Conducting Outreach in the Fields with a Lunchtime Celebration

Emphasizing Behavior Change in Healthy Weight Management

Reaching out to Farmworker Men via a Soccer Tournament Event

Community Health Promoters Enhancing Outreach Services

Camp Health Aides Closing the Loop in Outreach

Using Technology to Increase Medicaid Application Process for Farmworker Children

Community-Level HIV Prevention

Using Creative Skits to Deliver Health Education

Diabetes Lay Educators on the Move

Creating a Safety Net for Homeless Farmworkers

Empowering Oaxacan Farmworkers through Monthly Community Meetings

Successes of a Workplace Wellness Program

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Conducting Outreach in the Fields with a Lunchtime Celebration
2007, Clinica Sierra Vista, Bakersfield, California top

Clinica Sierra Vista (CSV) staff and promotores/as have implemented a special outreach and education project called the Cuadrillas de Mes or Farmworker Crew of the Month, which identifies a different crew of farmworkers to provide medical services to in the fields each month. At each event, CSV’s mobile medical unit staff—two physicians and four medical assistants or nurses—conduct glucose and blood pressure checks, provide minor treatment and consultations, cancer screening, and nutrition education. Rotating CSV staff representing some of the 30 health and social services programs housed within the health center such as Medi-Cal, WIC, and the local family resource center, provide critical information on the various services available to the farmworkers and their families. These staff members also routinely follow up with farmworkers after the event to ensure that they get connected with needed services even if the services are not provided by CSV’s respective programs.
In order to attract farmworkers and make the staff more approachable, this event is set up to be a lunchtime celebration with all of the fanfare of a mini-festival. CSV staff provide participants with information packets that include incentives such as water bottles and toothbrushes. A raffle is also held to give away larger prizes such as toasters and coffee makers. A local restaurant donates a delicious lunch that feeds upwards of 125-150 farmworkers at each event, while a live DJ also volunteers his time to provide the necessary entertainment to draw a crowd.

The Cuadrillas de Mes event is a fun and highly effective venue for providing the much needed health care for hardworking farmworkers in CSV’s area communities. This project was initially proposed because CSV had a difficult time getting area farmworkers to come in for services even though CSV and its satellite sites offer bus passes, extended hours, and weekend hours to mitigate some of the common barriers farmworkers face. Farmworkers are often not culturally accustomed to and financially able to seek medical care until it is too late. By targeting a different crew each month and making it fun to receive health care and information, CSV staff have been able to create trust with the crew leaders and the farmworkers who might otherwise never access services. As a result, not only have crew leaders become more open to hosting events, but farmworkers in need of further care have been more inclined to follow up after participating in one of these events.


Emphasizing Behavior change in Healthy Weight Management
2007, La Clinica del Carińo Family Health Care Center, Inc. top

Vida Entera y Sana (Whole and Healthy Life) is a three-year demonstration project of La Clinica del Carińo Family Health Care Center, Inc. (LCDC) to address overweight and obesity in the Latino farmworker community. LCDC created a healthy weight management health promotora program called Redes (Networks). Twelve obese Hispanic farmworker women were recruited to work on personal healthy weight management and met weekly for 20 classes, in a support group setting and using Popular Education techniques. The women who were successful in the program were trained as promotoras. They now work with their communities, both on the individual and group level, sharing key information on weight management. More importantly, they work with contacts that are ready to achieve long-term behavior change. The key messages for healthy weight and stress management are to: 1) exercise for 30 to 60 minutes per day; 2) eat a healthy breakfast every day; 3) eat three cups of vegetables per day; 4) eat two fruits per day; 5) drink 6 cups of water per day, and 6) do something besides eat when feeling sad, bored, or anxious.

The goal of the Whole and Healthy Life program is to change current cultural norms about exercise, food and stress management by delivering messages and guiding behavior change in a way that honors cultural heritage. New behaviors repeated for four consecutive weeks have the best chance of becoming habit. This health education program is innovative because it focuses on behavior change by helping participants to: 1) set reasonable goals; 2) recognize personal achievements and obstacles; and, 3) learn and practice individualized strategies to overcome obstacles. To date, 76% of contacts have kept their healthy weight management goal for four or more weeks. Pre and post intervention self-reported changes show an 83% increase in hours of exercise per week, and a 119% increase in cups of vegetables eaten per day.


Reaching out to Farmworker Men via a Soccer Tournament Event
2007, Benton County Health Department top

Last year, the Benton County Health Department (BCHD) organized the 1st Annual Benton County Soccer Tournament and Family Weekend over two days in August. The goal of the event was to attract a large number of farmworker families, particularly the men of the family. In support of the event, the BCHD administration proposed this idea to a Benton County Commissioner, who in turn provided funding to rent the soccer fields for two days.

Eight local and regional recreational soccer teams played in approximately 18 hours of soccer matches over the weekend. The County Commissioner presented the trophies following the championship match. With little funding to host the event, BCHD’s promotores/as secured support and donations from local businesses for time, money, food, water, prizes and even a DJ. In addition to the tournament, a community resource fair was organized with over 30 community agencies. One of the key community partners to participate was the Lion’s Club who provided health screenings on their mobile health unit and worked closely with the Benton Community Health Center to organize follow-up medical care. Approximately 400 people attended this event.

Recognizing the difficulty of reaching Latino men with health services, the idea for this event came from one of the health promotores/as who felt that it would offer a non-threatening environment to men. The added benefit though was that in organizing a soccer tournament, the men’s families also came out to participate, cheer on the teams, and take advantage of all that the weekend event had to offer. BCHD staff were present throughout the weekend to share information on medical, dental, and mental health services. In addition, the smooth collaboration between the Lion’s Club and the community health center to schedule appointments immediately after the screenings increased the likelihood that participants would receive follow-up health care services even after the weekend event was over.


Community Health Promoters Enhancing Outreach Services
2006, InterCare Community Health Network top

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.


Camp Health Aides Closing the Loop in Outreach
2006, InterCare Community Health Network top

InterCare has implemented three Camp Health Aide programs at three health center sites. Twenty farmworker men and women were recruited as volunteer lay health advocates in their respective camps and trained in vital signs, first aid and CPR. In the camps, they have facilitated early and continuous prenatal care of pregnant women in the camps, encouraged annual well woman care, assessed the immunization status of children, provided minor health care, referred patients to ICHN for care, translated documents, facilitated interventions by human service agencies, and have taught a variety of classes.

Camp Health Aides have greatly increased farmworker participation in camp-setting outreach activities. In the past, a nurse and outreach worker would go door-to-door in a camp searching for patients but only see a few families using this approach. CHAs have streamlined the scheduling process for camp visits by informing nurses and CHPs of the farmworkers’ schedules; in turn, CHAs inform farmworkers when the nurse and CHP will arrive to hold camp clinics. Because of CHA involvement, the farmworkers are more receptive to the health center staff and the nurses no longer worry about a lack of patients to see during their camp clinic visits.


Using Technology to Increase Medicaid Application Process for Farmworker Children
2006, La Clinica de Familia, Inc. top

La Clinica de Familia, Inc. (LCDF) Health Promoter Program equips its health promoters with digital cameras and portable scanners to assist in the process of registering farmworker children for Medicaid benefits. The health promoters carry this equipment with them during their home-based care visits and make copies of all key documents necessary for Medicaid applications. They then take the copied information back to health center and submit the applications for the farmworker families in order to expedite their access to financial coverage of health care for their children.

The scanning service offered during home visits has greatly increased the volume of children getting registered for Medicaid and has freed up the health promoters’ time to do other outreach activities because they no longer go back and forth between clinic and farmworkers’ homes with Medicaid application documents. Farmworker families no longer have to miss work to apply for Medicaid nor do they have to worry about losing or damaging critical documents by carrying them around. When farmworkers return to the area after migrating, they only have to provide income verification to get their children reinstated with Medicaid since copies of their documents are on file at the health center.


Community-Level HIV Prevention
2006, Farmworker Justice Fund, Inc. top

Farmworker Justice Fund has implemented the Young Latinos Promotores (YLP) project which is a community-level HIV prevention project targeting 18-30 year old migrant men who have sex with men with HIV risk-reduction messages based on the Popular Opinion Leader model. At the suggestion and input of the YLPs, bilingual English/Spanish educational cards about STIs were developed. All YLPs were trained on how to use the education cards and rated them as their most useful health education tool. Participants who received the health education training shared that their lifestyles were never discussed in their communities or with their families, which was a cause for great stress, leading some of them to engage in high risk behaviors.

The YLP project, an adaptation of an intervention originally designed for homosexual white men in bar settings, addresses the health education needs of a marginalized subset of the farmworker population: migrant young men who have sex with men. The approach was innovative because the peer health education tools were developed with direct farmworker input. The interactions with this population generated a lot of useful information about their behaviors and the challenges they face. In addition, the project ensured that all participants had the option to be tested for HIV and other STIs. Those that were infected were immediately referred for treatment at the collaborating clinic, Vista Community Clinic in Vista, California.


Using Creative Skits to Deliver Health Education
2006, Valley Family Health Care top

The health promoters of Valley Family Health Care’s (VFHC) La Familia Sana Lay Health Promoter Program go out to farmworker housing areas to conduct interactive health education skits on a variety of health topics. All of these promoters come directly from the communities they serve and have been taught the popular education method. Using this method, the promoters try to create a relaxing environment and present the topics in a visually interesting manner using humor to break the ice. The skits are followed by a discussion with farmworkers regarding what they have seen in the presentation. At the end of the group discussion, health promoters stay behind to speak individually with those farmworkers who want to have their questions answered privately. The health promoters also have an open door policy and farmworkers are invited to visit their offices at any time.

This approach creates a fun and interactive environment for doing health education outreach and has proven effective with all age groups. The non-traditional and non-threatening manner in which the messages are delivered makes it easier for farmworkers to open up to receiving the information shared. Moreover, the facilitated follow-up discussions and the availability of the health promoters to speak to farmworkers one-on-one, just after the skits have finished or back in the lay health promoters’ office, provide appropriate and varied opportunities for farmworkers to get their specific health-related questions answered.


Diabetes Lay Educators on the Move
2006, Migrant Health Services, Inc. top

Migrant Health Services, Inc. added the Diabetes Lay Educator Program as an outreach component to its diabetes program in 2000. Diabetes Lay Educators (DLE) were recruited from a pool of natural leaders within the farmworker population. The DLEs migrate with the populations they serve between Minnesota, North Dakota and Texas to foster and maintain continuity of diabetes care. They assist in the provision of direct service and health education to farmworkers, their families, peers and health care providers in each of the communities where they migrate. They also participate in research projects and contribute to the success of the overall diabetes program across three states.

The DLEs are able to prevent gaps in services and education that might normally occur during migration because the DLEs come from within the communities they serve and they migrate with these same populations, even when farmworkers return to their home bases in Texas. With this truly mobile outreach model, a diabetic patient can stay with the same support group throughout the full migration loop, resulting in a unique and effective opportunity to build ongoing trusting relationships with his/her DLE. DLEs also provide crucial “insider” information on farmworker health care beliefs, practices, and cultural issues to health care providers who do not have continuous interaction with farmworkers so that they can better understand and be responsive to their migrant populations.


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.

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.


Empowering Oaxacan Farmworkers through Monthly Community Meetings
2008, Mixteco/Indigena Community Organizing Project top

Since 2001, the Mixteco/Indigena Community Organizing Project (MICOP) has been empowering the 20,000 indigenous Oaxacan farmworkers in Ventura County who face linguistic and cultural barriers to health care. In monthly community meetings, an average of 200 Mixtec families come together to share a communal meal, exchange information and concerns in their own language, receive assistance with the necessities of life (i.e., food, clothing, and disposable diapers), and develop a strong collective voice. The meetings offer an excellent forum for presenting health-related information, collaborating with public and private service agencies, and assisting community members to access medical services.

The community meeting approach is culturally appropriate and effective because it draws on the inherent strengths and communication style of the indigenous community it serves, with an emphasis on cultural pride and language preservation. The Mixtec traditional community service model, where everyone is expected to share in the work of maintaining the community, aids the functioning of the meetings. Also, because Mixtec is a non-written language, verbal exchanges and interactive presentations are the most effective approaches to communication. Cultural events are celebrated as well such as “Children’s Day” and Guelaguetza, a traditional holiday where Oaxacans renew their commitment to contributing to the betterment of their community. Also, instead of banning children at meetings, a degree of disruption is accepted as a small price to pay for enabling entire families to attend.

Mixtec health promoters are a key example of the leadership development that MICOP embraces; they play a critical role in organizing these monthly meetings. They serve as community health advocates and have assisted the community in demanding culturally and linguistically appropriate services. Their efforts have resulted in the hiring of over a dozen Mixtec interpreters and outreach workers at health care agencies. The visibility and leverage of the Mixtec community in Ventura County and beyond has increased immeasurably due to this program.


Successes of a Workplace Wellness Program
2008, La Comunidad Hispana top

Work Healthy is an innovative workplace wellness program organized by La Comunidad Hispana (LCH) offering primary care services and health education at three mushroom farms in rural Pennsylvania. Mushroom cultivation is the dominant year-round industry in the area employing thousands of Mexican farmworkers. The goal of the program is to improve the health status of area farmworkers and their families by providing clinical and health education services in the workplace setting.

The health education component of the program includes a monthly two-page bilingual Work Healthy newsletter and presentations by lay health promoters. The newsletter is placed in the farmworkers’ paycheck envelopes with the employers covering the costs associated with photocopying it. Each newsletter reaches 1,300 farmworkers and contains two articles based on topics found on the National Health Observance calendar and brief health tips which are presented in a simple, culturally and linguistically appropriate format. Information about the on-site clinics (hours of operation, locations, and payment methods) are also listed.

Work Healthy bulletin boards are strategically placed by entryways and time clocks and are updated regularly with issues highlighted in the newsletter. Ten lay health promoters, who are also mushroom workers, organize monthly lunchtime education talks at the farms on topics such as domestic violence and alcohol abuse.

An evaluation of the program showed that 216 visits were made by farmworkers to the Work Healthy clinics in the first year. More than one-third of workers believe that a promoter or nurse practitioner helped them to learn more about their health; another one-third intend to live healthier lifestyles because of the knowledge gained from their interactions with the Work Healthy team. The majority of workers read the newsletter and more than one-third talked to a promoter about their health. In addition, approximately 47% indicated the Work Healthy Newsletter is their preferred means of health education.