Regional Coalition Assesses Farmworker Needs in Eastern North Carolina

Community-Based Approach to Addressing Mental Health Needs

Opening a Dialogue with Growers through a Growers’ Survey

Reaching Every Farmworker Home through Proyecto Puente

Putting Farmworker Needs First

Assessing and Reassessing Health Needs

Assessment Leads to Development of New Model of Care

Committee Ensures Cultural Competence

Assessing Childhood Obesity

Increasing Male Farmworkers’ Interest in Seeking Health Services

Assessing Employers’ Needs and Interests

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Regional Coalition Assesses Farmworker Needs in Eastern North Carolina
2007, 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.


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


Opening a Dialogue with Growers through a Growers’ Survey
2007, Northwest Michigan Health Services, Inc. top

NMHSI designed and conducted a survey with over 30 growers in the tri-county service area of one of its clinic sites. The objective of the survey was to discover perceptions of farmworker health issues and barriers to care from the growers’ perspectives. In addition, growers were asked about: 1) the location of farmworker housing areas; 2) how they recruit farmworkers; 3) the percentage of farmworkers who return each year; 4) how the growers prefer to be approached and contacted by NMHSI; and, 5) whether they would be open to hosting an outreach clinic on their property, ensuring minimal workers’ time lost due to travel to and from the clinic. Most of the surveys were conducted over the phone and in person and took place during the off-peak season when the growers were not as busy. Some growers expressed their unfamiliarity with local resources and requested materials in Spanish for their workers. All interviews were followed up with a thank you letter and relevant informational materials about the organization and other community resources.

Maintaining positive relationships and open dialogue with growers supports the health and well-being of farmworkers. The survey opened a forum for discussion and exchange of information with growers. It also reinforced anecdotal evidence that the vast majority of growers in NMHSI’s service area care about the welfare of their farmworkers. As a result of this survey, NMHSI was invited to set up four outreach clinics on growers’ premises. In addition, because the survey allowed NMHSI to quantify for the first time the number of farmworkers in the area who are monolingual Spanish speakers, NMHSI has set up a language assistance program in the community for the benefit of all community-based providers who serve Spanish-speaking patients. Based on last year’s successes with this survey, NMHSI plans to repeat the project this year in the service areas of its other two clinic sites.


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.


Putting Farmworker Needs First
2006, Hudson River HealthCare, Inc. top

Hudson River HealthCare outreach staff participated in a state-funded project with the New York Center for Agricultural Medicine entitled “Community Collaboration for Farmworker Health and Safety.” This project involved farmworkers identifying health conditions affecting them on the job. When the top three preventable diseases were identified, farmworker patients received information on possible prevention and treatment strategies for each of these diseases. A prevention program was designed to address eye problems, their biggest concern, as part of the project.

The process that HRHCare undertook to determine the needs of farmworkers in an occupational setting effectively demonstrates HRHCare’s commitment to being accountable to farmworkers. HRHCare prioritized and incorporated farmworker input and participation in all stages of the project design and delivery. HRHCare has also illustrated how well its outreach staff is able to collaborate with other farmworker-serving organizations in order to more comprehensively address farmworker health needs.


Assessing and Reassessing Health Needs
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.


Assessment Leads to Development of New Model of Care
2005, Panhandle Community Services, Community and Migrant Health Center top

The staff of PCS actively support many health and research initiatives designed to identify and respond to the needs of their community. In 2003, PCS initiated the Southwest Nebraska Migrant Study, which involved conducting surveys, extensive health screenings, and chart reviews to identify the health needs and barriers to care for the MSFW community. Goals are set by using study results to establish a baseline and are compared against national goals like the Healthy People 2010 goals. PCS used the findings of this study to modify the Migrant Health Program’s strategic planning, functions, and outreach activities.

PCS is using comprehensive needs assessment results to develop a new model of care for migrant and seasonal farmworkers. They have applied for Expanded Medical Capacity and are attempting to build on the local infrastructure rather than trying to develop competing clinics. Although PCS currently works within a voucher system, it is trying to move toward a unified health care model, where all participating providers would maintain farmworker patients’ records in a networked, “paperless” system.


Committee Ensures Cultural Competence
2004, Terry Reilly Health Services top

TRHS has a Farmworker Health Advisory Committee that includes farmworkers as members. The Advisory Committee reviews all their bilingual materials and assists in the assessment of the needs of the farmworker community. The committee was established 11 years ago to include community input. TRHS identified the importance of including service users in addition of staff providing services to assess the quality of their services. The Advisory Committee meetings are held sometimes at the labor camps or in Spanish.

The practice of including farmworkers at different levels is a key component in outreach. Including farmworker feedback on educational materials ensures that the material is appropriate for the community in terms of culture and language. Involving members of the community to assist in the assessment of the community needs provides wider perspectives about the health needs of the community. The inclusion of service users also helps to assess the quality of the services provided. Finally, holding the advisory committee meetings at labor camps or conducting the meetings in Spanish ensures farmworker participation since their ability to participate is increased by the location and language used.


Assessing Childhood Obesity
2004, Terry Reilly Health Services top

TRHS conducted a pilot study with 182 farmworker children whose body mass indexes placed them in the overweight or obese range to check for possible early signs of diabetes and pre-diabetes. Preliminary results showed levels of overweight and obesity was at least as high as national averages. TRHS staff went door-to-door to recruit participants for the study and sent letters out to the community. The initiative was well received by the community. As a result of the study, TRHS was able to secure a community collaboration funding from the Governor’s Office, State of Idaho to establish a Childhood Obesity Task Force.

Conducting studies with the farmworker community is essential in identifying and verifying health needs. Studies conducted with farmworkers can serve as a stepping stone for building a program effort and securing funding for it. The personal contact with farmworkers, such as going door-to-door to recruit participants for studies or focus groups, is sometimes more effective in securing farmworker participation. As a result of TRHS’ well-planned study with adequate farmworker participation, they not only earned state-wide recognition, but also additional funding, which will further enable them to provide quality services to farmworker children, often not the focus of farmworker health care services.


Increasing Male Farmworkers’ Interest in Seeking Health Services
2008, Vista Community Clinic top

The goal of Vista Community Clinic’s (VCC) Male Health Services Project is to increase access to reproductive health education and clinical services for male migrant farmworkers, ages 25 and older in north San Diego County. The bicultural and bilingual project staff provides age-appropriate, culturally and linguistically competent reproductive health education to male farmworkers in a variety of locations including farmworker residences and work sites. Another component is the male reproductive health exam, which includes vital sign screenings, screenings for testicular and prostate cancer, instruction on self-screening for testicular cancer, diagnosis and treatment of sexually transmitted infections (STIs), and information and referrals for fertility services.

Based on feedback from a needs assessment and asset mapping project carried out in collaboration with an advisory committee made up of members of the target population, VCC implemented a multi-faceted community awareness campaign to provide culturally and linguistically appropriate health education and referrals for male exams in a variety of settings. VCC also developed a clinic-based male health services enhancement plan that included provider training on recognizing and responding to male reproductive health and psychological needs, and recognizing and responding to cultural and social barriers that influence or impede patient-provider communication.

This project has enabled VCC to create a male-friendly service delivery environment. Male-oriented reading materials have been placed in the waiting rooms, and appointments are scheduled at the main clinic site away from where women and children are routinely seen. Male exams are scheduled primarily during VCC’s evening and weekend service hours to accommodate work schedules. Furthermore, project staff guide clients through the male exam process, helping them to fill out forms and providing interpretation services as needed. Men who receive the male reproductive health exam are encouraged to also access additional comprehensive health screenings, such as adult immunizations, TB testing, and diabetes and hypertension screening. Since implementing this program, the number of male farmworkers accessing health exams each month has more than doubled.


Assessing Employers’ Needs and Interests
2008, Beaufort Jasper Hampton Comprehensive Health Services, Inc. top

As of 2007, Beaufort Jasper Hampton Comprehensive Health Services, Inc. (BJHCHS) begins its outreach season by administering a needs assessment questionnaire to area growers and crew leaders. At the onset of the season, growers are sent an introductory letter from the outreach coordinator describing BJHCHS’ services and the farmworker outreach program, the location of the BJHCHS’ clinics, and a request for 15 minutes of their time. The outreach coordinator visits local farms to conduct employer assessments whether or not the reply form included with the letter is received by BJHCHS. The simple yet comprehensive questionnaire requests information on the farmworkers employed, such as demographic and migration patterns; common health problems seen in the camps; barriers to care; where the farmworkers go to seek medical care; growers’ interest in on-site outreach services for their workers; and the types of services growers would like to see provided (transportation, screenings, referrals, language services, etc.).

Based on last year’s efforts, the outreach coordinator improved relations with area growers and also received accurate numbers of the farmworkers in BJHCHS’ service area. The outreach coordinator learned about individual growers’ needs and expectations of BJHCHS as well as the work patterns on each farm to make outreach visits more effective and less intrusive. Growers also benefited from participating in the assessment because they learned new information, such as their employees’ health problems. For example, many were unaware of the high rates of diabetes and hypertension, illnesses that can significantly impede the productivity of their labor force. This assessment activity, combined with other farmworker-accommodating services, such as evening hours, case management activities, and community partnerships has helped to ensure and enhance quality health services to migrant and seasonal farmworkers in the BJHCHS service area. This successful approach to assessing growers’ needs and interests will continue to be an annual activity for outreach staff.