Bringing Community Agencies Together through an Annual Summit

Coordinating Outreach and Clinic Activities through Daily Meetings

Quantifying Outreach Services Using Relative Value Units

Regional Coalition Assesses Farmworker Needs in Eastern North Carolina

Convening Head Start Community Partners at an Annual Meeting

Incorporating Clinical Case Management into Outreach

Training all Outreach Specialists as Medical Interpreters

Taking Cultural Competency Into The Community

Improving Staff Retention

Collaborating to Diversify Services

Empowering Oaxacan Farmworkers through Monthly Community Meetings

Increasing Male Farmworkers’ Interest in Seeking Health Services

La Placita Bilingüe Radio Show

---

Bringing Community Agencies Together through an Annual Summit
2007, North Carolina Farmworker Health Program top

What is the practice?
In 2005, North Carolina Farmworker Health Program (NCFHP) held the first Farmworker Summit and Networking Event to bring farmworker-serving advocacy agencies together. This has become an annual program coordinated in collaboration with other members of the North Carolina Farmworker Institute, an interagency project of the Farmworker Ministry Committee and funded through participant registration fees ($15 per person) and local sponsorships. In 2006, about 100 people representing approximately 35 organizations attended the day-long event. Session topics included the following: legal rights of farmworkers, trends in H2A recruitment, participatory educational techniques, college access for undocumented students, and ways for religious congregations to support farmworkers during the harvest season. During the closing plenary, there was a dinner and multi-media presentation titled, Nuestras Historias/Nuestros Sueños: Our History/Our Dreams – Educational Aspirations of Immigrant Farmworkers and their Families.

For several years, there was not a coordinated effort in North Carolina to bring together farmworker advocates from various disciplines, including health, education, legal rights, advocacy, and regulatory agencies. Individuals from these organizations expressed various needs, including:1) the need to collaborate more and make the most of limited resources; 2) the importance of agencies targeting farmworkers to be informed about what other organizations are doing; and, 3) the need for farmworker groups to be informed about national issues that affect the well-being of farmworkers in the state. The Farmworker Summit and Networking Event successfully responded to these requests bringing together a large interdisciplinary group of individuals from across the state. Overall, the response has been very positive and participants have encouraged the continuation of this event.


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.


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.


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.


Incorporating Clinical Case Management into Outreach
2006, Bluegrass Farmworker Health Center top

Bluegrass Farmworker Health Center has expanded the role of outreach to include clinical case management. This transition included moving the Clinical Case Manager under the umbrella of the outreach department while training Outreach Specialists on basic clinical case management skills. By creating specific guidelines regarding the Outreach Specialist’s role as case worker and incorporating home visits into clinical tracking and follow-up procedures, outreach staff are now an integral part of the clinical process. Patients who need follow-up but have not responded to phone calls and mailings receive home visits from Outreach Specialists before their case is closed. Patient compliance has greatly improved, especially among chronic disease patients.

This new approach to clinical case management is unique because it expands the role of the outreach worker, a role which did not traditionally include clinical case management. It also alters the traditional context of case management given that few programs send caseworkers out of the office setting directly to where patients live. By integrating case management and outreach, BFHC has been able to minimize many barriers to care while elevating the importance of outreach to clinical staff members who now see more concrete results from outreach efforts.


Training all Outreach Specialists as Medical Interpreters
2006, Bluegrass Farmworker Health Center top

At Bluegrass Farmworker Health Center, all Outreach Specialists are trained in medical interpretation as part of the integrated clinical case management model. Outreach Specialists serve as interpreters and accompany any BFHC patient referred to a specialty physician. The Outreach Specialist is able to help clients navigate all aspects of the referral process from arranging transportation, to discussing payment options to scheduling follow-up visits in the home. The outcome of this effort has been better patient compliance and improved relationships between the health center and referral providers.

Much like the clinical case management model, this practice has expanded the role and usefulness of outreach within the whole of the organization while also ensuring better care for patients. The specialty providers greatly appreciate the interpretation services. As a result, they have become more flexible in scheduling BFHC’s patients on short notice and have become more willing to arrange lower fees and better payment plans.


Taking Cultural competency Into The Community
2005, Greene County Health Care, Inc. top

The outreach department at Greene County Health Care, Inc. provides free trainings on cultural competency and traditional Mexican medicine and curanderos to community and migrant health centers, hospitals, medical centers, and universities throughout North Carolina. The trainings are advertised through referrals, primary care associations, and migrant stream forums. An average of twenty trainings are provided each year.

Greene County Health Care, Inc. is not only doing outreach with farmworkers, but conducting outreach in the larger community to increase awareness of farmworkers and farmworker issues, and to ensure more culturally competent care across North Carolina. By conducting free trainings for other health care providers, Greene County Health Care, Inc. engages other organizations in sharing their mission to provide appropriate and adequate care to farmworkers, and increases the potential network of culturally competent health care services accessible to farmworkers in North Carolina.


Improving Staff Retention
2004, Farmworker Health Center, Union/Jackson Labor Camp top

Three to five years ago, the Farmworker Health Center had only one bilingual nurse and a very low staff retention rate. A goal of the current clinic supervisor was to specifically employ and retain bilingual nurses. This was a challenging goal, since southern Illinois is a federally designated health workforce shortage area. In 2003, the program employed five bilingual nurses and has retained them for a longer period of time. One successful retention strategy has been the integration of community health education into the clinical positions, which was an expressed interest of staff.

To offset the difficulty in employing Spanish-speaking staff members, the current clinic supervisor established incentives to employ and retain bilingual nurses. Many times, outreach programs have limited resources and high turnover rate among staff. Finding alternative ways to compensate staff members, such as expanding or diversifying work tasks, increasing flexibility in work schedules, or increasing collaboration with other departments or agencies can go a long way to improve staff job satisfaction.


Collaborating to Diversify Services
2004, Farmworker Health Center, Union/Jackson Labor Camp top

SHSDC creates relationships with other agencies in the community that increase and improve the services they are able to provide to farmworkers and their families. Two examples of this collaborative initiative are their interpreter services and dental services. Responding to the need for interpretation services for farmworkers, an SHSDC outreach worker began interpreting on a volunteer basis in hospitals and anywhere the service was needed. This has turned into an official interpreting service that has five members who carry beepers and are available twenty-four hours a day, seven days a week. Some hospitals reimburse for the service and formal negotiations are underway to encourage reimbursement by all users of the service.

Dental care continues to be a desperately needed service for farmworkers in Southern Illinois. The center works to provide care, but has difficulty finding dental providers. To alleviate this barrier, the health center partners with the Southern Illinois University Dental Hygiene Program. Students rotate through the clinic providing assistance and, in turn, receive a hands-on public health experience. The center also utilizes the expertise of the Dental Hygiene Program’s faculty for promotor de salud training and community health education programs.

Creating partnerships with outside organizations enables SHSDC to effectively leverage their funding. Through these partnerships, SHSDC avoids duplication of services and employs a creative way to approach service gaps for their clients while providing continuity of care.

Additionally, the interpreter and dental services added to SHSDC’s menu of services provide supplementary training expertise for SHSDC staff members, including cross training for the majority of staff members, and engages students in the field of public health.


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.


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.


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.