Regional Coalition Assesses Farmworker Needs in Eastern North Carolina
Coordinating Outreach and Clinic Activities through Daily Meetings
Community Health Promoters Enhancing Outreach Services
Pre-season Orientation for Health Center Staff
Outreach Orientation and Farmworker Lifestyle Tour
Satellite Clinics Put Providers in the Field
Using GIS to Identify Farmworkers
Integrating Behavioral Health Into Primary Care Program
Post-Natal Program for Farmworker Families
Assessing Patient Satisfaction
NCFHP develops goals, objectives and activities through an internal and external planning process
Satellite Link in the Field
Integrating Outreach Program with the Health Center
Integrating Outreach Improves Overall Care
Newsletter Helps Facilitate Organization Communication
Using MiVia and Telemedicine Technology to Increase Access to Specialty Care
Increasing Access to Medications while Maximizing Internal Resources
Creating a Safety Net for Homeless Farmworkers
Regional Coalition Assesses Farmworker Needs in Eastern North Carolina
2007, Kinston Community Health Center
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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.
Coordinating Outreach and Clinic Activities through Daily Meetings
2007, Northwest Michigan Health Services, Inc.
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In order to coordinate all facets of outreach with clinic activities, NMHSI holds daily, 30-minute team meetings with the entire health center staff. The purpose of these meetings is to better coordinate efforts and communication between outreach and clinical staff who in the past, did not communicate as consistently and effectively. During the team meetings, staff review activities from the previous day, discuss case management issues, look at overall progress and plan action steps for the day ahead.
The team meeting strategy represents a more holistic approach to meeting the ever-present needs of farmworkers. Clinicians rely on outreach workers to serve as their eyes and ears, providing them with information on the farmworkers’ lifestyles, including migration information to facilitate continuity of care at their next destination. The outreach staff also learn from clinicians who train them on the symptoms and causes of specific illnesses in order to better observe farmworkers in the field and conduct responsive and effective health education. This type of training was instrumental last year for coordinating an appropriate response during an outbreak of diarrheal illnesses in the camps. Overall, these meetings allow for participation of all members of the outreach program and clinic staff to achieve a common goal and ultimately, this has resulted in better patient care.
Community Health Promoters Enhancing Outreach Services
2006, InterCare Community Health Network
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InterCare has trained a cadre of skilled bilingual Community Health Promoters to provide crucial information to newly-arrived farmworkers regarding benefits, resources and specific details about ICHN’s services. The CHPs have also provided key support to outreach nurses by setting up schedules for nursing outreach, serving as interpreters during outreach visits, facilitating appointment-setting, transporting farmworkers to services, tracking outreach activities in ICHN’s management information system and locating farmworkers with limited contact information.
By training CHPs to provide education and information, ICHN has responded effectively to the lack of outreach nurses in the area and the need to effectively facilitate farmworkers’ interactions with the health system. The outreach nurses are specifically trained to provide clinical services while the CHPs are trained to provide crucial enabling services that encourage farmworkers to seek and access care. With this model, each group is able to maximize the services that it can offer farmworkers. As a result, outreach nurses and CHPs are able to reach many more farmworkers during their camp visits and provide a higher quality of care overall.
Pre-season Orientation for Health Center Staff
2006, InterCare Community Health Network
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Last year, InterCare conducted a pre-season orientation at each of the health centers to familiarize staff with the scope of the outreach programs and how to utilize outreach workers as an extension of the primary care services delivered on site. An outreach encounter form was introduced to health center staff as a tool for referrals to/from the health center and procedures for efficiently calling in appointments was established.
Conducting a pre-season orientation with all health center staff is an effective tool for integrating outreach into the rest of the organization and clarifying the role of outreach in delivering health care services. Health center employees are now more aware of the purpose of outreach and the key outreach services provided to farmworkers. As a result, staff members have become more open to scheduling appointments requested by outreach workers when they call in from the outdoor camp clinics.
Outreach Orientation and Farmworker Lifestyle Tour
2006, Blue Ridge Community Health Services, Inc.
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Blue Ridge Community Health Services, Inc. (BRCHS) provides all new employees with an outreach orientation in addition to providing cultural competency trainings annually to all staff. The outreach orientation is a cornerstone of the overall orientation to BRCHS, given the center’s founding as a migrant health center. The outreach orientation session, led by the Outreach Coordinator, gives a comprehensive overview of the outreach department, farmworker-specific lifestyle issues and the history of the health center. Participants learn how BRCHS defines and conducts outreach, the difference between migrant and seasonal farmworkers and the impact of farmworkers on the local economy. Employees also tour the agricultural areas surrounding the clinic in the clinic van visiting grower-provided farmworker housing as well as community-based housing.
The outreach orientation is an effective way to create awareness and a better understanding of the lifestyle of farmworkers in the area. Some staff members have never interacted with farmworkers or been exposed to the substandard conditions in which many farmworkers live. It has also been important to introduce staff to the roots of the organization as a migrant community health center in order to emphasize BRCHS’ long-standing commitment to farmworkers. The annual all-staff cultural sensitivity trainings and the new hire outreach orientation together illustrate how well the outreach department is integrated into the overall health delivery system at BRCHS.
Satellite Clinics Put Providers in the Field
2005, Greene County Health Care, Inc.
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Four providers, each from a Greene County Health Care, Inc. satellite clinic, conduct outreach in their clinics’ service area and refer patients needing follow-up care back to their own clinic to be seen for needed services. Each satellite clinic has a provider, front desk staff person, and translator, so that when farmworkers are referred for services there, they are guaranteed to see the same provider they received services from during outreach. Farmworkers first seen in the clinic will also be seen by that same provider on any subsequent outreach visits. During peak season clinics are open during the afternoon, and providers conduct outreach in the evenings until 10:00 or 11:00pm.
By connecting the care provided in the field during outreach services with health services provided in the clinic, Greene County Health Care, Inc. has improved the continuity and consistency of care for farmworker patients and has presented a unique opportunity for patients and providers to build a more trusting relationship. Having providers in the field in the evenings allows farmworkers who may not be able to travel to the clinic during the day to have the opportunity to been seen by a provider at night.
Using GIS to Identify Farmworkers
2005, Panhandle Community Services, Community and Migrant Health Center
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PCS uses multiple methods to identify the needs of the migrant population in the region. One particularly innovative method is the use of Geographic Information Systems to map key geographic barriers to care and to support program planning and funding efforts. By laying local maps over maps produced from the 2002 U.S. Department of Agriculture national census, PCS was able to identify the farms in their region using farmworker labor.
Using the advanced technology of GIS has led to a vast increase in PCS staff awareness of the use of migratory labor in the region and subsequent identification of MSFWs living and working in the region. PCS has been able to reallocate a limited amount of resources and place an outreach worker in the region. It has also added a Mobile Health Clinic that supports direct field screening and limited clinical and laboratory services, thereby significantly increasing access to care for farmworkers in extremely remote locations.
Integrating Behavioral Health Into Primary Care Program
2005, Darin M. Camarena Health Centers, Inc.
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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.
Post-Natal Program for Farmworker Families
2005, Golden Valley Health Centers
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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.
Assessing Patient Satisfaction
2005, Salud Para la Gente
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At Salud Para la Gente outreach staff conduct a quarterly telephone survey and focus group to assess satisfaction with center services in an effort to continually improve services to farmworkers. The survey and focus group ask participants who have visited the health center in the last quarter questions regarding satisfaction with services; the quality of treatment received at the clinic; satisfaction with staff interactions, all the way from the receptionist to the doctor; and for recommendations on how to improve services. The survey is conducted mostly in Spanish with about fifty people each quarter. Results are shared with the Board of Directors, senior staff, and some of Salud Para la Gente’s funders.
Salud Para la Gente has improved upon efforts to evaluate patient satisfaction by conducting organized and quarterly assessments with large numbers of patients. Their efforts give farmworker patients a greater voice in the services they receive at the health center, and help to further build a relationship between the health center and the farmworker community. By sharing results of the survey with the Board of Directors and funders, Salud Para la Gente demonstrates its commitment to applying the information it receives and monitoring the results of any changes in the coming quarters.
NCFHP develops goals, objectives and activities through an internal and external planning process
2005, North Carolina Farmworker Health Program
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NCFHP develops goals, objectives and activities for its program using a two-pronged approach. The NCFHP planning process involves both the central office program staff, but also includes the contract voucher sites in consideration of program plans. Internally, the process involves collecting, analyzing and applying feedback from NCFHP contract sites at an annual operational planning retreat. At this retreat, farmworker health outreach program coordinators have an opportunity to voice their concerns and interests for the next season’s health plans, and to offer their assessment of NCFHP central office performance and support. At the retreat, participants also develop goals and objectives to respond to federal grant responsibilities as well a meet the objectives of the Health People 2010 prevention agenda.
Externally, NCFHP receives grant proposals from both existing and prospective contract sites to create or continue farmworker health programs in underserved areas statewide. Proposals meeting eligibility criteria are evaluated by a review committee of field professionals and peers, who make recommendation on the selection of new sites or funding renewal for existing sites.
NCFHP utilizes input from a wide variety of sources to determine the goals of the program, going beyond funders’ expectations and using staff experience to drive planning. By conducting its own call for proposals, NCFHP utilizes community resources and innovative ideas in an effective way to ensure that it is providing quality outreach and health services to farmworkers.
Satellite Link in the Field
2005, North County Health Services
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North County Health Services uses a satellite communication system that allows staff in their mobile clinic to have immediate access to patient registration, billing records, and lab results from the health center system from their laptop computers. Using the new communication system, staff in the Mobile Clinic can also remotely complete new patient registrations and create an electronic file for patient records. The Mobile Clinic reaches out to farmworkers everyday in housing camps, nurseries, and in the fields.
In implementing this system, North County Health Services took advantage of the resources they already had in house – a relatively small geographic area and laptop computers on the mobile clinic – and used them to improve services with a satellite link-up. NCHS chose this system over other, more expensive alternatives to linking mobile clinic services to the health center such as using PDFs or other telemedicine alternatives. By implementing the Mobile Clinic’s communication system, North County Health Services enabled outreach staff to network to its central information system, significantly speed up their patient registration process, and improve outreach services NCHS provides to farmworkers in the places they work and live.
Integrating Outreach Program with the Health Center
2004, Southern Jersey Family Medical Centers, Inc.
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SJFMC’s outreach program staff members consistently share farmworker information with the rest of the organization. Through interdepartmental audit meetings, farmworker data is examined quarterly. Outreach workers share their experiences with other organization staff members through a bulletin board in the lunchroom, and the outreach program presents farmworker information and issues at provider meetings periodically. Before the start of each season, the coordinator of the migrant outreach program shares a detailed presentation with the entire SJFMC staff, relating the special needs of the migrant population and increasing awareness about the special challenges facing both the farmworker population and the providers who manage their care.
SJFMC has ensured interdepartmental collaboration through a variety of mechanisms. Most importantly, by utilizing a variety of methods the outreach program ensures that staff members at all levels will be tied into outreach program activities and kept aware of farmworker issues. In addition, through audit meetings and other interdepartmental interaction, SJFMC addresses issues of quality, incorporating clinical, administrative, and other departmental perspectives on services provided and taking steps toward providing seamless care.
Integrating Outreach Improves Overall Care
2004, Farmworker Health Center, Union/Jackson Labor Camp
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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.
Newsletter Helps Facilitate Organization Communication
2004, Golden Valley Health Centers
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Golden Valley Health Centers (GVHC) provides a Health Education and Outreach newsletter,
Health Education News, every other month to all GVHC employees. The newsletter has articles about health education and the health center program, changes and information about the Outreach Staff, upcoming events, and a real-life story about a person that the Outreach Staff was able to assist.
In addition to their current practices of involving Outreach staff in site meetings and clinical committees, the Outreach and Health Education coordinators in management meetings, and providing an overview of Health Education/Outreach at Employee Orientation, this practice goes a step further to integrate Outreach/Health Education staff into the rest of the health care organization. Providing a newsletter to all GVHC employees is a creative way to foster cooperation and a sharing of information between the Outreach/Health Education department and the rest of the organization. It increases the overall awareness of farmworkers in the organization (through the use of real-life Outreach/Health Education impacts), thereby increasing the likelihood of providing culturally appropriate care to farmworkers and their families.
This practice builds upon the base of integration already existing in the organization between the Outreach/Health Education department and the rest of the organization. It provides a creative venue for increasing cooperation and collaboration between the various GVHC departments, which in turn allows for continuity of care and increased culturally appropriate care for farmworkers and their families.
Using MiVia and Telemedicine Technology to Increase Access to Specialty Care
2008, Finger Lakes Migrant Health Care Project, Inc.
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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.
Increasing Access to Medications while Maximizing Internal Resources
2008, Migrant Health Service, Inc.
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To combat a shrinking pharmacy budget, Migrant Health Service, Inc. (MHSI) staff have developed and implemented an innovative program whereby patients bring a pre-stamped postcard to the pharmacy and pay $10 for each 30-day supply of prescription medications received. There are approximately 50 generic medications that qualify for the $10 card program including antibiotics, anti-hypertensives, and diabetes medications. Agreements were established with more than 50 local pharmacies throughout rural Minnesota and North Dakota. The $10 card program, combined with aggressively utilizing the $4 retail programs where available, has allowed MHSI to continue to provide or increase patients’ access to pharmaceuticals while drastically lowering the operating costs to the agency.
Two unique Excel tracking systems were developed to determine initially which medications should be included in the $10 card program and to track the cards mailed back from the participating pharmacies. In addition, an extensive retail list that is updated quarterly was created to assist clinicians in determining where their patients could find the most appropriate medications at the lowest prices. Patients are more apt to adhere to their treatment regimen because they are now more likely to afford their medications. Also, by being switched to generic medications, the hope is that they will be able to continue with less expensive medications upon returning to their home base when MHSI is no longer able to assist them with cost.
Approximately 500 patients have benefited from MHSI’s $10 self-pay card program since its inception. The $10 card plan is easy for pharmacies to use because they get immediate payment with little paperwork; they simply drop the pre-stamped card in the mail and receive reimbursement shortly after. MHSI has also seen a decrease in the workload for staff. Fewer pharmacy vouchers are written and the number of phone calls to/from pharmacies for voucher requests and authorizations has decreased substantially. Most importantly, however, staff are assured that patients are getting the medication they need both in and out of the service area which increases the likelihood of uninterrupted care for the mobile farmworker population.
Creating a Safety Net for Homeless Farmworkers
2008, Community Health Centers of the Central Coast
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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.
The program’s case managers follow the
promotora model. Many of the case managers have been homeless themselves. As a result, they are better able to understand a diagnosis of anemia from lack of food or a communicable disease from lack of health access. The program also utilizes innovative community building methods to find farmworkers, such as organizing cultural events offering free food, or projecting documentary films in farmworker housing areas, and then conducting health outreach afterwards. As case managers speak with attendees at these events, they become aware of major issues such as mental health or basic necessities of life. The case managers make referrals to the clinic, the mobile unit, or any number of other collaborating agencies, which brings the community together to achieve better health follow-up and outcomes within the homeless farmworker population.
