Tracking Effectiveness of Outreach with Incentive Cards

Quantifying Outreach Services Using Relative Value Units

Regional Coalition Assesses Farmworker Needs in Eastern North Carolina

Coordinating Outreach and Clinic Activities through Daily Meetings

Reaching Every Farmworker Home through Proyecto Puente

Using Data to Respond to Farmworkers’ Needs across the State

Bringing Key Stakeholders to the Table

Assessing and Reassessing Farmworker Needs

Identifying Barriers to Care and Health Needs

Assessing Patient Satisfaction

NCFHP develops goals, objectives and activities through an internal and external planning process

Organizational Integration

Access to Medications while Maximizing Internal Resources

Increasing Male Farmworkers’ Interest in Seeking Health Services

Assessing Employers’ Needs and Interests

La Placita Bilingüe Radio Show

Successes of a Workplace Wellness Program

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Tracking Effectiveness of Outreach with Incentive Cards
2007, Clinicas del Camino Real, Inc. top

Clinicas del Camino Real, Inc. (“Clinicas”) has implemented several strategies for tracking how many patients are brought in as a result of outreach activities. One strategy is to distribute pre-printed incentive cards to potential farmworker patients during outreach. Outreach workers fill out the incentive cards which include the name of the outreach worker, site visited, date, and time. When farmworkers see a provider and present the incentive card, they receive a $5 gift card. The data from the incentive cards returned to the health center are entered into a computer program for periodic analysis.

In the case of patients who forget to bring in the incentive cards, the Director is considering administering a questionnaire, asking them about how they learned about Clinicas. These data would be reviewed in the same manner as the incentive card data.

Though this strategy was just recently implemented, tracking data from the incentive cards will allow the Program Director to measure and assess the cost-effectiveness, efficiency, and productivity of outreach activities carried out at Clinicas’ various sites by determining which outreach activities and staff members are generating more clinic visits. The Director believes it will be helpful for making programmatic decisions about the use of human and financial resources; for adjusting outreach methods to achieve optimal effectiveness; and for providing evidence about the outreach program's effectiveness to the head of the health center and potential funders.


Quantifying Outreach Services Using Relative Value Units
2007, Columbia Basin Health Association top

Columbia Basin Health Association (CBHA) has been working diligently to quantify and get credit for the outreach services it performs—a challenge that many health centers face. CBHA has found that the role of these services is often undervalued because it is very difficult to measure. To address this, CBHA has implemented the use of relative value units (RVUs) as a way to quantify individual outreach activities in the same way that clinical interventions are assessed and tracked. In order to modify this system to benefit outreach, CBHA worked with a consultant to assign a code and an RVU to each routinely performed outreach activity. The RVU is determined based on the time commitment and intensity level of each activity. For instance, a 45 minute individual health education session is assigned 1.17 RVUs while 30 minutes devoted to assistance with forms completion is assigned 0.60 RVUs.

Using the assigned codes, outreach workers indicate on their encounter forms which activities they performed and the length of time involved. Once this information is in inputted into CBHA’s data management system, the codes are automatically converted into RVU values. The information is reviewed monthly and used to allocate internal resources, determine staffing plans and inform future grant applications.

Even though outreach breaks down the barriers that farmworkers face when trying to access medical care, it can be difficult to maintain support for outreach services. At CBHA, developing a standardized system for tracking outreach activities has been a key step in demonstrating the value of and making a case for the necessity of outreach. By assigning RVUs to various outreach activities and analyzing the data periodically, CBHA’s Program Director is able to measure staff productivity more concretely, gauge the effectiveness of outreach efforts and justify funding for future outreach activities. Perhaps if more farmworker-serving health organizations like CBHA tracked their outreach activities using a standardized system, a stronger case could be made for reimbursable outreach services or increased funding of outreach.


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.


Coordinating Outreach and Clinic Activities through Daily Meetings
2007, Northwest Michigan Health Services, Inc. top

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.


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.


Using Data to Respond to Farmworkers’ Needs across the State
2007, North Carolina Farmworker Health Program top

As a statewide voucher program, NCFHP developed a customized data tracking and documentation system, Farmworker Health Administration System Electronic Services (FHASES), in collaboration with a volunteer computer programmer, to ensure consistent tracking of services at its 14 voucher sites—including medical, enabling, and outreach services. Each of the voucher sites uses standardized health assessment and encounter forms during outreach and the data documented on these forms are then entered into the FHASES program. Because FHASES is web-enabled, data are updated immediately and they can be viewed in real time by staff at NCFHP’s office in Raleigh. NCFHP staff use the data to: 1) examine trends in the services being provided at each of the sites; 2) review the needs of each site and its respective farmworker population; 3) plan programs and services with each of its sites; and, 4) develop relevant health education lessons that respond to emerging farmworker health issues.

Because outreach staff can input data into FHASES wherever they have internet access, they have been able to more effectively keep pace with data entry which used to be difficult to manage in a timely fashion. As a result, NCFHP staff has a much truer picture of farmworker and service needs at each of the sites across the state. The program FHASES, which can be used by any organization with multiple sites, allows NCFHP to consistently and effectively track outreach and medical services and make data-driven decisions for increased funding and/or targeted health interventions, including health education that responds to local needs. Data-driven decision-making also facilitates the rationale and effective use of NCFHP’s limited financial resources and ensures that as many farmworkers as possible access health services in North Carolina.


Bringing Key Stakeholders to the Table
2006, Hudson River HealthCare, Inc. top

Hudson River HealthCare has instituted a deliberate process for setting goals for the outreach program. Formal planning sessions are held annually, pre- and post- season, and involve all Migrant Health staff, including outreach staff working within the health centers as well as staff of the Voucher Program. Goal setting is also informed by feedback from the Community Advisory Board which consists of farmworkers, a grower, and community agency staff, and via direct visits to farms by HRHCare administrative and clinical staff. In addition, Voucher Program staff members meet monthly to do continuous planning to improve services.

Hudson River HealthCare involves and engages all key stakeholders in the betterment of health for farmworkers in the area through its comprehensive and deliberate outreach goal-setting process. The implementation of this process shows a commitment to collecting ongoing and timely information from sources that have the most insight and pertinent feedback to offer to improve services to farmworkers.


Assessing and Reassessing Farmworker 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.


Identifying Barriers to Care and Health Needs
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.


Assessing Patient Satisfaction
2005, Salud Para la Gente top

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 top

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.


Organizational Integration
2004, Farmworker Health Center, Union/Jackson Labor Camp top

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.


Access to Medications while Maximizing Internal Resources
2008, Migrant Health Service, Inc. top

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 $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.


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.


La Placita Bilingüe Radio Show
2008, Radio Bilingüe top

La Placita Bilingüe is a weekly live call-in Spanish program on Radio Bilingüe. The show is produced in Salinas, CA and is broadcast via its six network stations:

• KSJV 91.5 FM Fresno


• KMPO 88.7 FM Modesto


• KTQX 90.1 FM Bakersfield


• KHDC 90.9 FM Salinas


• KUBO 88.7 FM El Centro, and


• KVUH 88.5 FM Latonville.

The program was founded on the principles of building community and empowering immigrant farmworkers. It is grounded in a Communication for Social Change framework, which seeks to put farmworkers in leadership positions where they act as agents of change rather than objects of change. In addition, La Placita Bilingüe instills principles of tolerance, self-determination, equity, social justice, and active participation for all farmworkers.

The topics and themes discussed during the radio show come directly from representatives of the farmworker community such as parents, mothers, youth, etc. Oftentimes, the show invites special guest experts to provide their opinions and commentary about a variety of issues faced by the farmworker community. Some special guests have come from well-known community health centers and social service agencies in the San Joaquin Valley of California. Past topics addressed on the show include: asthma, education, nutrition, chronic diseases, overall preventive health practices, parenting, environmental health issues, and financial literacy.

Additionally, because of quality assurance standards set forth by Radio Bilingüe, La Placita Bilingüe programming is informed by continued research and evaluation of farmworkers’ reactions and feedback. Staff conduct focus group discussions and interviews at flea markets and community events to gain a better understanding of the effectiveness of the programming in addressing the farmworker community’s health and social needs. Overall, this radio program is an innovation in outreach because it gives the farmworker community a voice, and provides a medium for addressing the most pressing issues faced by the community, including health care access and utilization.


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.