Emphasizing Behavior Change in Healthy Weight Management
Community-Based Approach to Addressing Mental Health Needs

A Culturally Inclusive Approach to Nutrition and Physical Activity

Convening Head Start Community Partners at an Annual Meeting

Combining Literacy and Nutrition Education for Farmworker Children

Providing Comprehensive Diabetes Care in One Location

Assessing Childhood Obesity

YMCA Collaboration Focused on Promoting Exercise

Encouraging Home Gardening through the Raíces (Roots) Program

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

Vida Entera y Sana (Whole and Healthy Life) is a three-year demonstration project of La Clinica del Cariño 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.


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.


A Culturally Inclusie Approach to Nutrition and Physical Activity
2007, Yolo County Health Department Maternal Child Adolescent Health Program top

Yolo County Health Department Maternal Child Adolescent Health Program began the Healthy Lifestyle Program in 2003 in response to the rise in overweight and obesity and incidences of chronic diseases among Latinos in the county. Implemented in a labor camp, the program offers a series of eight classes that emphasize the importance of healthy nutrition choices and physical activity. Each lesson incorporates hands-on experiential learning in addition to the lecture component. During these classes, families learn how to prepare healthy meals and include physical activities into their lives. Everyone is encouraged to bring favorite food recipes from home and share them with the rest of the class. Conversations then ensue about how to make healthy modifications to these much loved recipes. Participants help with the cooking and then enjoy sampling their healthy food together.

The physical activity component emphasizes the many benefits of exercising, including reducing the risk of chronic diseases, providing relaxation for the family, and decreasing stress. There is a 15-minute exercise component within each class where families engage in a variety of physical activities.

With the end goal of cultural appropriateness and responsiveness in mind, the Healthy Lifestyle Program incorporates the farmworker lifestyle by addressing the healthy choices that exist within the context of their lives. For example, the program understands that farmworkers face barriers to accessing quality food (e.g., geographic isolation, high cost of fresh produce) and recommends nutritional alternatives based on what is readily available to farmworkers. Given that the labor camp also serves as a food bank, the program uses the foods being distributed for cooking demonstrations. Because the program encourages farmworkers to support each other and exercise, this is a great opportunity for building community with neighbors.


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.


Combining Literacy and Nutrition Education for Farmworker Children
2006, Darin M. Camarena Health Centers, Inc. top

Darin M. Camarena Health Centers, Inc. (DMCHC) is one of over 2,200 clinics and hospitals nationwide partnering with Reading Is Fundamental, Inc. and the Reach Out and Read® (ROR) program. Children are provided with age, culture and language appropriate books at their wellness check-ups and health promoters read aloud to children in health center waiting rooms, modeling reading techniques for parents. DMCHC also conducts home visits with farmworker families where they speak to families about the importance and benefits of reading aloud to children. The health promoters also promote good nutrition through “Darin’s Eat and Read Club” where both parents and children are invited to the health center every 3rd Friday of the month for fun reading and nutritional promotion activities.

By reading and modeling story-telling to children, DMCHC staff members are introducing the activities of reading and story-telling to both children and parents, regardless of a parent’s ability to read. This program helps children to improve motor skills by encouraging them to become more comfortable with holding and manipulating books. It also allows physicians and staff to assess whether or not an individual child’s cognitive and motor skills are up to par. The ROR program provides health education messages through books with specific health themes (Vegetable Garden, Everyone Eats Rice, and the Cheerios Counting Book) and through the nutrition education sessions conducted during Darin’s Eat and Read Club. Lastly, having parents involved in health education sessions with their children encourages the children to make smart nutritional choices in the future.


Providing Comprehensive Diabetes Care in One Location
2005, Migrant Health Service, Inc. top

Migrant Health Service, Inc., (MHSI) in conjunction with providers from the surrounding community, holds “Diabetes Cluster Clinics” seven times during peak season in which farmworkers are able to access a multidisciplinary diabetes team consisting of lay health educators, outreach workers, a diabetes educator, a nutritionist, an ophthalmologist, a hygienist, a physician or mid-level nurse specializing in podiatry, MHSI clinical staff, and a phlebotomist. At locations throughout the service area in Minnesota and North Dakota, patients are able to cycle through what would normally take up to eleven outreach and clinical office visits in 3-4 hours time, addressing issues such as nutrition, diet, exercise, eye and foot care. At the final station, patients meet with a nurse who reviews the patient’s overall findings and makes any necessary referrals for further care.

By holding the Diabetes Cluster Clinics, Migrant Health Service, Inc. has successfully made services more accessible to farmworkers in an area of particular health concern, diabetes. This practice meets the needs of farmworkers who may not have time for more than one office visit, and also allows farmworkers and MHSI to save on medical costs by cutting down on the need for multiple appointments. The practice has also successfully integrated services offered through MHSI with those of area practitioners to the benefit of farmworker patients.


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.


YMCA Collaboration Focused on Promoting Exercise
2008, Migrant Health Service, Inc. top

In 2006, Migrant Health Service, Inc (MHSI) received a small grant from the Blue Cross Blue Shield Foundation of Minnesota to purchase YMCA memberships for migrant and seasonal farmworker families. The YMCA waved enrollment fees and adjusted the price to fit the unique needs of the agency and its patients. The relationship has been very successful; as of September 2007, a total of 19 families (77 individuals) have benefited from MHSI’s partnership with the YMCA.

With this project, MHSI clients have utilized facilities in multiple locations that would have been unattainable to them normally. The nurses and program staff have been determined to make the project a success so that families have a safe and fun atmosphere to exercise and become motivated to engage in healthy lifestyles. Staff recruited members for enrollment, accompanied them on tours of the YMCA facility, provided interpreting services for them in Spanish, and enrolled them in fitness classes.

Participants in the program are required to have at least one family member attend the YMCA a minimum of eight times per month to maintain the membership. One family, a 79-year old gentleman and his wife, has averaged 23 visits per month! The combination of medication, nutrition, and exercise helps the gentleman manage his Type 2 diabetes, hypertension, and hyperlipidemia. Their participation in the program has served as a true inspiration and proof that healthy living can occur at any age. Another success story comes from a woman who goes to the YMCA about 10 times a month and has lost more than 20 pounds and 2½ inches off her waist since starting with the program. The success of this initial collaboration with the YMCA has prompted the MHSI Chronic Disease Program to seek additional funding to continue the program.


Encouraging Home Gardening through the Raíces (Roots) Program
2008, La Clínica del Cariño Family Health Care Center, Inc. and Nuestra Comunidad Sana, a program of The Next Door, Inc. top

Raíces, a partnership program of La Cliníca del Cariño’s (LCDL) Vida Entera y Sana project and Nuestra Communidad Sana (NCS), encourages farmworker families to reconnect with their cultural roots of growing their own food, adopting healthier food choices, being more active, coming together in community, and taking pride in reconnecting with their history. The objectives of the Raíces program are: 1) to encourage families to grow home gardens using organic methods; 2) to build community, social support, and self-sufficiency through gardening in ways that honor Latino cultural traditions; and, 3) to examine the impact of gardening on eating habits and food security.

Raíces has completed three growing seasons, with a total of 46 families participating and 287 people touched by the program. Participants were first invited to attend an orientation where healthy food was served. The families continued to meet regularly to socialize, and share information, tips, and extra vegetables. Families taught each other canning and freezing methods to battle food insecurity year round. Those without gardening space were encouraged to use the clinic’s community garden or other creative alternatives. A Harvest Fiesta is held each fall with music and a piñata for families to enjoy the fruits of their gardens together.

The dramatic impact of Raíces is demonstrated by data gathered on families before and after having a garden. The number of adults eating vegetables several times a day increased by 140% (117% for children). The number of adults skipping meals because the family ran out of money decreased by 78% (100% for children). In addition, Raíces has helped to: 1) teach children that vegetables are rewarding, delicious, and nutritious; 2) create health promoter families who continue to take leadership in the community; 3) re-establish the cultural norm among Latino farmworkers of growing their own food; and 4) counteract the societal norm of “produce deserts” in poor areas.