Reaching Every Farmworker Home through Proyecto Puente

Convening Head Start Community Partners at an Annual Meeting

Calming Fears and Opening Communication between Farmworkers and Law Enforcement

Community-Based Approach to Addressing Mental Health Needs

Regional Coalition Assesses Farmworker Needs in Eastern North Carolina

Mid-Season Farmworker Appreciation Festival

Screening Tool Improves Outreach Worker’s Ability to Identify Behavioral Health Problems

Collaborations Enable Diversified Care

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Reaching Every Farmworker Home through Proyecto Puente
2007, Northwest Michigan Health Services, Inc. top

Northwest Michigan Health Services, Inc. (NMHSI) Office of Public Outreach has created a specialized internship, Proyecto Puente or the Bridge Project, for four bilingual college students from the University of Michigan, Ann Arbor and Michigan State University’s College Assistance for Migrants Program. The goal of this pilot project was to reach every farmworker home in three of the seven counties covered by NMHSI. The interns work as part of the greater outreach program, and as such, undergo extensive training in cultural competence and lay health education using a popular education model. Working out of the main clinic in Traverse City, the interns travel to farmworker camps and perform three main activities: 1) conducting enumeration studies (which include a needs assessment component); 2) delivering health education based on farmworkers’ interests; and, 3) helping connect farmworkers to the clinic and other resources in the community.

By taking advantage of the extra staff members, NMHSI was able to conduct its first ever needs assessment and enumeration study last year. To date, the interns have completed 369 interviews with heads of households accounting for over 1,300 farmworkers and their family members. The information gathered has guided long-term program development based on new demographic data and farmworker input. The four interns—some of them former migrant farmworkers—have gained valuable insight into the issues facing the farmworker community in northwest Michigan. At the end of 2006, NMHSI saw a 31% increase in the number of clinic users. This increase, which surprised clinic staff, has been attributed in part to the strong relationships that the interns built with this segment of the farmworker population.


Convening Head Start Community Partners at an Annual Meeting
2007, East Coast Migrant Head Start Project, North Carolina Direct Services top

The East Coast Migrant Head Start Project North Carolina Direct Services (ECMHSP/NCDS) organizes and hosts an annual Community Partners Meeting for each of its Head Start Centers in North Carolina. The meeting brings together service providers and other potential community partners to lay the ground work for better collaboration to improve services for children and families. Representatives from numerous local, state, and regional organizations attend this one-day meeting, including: local health departments, private providers, community health centers, social service agencies, community colleges, universities, mental health providers, the North Carolina Farmworker Health Program, and the Agricultural Resource Center’s Pesticide Education unit among others.

The meeting is split into three general segments: 1) a Health and Family/Community Partnership session, 2) a catered networking lunch and 3) an Early Childhood Education and Family Literacy/Disability session. Participants are welcome to attend the entire meeting or the segments of their choice. The meeting is scheduled before the center is open for the peak season and is a component of ECMHSP/NCDS’s planning process.

ECMHSP/NCDS has taken collaboration to a new level by expanding beyond farmworker-serving organizations to address the health and social service needs of farmworkers in North Carolina. This unique cross section of partners would not ordinarily be at the same table together. By giving them an opportunity to meet and share information, unique and effective service delivery plans are often developed.

For the past four years, this meeting has yielded numerous fruitful outcomes, such as nutrition and physical education training for teachers, ESL classes for parents, health fairs for migrant children, expedited Medicaid services for families, and pesticide education classes for parents and staff. These collaborative initiatives are essential to address Migrant and Seasonal Head Start’s Performance Standards, and ultimately yield more effective and efficient programs for serving farmworkers and their families in the state.


Calming Fears and Opening Communication between Farmworkers and Law Enforcement
2007, Ellenton Health Clinic Farmworker Health Program top

Following an outbreak of violent and deadly home invasions against Latino farmworkers in two South Georgia counties, the Ellenton Health Clinic Farmworker Health Program (“Ellenton Clinic”) served as a safe haven of understanding, awareness, and advocacy for the farmworker community. Committed to cultural responsiveness, the Clinic Director invited the local sheriff’s department, the US Department of Justice, Colquitt County Cooperative Extension Service, MALDEF (the Mexican American Legal Defense and Educational Fund), the Superintendent of Schools for Colquitt County, and the Southern Pines Migrant Education Agency to discuss concerns at two community forums and help allay the fears of the farmworker community during this difficult period.

Concerned farmworkers were able to raise the following issues: 1) their mistrust of and inability to access the banking system; 2) the lack of Spanish-speaking law enforcement officers and 911 dispatchers; 3) the lack of proper housing available to undocumented workers; and 4) the fear that if they report crimes, they themselves might get deported as a result. The clinic provided space and translation services for two of these community forums.

Because many farmworkers are unable to open bank accounts and subsequently forced to keep a lot of cash at home, they become easy targets for violence. Organizing these community meetings brought the community together during a time when fears could have grown into explosive divisiveness. The Ellenton Clinic successfully demonstrated the role that community organizations can play in facilitating dialogue among city, county, and federal officials on behalf of the farmworker community. At the community forum, the 75-person classroom overflowed with participants. Farmworkers attended these meetings because clinic outreach staff were effective in making them feel safe enough to attend.

The Ellenton Clinic continues to support the farmworker community by: 1) providing home safety education to farmworkers; 2) collaborating with the Justice Department to create an ongoing community committee to address these issues; 3) educating the farmworker community about the US banking system; and, 4) partnering with the University of Georgia Archway Partnership to advocate that the banking community offer alternative banking services to farmworkers.


Community-Based Approach to Addressing Mental Health Needs
2007, Watauga Medical Center Farmworker Health Program, Boone, North Carolina 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.


Regional Coalition Assesses Farmworker Needs in Eastern North Carolina
Kinston Community Health Center top

Kinston Community Health Center (KCHC) is a founding member of the Migrant Education Outreach Cooperative (MEOC), which began as a joint effort between the Migrant Education Program and KCHC to create a platform for communicating among agencies that serve farmworkers in Eastern North Carolina. The cooperative involves representatives from two public school systems, a head start agency, a community college, one health center, and two family-focused non-profit organizations. In addition to meeting monthly, conducting joint outreach activities, and communicating via a blog site, the seven coalition members are conducting a comprehensive farmworker needs assessment across the region. All representatives have assisted in the survey design, received training for administering the surveys, and mobilized their respective community volunteers to carry out the assessment. The assessment covers a five county service area, reaching 240 farmworkers and their families.

Some of the coalition members have carried out individual needs assessments of their farmworker clients in the past, but none have ever jointly conducted a comprehensive regional assessment that addresses farmworker needs beyond the scope of their individual organizations. The activities of this coalition, particularly the needs assessment, reflect a commitment to effective partnering so that each of the organizations can more comprehensively address the needs of farmworkers in this part of the state. Though data collection has just begun, all coalition members were eager to be a part of the assessment effort and the results will be used to identify and evaluate service gaps in the region and to guide and inform program design and grant applications.


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.


Screening Tool Improves Outreach Worker’s Ability to Identify Behavioral Health Problems
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.


Collaborations Enable Diversified Care
2004, Farmworker Health Center, Union/Jackson Labor Camp top

SHSDC creates relationships with other agencies in the community that increase and improve the services they are able to provide to farmworkers and their families. Two examples of this collaborative initiative are their interpreter services and dental services. Responding to the need for interpretation services for farmworkers, an SHSDC outreach worker began interpreting on a volunteer basis in hospitals and anywhere the service was needed. This has turned into an official interpreting service that has five members who carry beepers and are available twenty-four hours a day, seven days a week. Some hospitals reimburse for the service and formal negotiations are underway to encourage reimbursement by all users of the service.

Dental care continues to be a desperately needed service for farmworkers in Southern Illinois. The center works to provide care, but has difficulty finding dental providers. To alleviate this barrier, the health center partners with the Southern Illinois University Dental Hygiene Program. Students rotate through the clinic providing assistance and, in turn, receive a hands-on public health experience. The center also utilizes the expertise of the Dental Hygiene Program’s faculty for promotor de salud training and community health education programs.

Creating partnerships with outside organizations enables SHSDC to effectively leverage their funding. Through these partnerships, SHSDC avoids duplication of services and employs a creative way to approach service gaps for their clients while providing continuity of care.

Additionally, the interpreter and dental services added to SHSDC’s menu of services provide supplementary training expertise for SHSDC staff members, including cross training for the majority of staff members, and engages students in the field of public health.