Closing the Gap - Hispanic Migrant Farmworker Diabetes Education Program

State: FL Type: Model Practice Year: 2011

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The mission of the proposed Closing the Gap Promotores/as de Salud Program is to minimize barriers to chronic disease care, increase access to quality health care and improve the health status of Hispanic farmworkers and their families in DeSoto County, Florida.

The Closing the Gap Promotores/as de Salud Program goals are to: 1. Prevent and reduce cases of Type 2 Diabetes and related risk factors, such as poor nutrition, obesity and tobacco use in the Hispanic Farmworker Community (HFC) through community empowerment, systems change and popular education initiatives. 2. Establish a successful and sustainable link between the Closing the Gap Promotores/as de Salud Program and the Hispanic Farmworker Community (HFC) that bridges the gap between Hispanic farmworker culture and the culture of the health care system. 3. Mitigate diabetes-related emergencies by forming collaborative partnerships with local health centers to improve cultural competency of health care providers and increase access to appropriate health education and care.

The DeSoto County Health Department (DCHD) was responsible for direct implementation of the Closing the Gap Promotores/as de Salud Program, with complimentary support and guidance from Florida Department of Health's Migrant Health Promotion’s Capacity-Building Team in April 2009. Promotores y Promotoras de Salud, refer to famrworker men and women who are trained as Camp Health Aides to promote health in the camps and communities were they live and work. Camp Health Aides or Promotores/as will be instrumental in establishing a viable link between the Closing the Gap Promotores/as de Salud Program and members of the Hispanic Farmworker Community (HFC), who suffer from diabetes and associated risk factors. Camp Health Aides advocate for healthier lifestyles by disseminating information on a wide array of health topics regarding diabetes and related risk factors including: prevention, self-management, eligibility for other public programs and services (Medicaid,WIC, DCHD Dental, Tobacco Prevention and Cessation) and recommended screenings and exams, such as foot and eye exams, A1C and flu shots.

They accomplish this by scheduling weekly outreach Encounters consisting of individual or group health education sessions. Encounters will also be used as an opportunity to enroll participants in the Program’s Diabetes Health and Wellness Education Course, which will be conducted by Program Coordinator with help from CHA. Additionally, CHA will serve as a liaison between farmworkers and clinics, such as the DeSoto Center for Health and Disease Management by offering translation, referral and follow-up services to help members of their community gain access appropriate and timely health care.

To determine the outcome and impact of all activities, the Program will use documentation forms and questionnaires to acquire community-specific data that will be tallied and reviewed by Program Coordinator. Specifically, educational classes which featured cooking demonstrations were designed in coordination with an LDRD and health education staff were implemented. Through working with migrant farmworker camps, local churches, and promotion of the program through word of mouth and advertising in local media, the Closing the Gap program has reached over 350 migrant farmworkers, and have direct serviced 150 in educational classes.

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DeSoto County Health Department
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Closing the Gap - Hispanic Migrant Farmworker Diabetes Education Program
The mission of the proposed Closing the Gap Promotores/as de Salud Program is to minimize barriers to chronic disease care, increase access to quality health care and improve the health status of Hispanic farmworkers and their families in DeSoto County, Florida. The Closing the Gap Promotores/as de Salud Program goals are to: 1. Prevent and reduce cases of Type 2 Diabetes and related risk factors, such as poor nutrition, obesity and tobacco use in the Hispanic Farmworker Community (HFC) through community empowerment, systems change and popular education initiatives. 2. Establish a successful and sustainable link between the Closing the Gap Promotores/as de Salud Program and the Hispanic Farmworker Community (HFC) that bridges the gap between Hispanic farmworker culture and the culture of the health care system. 3. Mitigate diabetes-related emergencies by forming collaborative partnerships with local health centers to improve cultural competency of health care providers and increase access to appropriate health education and care. The DeSoto County Health Department (DCHD) was responsible for direct implementation of the Closing the Gap Promotores/as de Salud Program, with complimentary support and guidance from Florida Department of Health's Migrant Health Promotion’s Capacity-Building Team in April 2009. Promotores y Promotoras de Salud, refer to famrworker men and women who are trained as Camp Health Aides to promote health in the camps and communities were they live and work. Camp Health Aides or Promotores/as will be instrumental in establishing a viable link between the Closing the Gap Promotores/as de Salud Program and members of the Hispanic Farmworker Community (HFC), who suffer from diabetes and associated risk factors. Camp Health Aides advocate for healthier lifestyles by disseminating information on a wide array of health topics regarding diabetes and related risk factors including: prevention, self-management, eligibility for other public programs and services (Medicaid,WIC, DCHD Dental, Tobacco Prevention and Cessation) and recommended screenings and exams, such as foot and eye exams, A1C and flu shots. They accomplish this by scheduling weekly outreach Encounters consisting of individual or group health education sessions. Encounters will also be used as an opportunity to enroll participants in the Program’s Diabetes Health and Wellness Education Course, which will be conducted by Program Coordinator with help from CHA. Additionally, CHA will serve as a liaison between farmworkers and clinics, such as the DeSoto Center for Health and Disease Management by offering translation, referral and follow-up services to help members of their community gain access appropriate and timely health care. To determine the outcome and impact of all activities, the Program will use documentation forms and questionnaires to acquire community-specific data that will be tallied and reviewed by Program Coordinator. Specifically, educational classes which featured cooking demonstrations were designed in coordination with an LDRD and health education staff were implemented. Through working with migrant farmworker camps, local churches, and promotion of the program through word of mouth and advertising in local media, the Closing the Gap program has reached over 350 migrant farmworkers, and have direct serviced 150 in educational classes.
Within the lat three years, over half of the HMF diagnosed with Diabetes in DeSoto County have been admitted to DeSoto Memorial Hospital for diabetes-related emergencies, with outstanding costs totaling $1,120,900.00. This does not include the untold number of migrant farmworkers with diabetes who do not seek emergency medical care, due to a sense of intitutional mistrust or fear of deportation. With the underlying premise that a a community is the only healthy as its individual members, intergrating HMF and their families into the health care system in an effective and respectful manner is crucial to reducing health disparities and improving the health status of all Hispanics.
Agency Community RolesThe DeSoto County Health Department is the organization responsible for direct implementation of the proposed Closing the Gap Promotores/as de Salud Program is the DeSoto County Health Department (DCHD). Migrant Health Promotion will provide complimentary, capacity-building support and guidance at the discretion of DCHD. DCHD’s mission is to promote, protect, maintain and improve the health and safety of citizens and visitors through promotion of public health and the control and eradication of preventable diseases. By upholding this mission to the fullest extent, DCHD has provided quality health care services to all in DeSoto County for over fifty years. Costs and ExpendituresThe mission of the proposed Closing the Gap Promotores/as de Salud Program is to minimize barriers to chronic disease care, increase access to quality health care and improve the health status of Hispanic farmworkers and their families in DeSoto County, Florida. The Closing the Gap Promotores/as de Salud Program goals are to: 1. Prevent and reduce cases of Type 2 Diabetes and related risk factors, such as poor nutrition, obesity and tobacco use in the Hispanic Farmworker Community (HFC) through community empowerment, systems change and popular education initiatives. 2. Establish a successful and sustainable link between the Closing the Gap Promotores/as de Salud Program and the Hispanic Farmworker Community (HFC) that bridges the gap between Hispanic farmworker culture and the culture of the health care system. 3. Mitigate diabetes-related emergencies by forming collaborative partnerships with local health centers to improve cultural competency of health care providers and increase access to appropriate health education and care. Promotores y Promotoras de Salud, refer to farmworker men and women who are trained as Camp Health Aides to promote health in the camps and communities were they live and work. Camp Health Aides or Promotores/as will be instrumental in establishing a viable link between the Closing the Gap Promotores/as de Salud Program and members of the Hispanic Famrworker Community (HFC), who suffer from diabetes and associated risk factors. Camp Health Aides advocate for healthier lifestyles by disseminating information on a wide array of health topics regarding diabetes and related risk factors including: prevention, self-management, eligibility for other public programs and services (Medicaid,WIC, DCHD Dental, Tobacco Prevention and Cessation) and recommended screenings and exams, such as foot and eye exams, A1C and flu shots. They accomplish this by scheduling weekly outreach Encounters consisting of individual or group health education sessions. Encounters will also be used as an opportunity to enroll participants in the Program’s Diabetes Health and Wellness Education Course, which will be conducted by Program Coordinator with help from CHA. Additionally, CHA will serve as a liaison between farmworkers and clinics, such as the DeSoto Center for Health and Disease Management by offering translation, referral and follow-up services to help members of their community gain access appropriate and timely health care. To determine the outcome and impact of all activities, the Program will use documentation forms and questionnaires to acquire community-specific data that will be tallied and reviewed by Program Coordinator. Specifically, educational classes which featured cooking demonstrations were designed in coordination with an LDRD and health education staff were implemented. Through working with migrant farmworker camps, local churches, and promotion of the program through word of mouth and advertising in local media, the Closing the Gap program has reached over 350 migrant farmworkers, and have direct serviced 150 in educational classes. Implementation1. Improve the target group’s ability to gain new access to available resources and greater control over their own health, by bringing health education and information directly to isolated farmworkers and their families, This goal was achieved by holding convenient evening educational classes to provide the Farm Workers, their families and crew leaders how to improve cooking techniques used in the traditional migrant cooking environment, portion control, and access to information regarding local health care services available in the area for migrant farm workers. This also provided an opportunity for the program to develop an environment of trust within the Farm Worker community. 2. Prevent and reduce the number of diabetes-related emergencies by forming collaborative partnerships with local health centers to improve cultural competency of health care providers and increase access to appropriate health education and care among the Hispanic community. The Closing the Gap program provided any migrant farm workers seen in an emergency room or treated in-patient with educational information regarding services available in the area to insure that the farm worker is able to maintain their quality of health and wellness post discharge from their facility. Partnerships were developed with Desoto Memorial Hospital, Catholic Charities and local Emergency Medical Services to provide service information as to local Diabetic services in the area as well as other health care opportunities in the area aimed at caring for the Hispanic Migrant Farm Worker. 3. Increase access to formal diabetes self-management education by conducting comprehensive and culturally sensitive Diabetes Health and Wellness Education Course tailored to meet the self-management goals of Hispanics with low-literacy and minimum English-speaking skills. The on-going, training process used Community Health Workers/Camp Health Aides (CHW/CHA) to highlight and emphasize different health issues related to diabetes. This effectively and efficiently addressed the health needs. The CHW/CHA were responsible for bringing health information to isolated farmworkers, one on one or in small groups, in their own language, allowing access to available resources and greater control over their own health. During the first 2 years of the grant timeframe, the tasks were carried out to integrate the program into the community. The program made significant headway with marketing and gaining trust into the community thereby, facilitating our partnerships in the community. The current year 3 activities include completing our Plan, Do, Check, Act (PDCA) cycle to validate the activities and mission of the grant.
Improve the target group’s ability to gain new access to available resources and greater control over their own health, by bring health education and information directly to isolated farmworkers and their families. This objective will be accomplished primarily through individual and group health education encounters facilitated by Camp Health Aides (CHA). • Six Camp Health Aides (CHA’s) are expected to conduct a minimum of 2 individual educational health encounters per week with farmworkers or their family members for 15 weeks between the months of November 2009-May2010. Repeated encounters with farmworkers or their family members may be necessary and is encouraged. • CHA are expected to refer one out of every 2 individual encounters to appropriate services and resources, totaling 45 referrals (CHA may refer single participant to multiple services) • Camp Health Aides and Program Coordinator are expect to collectively conduct one group educational encounter with multiple members of the targeted group each month for 6 months (November 2009-May2010). Initial target attendance rate will be between 15-20 participants for first group encounter, with 5 new participants joining each session thereafter, totaling 45 participants. • Program Coordinator will conduct follow-up on all referrals from CHA and DeSoto Memorial Hospital to members of the Hispanic community to document if access to health care was gained and needs were met by at least 75% of program participants. Improve the target group’s ability to gain new access to available resources and greater control over their own health, by bring health education and information directly to isolated farmworkers and their families. This objective will be accomplished primarily through individual and group health education encounters facilitated by Camp Health Aides (CHA).  
The grant activity sustainability will be achieved through the community partnerships established both before and during the program. These community partners, such as Catholic Charities, Redlands Christian Migrant Association, The Hispanic Soccer League and the Crew Leader’s of local citrus growers will engage the Hispanic Migrant Farm Worker; promote health and wellness among the Hispanic populace. The relationship built with the crew leaders and harvesters will facilitate the communication, basic recognition of diabetes symptoms and most importantly how to access existing referral resources. The program will be sustained through the commitment and generosity of the community partnerships established during the program. These stakeholders realize the importance of the education to the Hispanic Migrant Farm worker as to the signs and symptoms of Diabetes. Missed work time and lowered productivity can be due to illness, understandably, productivity in enhanced with optimal employee health. By improving the overall health of the individual will insure the worker is at their best as a productive employee. Clearly, this will also reduce financial costs to the community if reimbursed health care is not accessed such as costly emergency room visits. These educated workers and their families will serve as Ambassadors in the community to guide and educate their peers as to services in the community aimed at educating and helping the Hispanic Migrant Farm worker. Using farm worker housing and camp facilities to host educational workshops and/or house education materials is another action for sustainability.
 
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