse provides the hands-on piece of the exam, under the specialist’s direction.

Thanks to this system, patients do not lose an entire day of work because of a trip to a specialty care center in a distant city, yet they gain access to top specialists. Also, FLMHCP’s case managers are more efficient because they do not have to drive long distances nor spend most of a day with one patient. A new component of the program is the use of a portable camera to transmit video images back to providers in the clinic. The camera will be used in farmworkers’ residences so that they will be able to access specialty care without having to leave their homes. The telemedicine program is effective, but more importantly, it addresses transportation barriers while assuring that patients have access to high-quality health care in a setting with limited providers.


Creating a Safety Net for Homeless Farmworkers 2008, Community Health Centers of the Central Coast top

Community Health Centers of the Central Coast (CHC) has begun an inter- and intra-agency collaborative program specifically targeting homeless farmworkers which maximizes resources within the health center as well as within the community. Housing in CHC’s service area is particularly expensive and not only are there no labor camps, farmworkers are not allowed to park their cars in the fields, forcing many to sleep in parking lots and outside of local community hubs. In many cases, it is very difficult to tell who is homeless until night falls.

CHC’s Los Adobes de Maria farmworker clinic has joined forces with the organization’s mobile unit and the Healthcare for the Homeless Program in order to find homeless farmworkers and offer case management as well as screenings, medical care, and urgent care. Aside from intra-agency collaboration, the program also works with other local organizers, farm companies, agencies, charities, as well as several Mixteco organizations such as Unidad Popular Benito Juarez to do referrals and organize community events. This unique collaboration, both internal and external to the organization, has opened many doors for the program to gain greater access to and better serve the population.