Screenings and Mobile Services as Gateway to Future Service Utilization

Using GIS to Identify Farmworker Communities

Satellite Link in the Field

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

Annual Farmworker Eye Clinic

Successes of a Workplace Wellness Program

Satellite Clinics Combine Outreach and Primary Care

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Screenings and Mobile Services as Gateway to Future Service Utilization
2006, Community Health Centers of the Central Coast top

Community Health Centers of the Central Coast’s (CHCCC) Community Health Outreach Program screens 225 people on average per month for diabetes and high blood pressure at various community-based health fairs organized by CHCCC or in collaboration with other health care organizations in targeted geographic areas where services are needed most. These screenings are also conducted as one service of CHCCC’s Mobile Medical Clinic in addition to the provision of limited medical services. The Mobile Medical Clinic is sent out regularly to the same key sites in areas with a large farmworker population where few health services are readily available without a means of transportation.

The overarching goal of CHCCC’s Community Health Outreach Program is to improve the health status of migrant and seasonal farmworkers by providing accessible medical and dental health services. By offering two major screenings for diabetes and hypertension, the outreach program has devised a cost-effective way to address key health problems in farmworker communities. CHCCC uses these large-scale screenings as a “hook” to get individuals to utilize CHCCC clinical services, whether in the mobile clinic or at one of its health centers, a few of which have been permanently established in locations where the Medical Mobile Clinic has been stationed in the past. Finally, because CHCCC’s Medical Mobile Clinic returns to the same sites every month, transportation barriers are mitigated and farmworkers are able to receive crucial follow-up visits and continuity of care.


Using GIS to Identify Farmworker Communities
2005, Panhandle Community Services, Community and Migrant Health Center top

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.


Satellite Link in the Field
2005, North County Health Services top

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.


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.

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.


Annual Farmworker Eye Clinic
2008, Valley-Wide Health Systems, Inc. top

In the course of facilitating outreach screening activities, it became apparent to the staff at Valley-Wide Health Systems, Inc. (VWHS) that farmworkers had no access to eye care. With large numbers of individuals needing diabetic eye exams or experiencing occupational hazards such as chemical exposure, VWHS pioneered a Farmworker Eye Clinic in 1998 to provide annual vision screenings to area farmworkers. Since that time, well over 2,400 patients have received eye care through this program including examinations and eyeglasses. A dedicated optometrist from an urban area has donated his expertise and time throughout the years, while glasses are donated by other local professionals. VWHS staff volunteer their time to carry out the event.

Personal testimonials emphasize the impact of this program. One patient, initially seen for an eye irritation, was referred to the eye clinic and given an exam and glasses. He remarked how surprised he was at what he was able to see, noting that his restored vision would make his work much easier, more productive, and he would be able to earn more money. As the event concluded last year and the clinic doors closed after 195 patients were screened, the optometrist looked to the event coordinator and said, “See you next year.” This play on words highlights the value of this event as many migrant farmworkers must be able to see in order to drive to their next place of work.


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.


Satellite Clinics Combine Outreach and Primary Care
2005, Greene County Health Care, Inc. top

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.