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EAST COAST MIGRANT AND SEASONAL FARMWORKER

POPULATION

Magdalena Fernandez, Regional Migrant Health Coordinator, Mid-AtlanticJames O’Barr, Regional Migrant Health Coordinator, NortheastEast Coast Migrant Stream Forum, October 19th, 2012

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Role of Regional Migrant Health Coordinators

Summary of 2011 Assessment Data Barriers to Care

◦ Effects of State Immigration Laws Technical Assistance Needs of MHCs

◦ Adapting Patient Centered Medical Home Recommendations 2012 Wall of Wonder

AGENDA

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Support MHCs in meeting 330g program expectations

Collect and disseminate information Identify underserved farmworker

populations Support program development for new sites Monitor federal and state legislation Facilitate and support continuity of care

from state to state

REGIONAL MIGRANT HEALTH COORDINATORS(RMHC)

Regional Coordinators

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• Migrant Health Regional Profiles

• Assessment of the Eastern Stream of Migrant and Seasonal Farmworkers

• Regional Migrant Health Coordinators, East Coast• James O’Barr, Northeast• Magdalena Fernandez, Mid-Atlantic• Erin Sologaistoa, Southeast

• Available on the National Center for Farmworker Health website: www.ncfh.org

DATA RESOURCES PRODUCED BY RMHCs

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TOP BARRIERS TO CARE REPORTED BY EAST COAST HEALTH CENTERS

•State Anti-immigrant Laws•Fear of Arrest, Deportation•Lack of Transportation •Finances •Language•Lack of KnowledgeSource: 2011 Assessment of the Eastern Stream of Migrant and Seasonal Farmworkers, Mid-Atlantic, Northeast and Southeast Migrant Health Profiles

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Cited as top barrier to accessing care◦ Harder to reach farmworkers ◦ High levels of fear and distrust ◦ Growers reluctant to allow access to workforce ◦ Fear of driving without a license further limits mobility◦ Decreased enrollment in enabling services and benefits

Discrimination◦ Reports from GA and AL that road blocks have been

set between clinic sites that appear to target patients◦ Profiling by local law enforcement reported in several

states

EFFECTS OF STATE ANTI-IMMIGRANT LAWS

Sources: Impact of Immigration Laws on Access to Healthcare for Farmworkers in the Southeast, 2011 Assessment of the Eastern Stream of Migrant and Seasonal Farmworkers

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Fewer patient visits Increased missed appointments Increased severity of chronic diseases such

as diabetes and hypertension Increased stress associated disorders Delayed entry into prenatal care Decreased use of preventative care

EFFECTS OF STATE ANTI-IMMIGRANT LAWS ON FARMWORKER HEALTH

Source: 2011 Assessment of the Eastern Stream of Migrant and Seasonal Farmworkers, Mid-Atlantic, Northeast and Southeast Migrant Health Profiles

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Decrease in number of workers◦ Fewer workers migrating for fear of being detained

Shift in migration patterns◦ Those who do migrate are changing paths to avoid traveling

through AL, GA and SC

Changes in demographics◦ Increase in number of families in Southeast◦ Decrease in number of families in Mid-Atlantic◦ Increase in Haitian farmworkers reported in GA, ME, NJ and NY

Source: 2011 Assessment of the Eastern Stream of Migrant and Seasonal Farmworkers

EFFECTS OF STATE ANTI-IMMIGRANT LAWS ON MIGRATION PATTERNS AND DEMOGRAPHICS

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Over 80% of health centers surveyed in FL and GA reported that growers were experiencing difficultly in finding workers.

Reports of field and orchard crops left unharvested due to lack of workers

PA Department of Labor has expressed concern that many migrants are not returning to PA due to fear of traveling through AL, GA and SC.

Source: Impact of Immigration Laws on Access to Healthcare for Farmworkers in the Southeast, 2011 Assessment of the Eastern Stream of Migrant and Seasonal Farmworkers

ECONOMIC IMPACT ON AGRICULTURAL INDUSTRY

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Anti-immigrant Laws Outreach Migrant Health Governance Developing Lay Health Programs Health Reform Migrant Health 101 Farmworker Identification and Eligibility Customer Service Cultural Competence Patient Centered Medical Home

TECHNICAL ASSISTANCE NEEDS FOR MIGRANT HEALTH CENTERS

Source: 2011 Assessment of the Eastern Stream of Migrant and Seasonal Farmworkers, Mid-Atlantic, Northeast and Southeast Migrant Health Profiles

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Unique challenges of serving migrant patients

Culturally and linguistically appropriate care

Access to “extended hours” of service Transportation services Remote access to medical records for

continuing care

PATIENT CENTERED MEDICAL HOME (PCMH)

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Partnering between providers, outreach workers and promotoras in multiple locations

Emphasis on self management of chronic illnesses

Migrant Voucher Programs More collaboration with other M/CHCs

(electronic/telemedicine networks), and other partners such as health departments, private providers, hospitals

Widespread use of Migrant Clinicians Network’s Health Network

PCMH FOR MOBILE POPULATIONS

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Education and advocacy on immigration issues◦ Emphasize public health risk and damage to

agricultural industry Improve cultural competency and

community trust in health centers Establish clear anti-discrimination policies in

health centers Educate farmworkers about their rights

RECOMMENDATIONS

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Provide training and technical assistance to improve effectiveness of Patient Centered Medical Home for migrant and seasonal farmworkers and to integrate outreach services into PCMH

RECOMMENDATIONS

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Assessment of Migrant and Seasonal Farmworkers in

the Eastern Stream

• Regional Migrant Health Coordinators, East Coast• James O’Barr, Northeast• Magdalena Fernandez, Mid-Atlantic• Erin Sologaistoa, Southeast

Wall of Wonder2012

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