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Part 4 of the 6 webinar series: Essential Clinical Issues in Migration Health

DATE RECORDED: May 14, 2014
PRESENTED BY:  Candace Kugel, FNP, CNM and Megan Danielson, CNM

View Recorded Webinar 

 Participant Evaluation  

 Presentation Slides (PDF)

To receive CME* or CNE credit after viewing any of these webinars you must do the following:
  • Complete the Participant Evaluation associated with each webinar
  • Send an email with your first and last name stating which webinar you completed to contedu@migrantclinician.org

Migrant women face significant disparities with an additional layer of complexity and require different intervention strategies. Among them are reproductive health, pregnancy and childbirth, sexual and intimate partner violence, and cancers that disproportionately affect women, including cervical and breast cancer. Women often face environmental and occupational health exposures both in the home and in the workplace that heighten health risks. This session will provide a follow-up to the July 2013 presentation “Women’s Health at the Intersection of Poverty and Migration” that was part of our Clinician Orientation to Migration Health webinar series.  During this presentation Candace Kugel, FNP, CNM, and Meagan Danielson, CNM will discuss quality improvement and health care services for migrant women. The HRSA clinical performance measures related to women’s health will be reviewed as well as resources and best practices for improving the health of migrant women.

Learning Objectives:

  1. Describe strategies to address clinical core measures that relate to women’s health .
  2. Discuss case studies that assist participants in understanding how creative collaborations and models of care can improve health outcomes for migrant women.
  3. Participants will be able to access clinical resources for working with female migrant patients.

 

FURTHER READING

Low Birth Weight Resources

Cervical Cancer Resources

Other Resources

Download Resource

Part 6 of the 7 webinar series: Clinician Orientation to Migration Health

DATE: presented live on July 17th, 2013

PRESENTED BY: Candace Kugel, FNP, CNM, Specialist in Clinical Systems & Women's Health and Melissa Bailey, Executive Director of North Carolina Field, Inc.

 Women's Health at the Intersection of Poverty & Migration
View Recorded WebinarParticipant EvaluationPresentation Slides

  

Additional Resources:

MCN Women's Health page

MCN Health Network

Any prenatal patient who may move out of your area before giving birth is eligible to be enrolled in the Health Network. MCN will provide care coordination throughout the course of her pregnancy, until her postpartum visit is completed, to help ensure that there are no gaps in her health care.  512-327-2017 or 800-825-8205.

 

MCN Environmental Health/Pesticides Resources
MCN Family Violence Resources
MCN Streamline articles
Other Women’s Health Resources for Migrant/Immigrant Care
  • Text4Baby:  A free service that provides health education by text to pregnant women and new mothers in English and Spanish
  • The Perinatal/HIV Hotline: The National Perinatal HIV Consultation and Referral Service (Perinatal Hotline) provides 24-hour advice from HIV experts on indications and interpretations of HIV testing in pregnancy as well as consultation on treating HIV-infected pregnant women and their infants. The Perinatal Hotline (888-448-8765) is available 24 hours, seven days per week.
  • Centering Pregnancy: A model of group prenatal care widely used in a variety of settings, including FQHCs and with immigrant populations.  Materials are available in Spanish.
  • Rural Women’s Health Project  Pregnancy fotonovelas in English and Spanish.
  • Auger Communications “Teach with Stories” Prenatal Care fotonovela series and “Pregnancy and Diabetes: Lucia’s Story”
  • Wake Forest University One-page pesticides and pregnancy handout in English and Spanish. 
  • Migrant Health Promotion Farmworker Doula Manual
  • National Women’s Health Information Center. This website and toll-free call center were created to provide free, reliable health information for women everywhere, including lots of materials in Spanish.
  • March of Dimes  An array of materials at various literacy levels and almost everything in Spanish. Pamphlets, videos, "Comenzando Bien" curriculum.
  • Centers for Disease Control The CDC's Spanish website for women's health includes handouts in Spanish that can be printed from the website
  • National Perinatal Association Published transcultural perinatal education curriculum.
  • California Diabetes and Pregnancy Program.  Catalog of patient education materials in English and Spanish for perinatal issues related to diabetes and gestational diabetes.
  • “Diabetes gestacional: Guía para la mujer embarazada”.  Spanish language guide on gestational diabetes from AHRQ.
  • Association of Farmworker Opportunity Programs: “The Fields: The Hidden Faces of Farmworker Women” Interviews and stories about the issues that matter most to farmworker women’s health and well-being
  • Human Rights Watch:  “Cultivating Fear: The Vulnerability of Immigrant Farmworkers in the US to Sexual Violence and Sexual Harassment”
  • Legal Momentum Immigrant Women Program legal rights for immigrant women
  • Trafficking information

 

 

Historically, the field of women's health consisted of issues surrounding reproduction and childbirth. However, increasingly, the health care community has come to see women as a distinct patient group that has unique health concerns over a lifetime. Migrant farmworker women experience unique risks during pregnancy and otherwise, due to the physical demands, environmental exposures and other circumstances of their lives.  The provision of healthcare services to migrant women presents distinctive challenges for both clinicians and organizations.  MCN’s Candace Kugel, CRNP, CNM, and Melissa Bailey, Executive Director of NC FIELD, Inc., both with many years of experience with this population will discuss the problems, solutions and rewards of working with migrant women, through case illustrations and review of resources.

After taking this webinar:

  • Participants will be able to identify at least 2 health risks unique to women farmworkers and the impact of those challenges on work, nutrition and health.
  • Participants will be able to describe environmental and occupational health exposures relevant to farmworker women of reproductive age.
  • Case studies will assist participants in understanding how creative collaborations and models of care can improve health outcomes for migrant women.
  • Participants will be able to access clinical resources for working with female migrant patients.

PRESENTER BIOS:

Candace Kugel, FNP, CNM, Specialist in Clinical Systems & Women's Health, Migrant Clinicians Network

ckugel@migrantclinician.org

Candace Kugel is a Family Nurse Practitioner and Certified Nurse-Midwife with over twenty years of experience in health care for the underserved. She has worked in various clinical settings, including family planning, migrant health, community health center, and private practice. She has worked almost exclusively in rural settings.

Candace has also been active in aspects of health care other than direct patient services. She has served as a clinical instructor for nurse practitioner, nurse-midwife, nursing, and medical students, and currently has faculty appointments with the University of Cincinnati and Penn State University’s Schools of Nursing. She has worked in program development in various arenas, including co-founding a “Stork’s Store” prenatal incentive program, initiating a natural family planning education program, and teaching childbirth education classes.

Melissa Bailey, Executive Director of North Carolina Field, Inc.

 mbailey@lenoir.k12.nc.us

Melissa Bailey is a native of southern West Virginia. She has worked in North Carolina migrant education programs since 2001. In 2010 AFOP’s Children in the Fields Campaign assisted community workers with forming the nonprofit NC FIELD. This effort aimed to establish an organizational empowerment and advocacy model to build capacity in farmworker communities, particularly among child laborers in agriculture. In 2012 Melissa became the Executive Director of NC FIELD. 

She has presented to local, state, and national stakeholders; assisted media; has worked as a research assistant on farmworker studies; assisted with organizational development and the leadership training of child farmworkers, and is a successful field organizer, consultant, and project manager. Melissa holds a certificate in Nonprofit Management from Duke University, among other certifications related to the delivery of supplemental education services and data.

In her spare time Melissa enjoys reading, writing, gardening, and spending time with loved ones.

Part 2 of the 6 webinar series: Essential Clinical Issues in Migration Health

DATE RECORDED: April 2, 2014
PRESENTED BY:  Hans Dethlefs, MD and Ed Zuroweste, MD

View Recorded Webinar  

 Participant Evaluation  

 Presentation Slides (PDF)

If you have any follow up questions for this webinar, feel free to contact Dr. Ed Zuroweste at kugelzur@migrantclinician.org or 512.579.4540 .

To receive CME* or CNE credit after viewing any of these webinars you must complete the Participant Evaluation associated with each webinar. If you have any questions, contact our Continuing Education Assistant at contedu@migrantclinician.org

At their best, clinical core measures serve as an important window to examine the impact and quality of care being delivered at health centers. However, without an effective system in place clinical core measures can require a great deal of time and effort without yielding important quality improvement. This session will examine both short and long term strategies health centers can employ to make the best use out of the clinical core measures to improve care for patients. Drs Zuroweste and Dethlefs will examine the building blocks health centers need for an effective quality improvement system. Through a series of case studies, this session will explore the role of clinical leadership, technology and strategies for building a short and long term quality infrastructure that works.

Learning Objectives:

  1. Identify common pitfalls health centers encounter related to the clinical core measures.
  2. Discuss strategies for assessing a health center’s current capacity to engage in meaningful quality improvement.
  3. Through case studies, evaluate different approaches to clinical quality improvement using the clinical core measures.

FURTHER READING

Approved Uniform Data System (UDS) Changes for Calendar Year 2014 Program Assistance Letter

New Clinical Measures 2014

Effective Data Management for the Pursuit of Quality Health Care: OneWorld Health Center. MCN's Streamline. Winter 2014 Issue 1.

330 Clinical Grant Requirements

These files are part of the Engaging Migrant Men project.

MCN developed 3 vignettes that portray the three messages developed in video and printed form.

Download Resource

These files are part of the Engaging Migrant Men project.

Accompanying discussion guides were created to be used by male peers, community leaders, or outreach workers for one-on-one and small group discussions with men.

Part 1 of the 6 webinar series: Essential Clinical Issues in Migration Health

DATE RECORDED: March 19, 2014
PRESENTED BY:  Deliana Garcia, MA, International Research and Development, Migrant Clinicians Network

View Recorded Webinar  

 Participant Evaluation  

 Presentation Slides (PDF)

To receive CME* or CNE credit after viewing any of these webinars you must do the following:
  • Complete the Participant Evaluation associated with each webinar
  • Send an email with your first and last name stating which webinar you completed to contedu@migrantclinician.org

**Note: Due to technical difficulities the first 7 minutes of the presentation are not recorded. Please refer to the pdf of the slides for the content that was covered in those 7 minutes.

Over the last 30 years, considerable attention has been paid in the clinical setting to cultural competency- the ability to mitigate against the effects of the sociocultural differences between clinicians and patients and to take into account how culture affects the symptoms presented or the patients’ attitude about health care.  More recently, scholars and clinicians have encouraged those in practice or health professions training to focus not only on the behaviors and beliefs of cultural groups but more importantly to consider the structural determinants, prejudices, injustices and blind spots, the “pathologies of social systems” that affect health outcomes and the stigma experienced by patients. The session will introduce participants to the broad framework of structural competency and the five core structural competencies.

Learning Objectives:

  1. Identify the structures that shape clinical interactions;
  2. Discuss the means of developing an extra-clinical language of structure;
  3. Rearticulate “cultural” formulations in structural terms;
  4. Explain the process of observing and imagining structural interventions; and
  5. Describe the concept of structural humility.

 

FURTHER READING

Farmer, Paul, Bruce Nizeye, Sara Stulac, Salmaan Keshavjee. 2006. Structural Violence and Clinical Medicine. PLoS Medicine 2006 (3): 1686-1691.

Holmes, Seth, Fresh Fruit Broken Bodies, 2013

Messac, Luke, Dan Ciccarone, Jeffrey Draine, Philippe Bourgois. 2013. The good-enough science-and-politics of anthropological collaboration with evidence-based clinical research: Four ethnographic case studies. Social Science & Medicine 99 (2013): 176-186

Quesada, James, Laurie Kain Hart, & Philippe Bourgois. 2011. Structural Vulnerability and Health: Latino Migrant Laborers in the United States. Medical Anthropology, Vol. 30, No. 4: 339- 362

Srivastava, Ranjana. Complicated Lives—Taking the Social History. New England Journal of Medicine 2011 (365): 587-589.

Willen, Sarah. 2012. How is Health-Related “Deservingness” Reckoned? Perspectives from Unauthorized Im/migrants in Tel Aviv. Social Science & Medicine 74 (2012): 812-821.

Download Resource

Hombres Unidos is a peer-led workshop focused on the primary prevention of sexual and intimate partner violence (s/ipv) with Latino migrant men.  Developed in 2005 with the support from the Centers for Disease and Control, this five session workshop is implemented using a popular education technique (Paulo Freire) which is a concept that incorporates notions of class, political struggle and social transformation.  

This webinar (sponsored by the Washington Coalition of Sexual Assault Programs) focuses on the collaborative development of a primary prevention workshop for Latino migrant men, the evaluation of the workshop, and the continuing effort on engaging Latino migrant men as allies with women in s/ipv prevention after the five session workshop.

After this webinar, participants will be able to identify:

  • methods on how to begin a conversation on sexual and intimate partner violence with Latino migrant men
  • process and outcome evaluation techniques on a primary prevention workshop developed for a specific population
  • efforts to continue to engage Latino migrant men in sexual and intimate partner violence prevention
  • how to incorporate existing efforts with your population

Recording & Materials

During the webinar, Adrian referenced a few handouts that are used in the program.  Below you will find a few of these in Spanish.

Reducing exposure to toxic environmental agents is a critical area of intervention for obstetricians, gynecologists, and other reproductive health care professionals.  The evidence that links exposure to toxic environmental agents and adverse reproductive and developmental health outcomes is sufficiently robust, and the American College of Ostetricicans and Gynecologists and the American Society for Reproductive Medicine join leading scientists and other clinical practitioners in calling for timely action to identify and reduce exposure to toxic envrionmental agents while addressing the consequences of such exposure.

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Families Talking Together (FTT) is an evidence based program designed to help Latino parents better communicate with their children and teens about healthy relationships, sex, contraceptive use, and preventing pregnancy.  Dr. Vincent Guilamo-Ramos, the creator of the program and co-director of the Center for Latino Adolescent and Family Health at New York University’s Silver School of Social work, along with Planned Parenthood Los Angeles and Visión y Compromiso, recently enlisted 25 promotores (community health workers) from three communities in California with high rates of teen pregnancy and high percentages of Latinos in an effort to help Latino parents address teen pregnancy. Over a four-day period, the 25 promotores were trained to deliver the FTT intervention.  In the next two months, the promotores will deliver the intervention to 250 families in California.  The National Campaign wishes to recognize and thank Dr. Guilamo-Ramos, PPLA, and Visión y Compromiso for their work on this innovative and important project. 

The FTT intervention—both the community health worker curriculum and parent materials---are available online, free of charge.  

Download Resource

Two high-production value, Spanish radio public service announcements(PSAs) to promote HIV testing services at local agencies. One PSA targets men and the other women. Each PSA features a blank space for you to record your organization’s contact information. Provided by Farmworker Justice

Comprehensive Spanish-language curriculum for individuals interested in training promotores de salud in HIV prevention. The curriculum is based on popular education techniques, and is culturally competent and linguistically sensitive.

 Provided by Farmworker Justice

A directory of organizations working to promote health and prevent HIV/AIDS in California, Florida, North Carolina, Oregon, and Texas.

 

Provided by Farmworker Justice

This is the final webinar in a series of seven in our Clinician Orienatation to Migration Health.

DATE RECORDED: Wednesday, August 7th, 2013
PRESENTED BY: Edward Zuroweste, MD, Chief Medical Officer, Migrant Clinicians Network

To view the recorded version of this webinar, click here

Download Resource

This webinar is the sixth in a series of seven in our Clinician Orienatation to Migration Health.

DATE RECORDED: Wednesday, July 17, 2013
PRESENTED BY: Candace Kugel, FNP, CNM, Specialist in Clinical Systems & Women's Health and Melissa Bailey, Executive Director of North Carolina Field, Inc.

To view the recorded version of this webinar, click here.

Download Resource

 

Geoffrey M. Calvert, Walter A. Alarcon, Ann Chelminski,
Mark S. Crowley, Rosanna Barrett, Adolfo Correa, Sheila
Higgins, Hugo L. Leon, Jane Correia, Alan Becker,
Ruth H. Allen and Elizabeth Evans
doi:10.1289/ehp.9647 (available at http://dx.doi.org/)
Online 21 February 2007

Geoffrey M. Calvert, Walter A. Alarcon, Ann Chelminski,Mark S. Crowley, Rosanna Barrett, Adolfo Correa, SheilaHiggins, Hugo L. Leon, Jane Correia, Alan Becker,Ruth H. Allen and Elizabeth Evans

doi:10.1289/ehp.9647 (available at http://dx.doi.org/) Online 21 February 2007

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Introduction

In August of 2005, the North Carolina Division of Public Health, Occupational and Environmental Epidemiology Branch (OEEB) was notified that three women who had worked on farms in North Carolina owned by Ag-Mart had delivered infants with birth defects.  All three births took place in Florida where the women also worked on Ag-Mart farms and lived near each other.  This report summarizes the OEEB’s investigation and assessment of the pesticide exposures likely experienced by these women while in North Carolina. 

Download Resource

The Occupational Health and Safety Resource Center is a virtual repository of Spanish educational materials, data sources, and links to bilingual informational websites on occupational health and safety issues related to agricultural work. It also contains an ample list of national and state agencies that have produced materials in Spanish for farmworkers’ health-related problems.

MCNs own Deliana Garcia helped in being a part of the advisory committee to this resource center.

What is the objective?  To facilitate a central access point to high quality Spanish educational materials on agricultural occupational health and safety issues for people conducting work on health promotion and prevention activities and on workers’ rights and problems related to agricultural work.

Who are the target audiences? Health-outreach workers (promotores), community advocates, health providers, contractors/employers, farmworkers and their families, and others interested in the health and safety issues of agricultural workers.

What areas are included? The materials cover five key relevant areas: 1) Farmworkers’ rights; 2) Injury prevention; 3) Respiratory illnesses; 4) Heat illnesses; and 5) Pesticide exposure.

How did we do it? To develop the Virtual Resource Center, the process entailed:

  • Asset mapping of educational, informational and research materials available in Spanish related to the five mentioned areas.
  • Selection of materials using the following criteria: accurate information, culturally and linguistically adequate (including literacy level), relevant to health area, and visually acceptable quality.
  • Insertion of resources into an excel format under five different categories, including source, type of material, and description of its content.

Development of new materials: to complement the existing educational resources, we developed a “Promotores Training Manual on Occupational Health and Safety of Agricultural Workers”.  Based on an ethnographic framework, the manual presents the perspective of agricultural workers on the five mentioned areas (their stories) and provides community health workers with tools on how to conduct prevention and promotion activities. It also refers them to existing resources.  We also produced a series of Spanish and selected indigenous languages Public Service Announcements (PSAs) on these areas.

An informative blog about workers' compensation, risk management, business insurance, workplace health & safety, occupational medicine, injured workers, and related topics.

This webinar is the fifth in a series of seven in our Clinician Orienatation to Migration Health.

DATE RECORDED: Wednesday, June 12th, 2013
PRESENTED BY: Dr. Jennie McLaurin, MD, MPH, Specialist in Child and Migrant Health, Migrant Clinicians Network

To view the recorded version of this webinar, click here.

Much of the medical home model is predicated on a relatively stable population that can access regular care at a single network of providers.  So how can this model effectively transfer to a mobile population?  One of the key elements needed is a more expansive vision of a medical home beyond a single geographic location.  This session will explore strategies to create a patient centered medical home for patients on the move.  The session will include an update and overview of MCN’s Health Network to manage critical health care issues such as infectious disease, Cancer, Diabetes and Pre-natal patient navigations.  Participants will also be engaged in a discussion around best practices in tracking outcomes and reporting test results to patients.  Presenters will highlight innovative promising practices in the creation of patient centered medical homes for migrant patients.

Download Resource

The Diabetes and Healthy Eyes Toolkit provides community health workers with tools to inform people with diabetes about diabetic eye disease and maintaining healthy vision. The toolkit has a flipchart that is easy to use in community settings and can be incorporated into existing diabetes classes or information sessions. It is available in English andSpanish.

Part 4 of 7 webinars in the CLINICIAN ORIENTATION TO MIGRATION HEALTH series.

DATE RECORDED: May 15, 2013

PRESENTERS: Amy K. Leibman, MPA, MA, Director of Environmental and Occupational Health, Migrant Clinicians Network

Dr. Mike Rowland, MD, MPH, Vice President, Medical Affairs and Medical Director, Occupational Health, Franklin Memorial Hospital

OBJECTIVES:

  • Recognize the unique health risks of migrants due to their working conditions and environment
  • Identify promising practices in environmental and occupational health that are feasible to implement in Migrant and Community Health Centers
  • Utilize online clinical and patient education tools and resources to recognize, prevent and manage environmental and occupaional illnesses and injuries
Download Resource

This webinar is the third in a series of seven in our Clinician Orienatation to Migration Health.

DATE RECORDED: Wednesday, April 17, 2013
PRESENTED BY: Edward Zuroweste, MD, Chief Medical Officer, Migrant Clinicians Network

To view the recorded version of this webinar, click here.

Download Resource

This webinar is the second in a series of seven in our Clinician Orientation to Migration Health.

DATE RECORDED: Wednesday, March 13, 2013
PRESENTED BY: Jennie McLaurin, MD, MPH, Specialist in Child and Migrant Health, Migrant Clinicians Network

To view the recorded version of this webinar, click here.

Download Resource

Good article on cultural humility--basically the groundbreaking one used to propose the term

Journal of Health Care for the Poor and Underserved; May 1998; 9, 2; Research Library
Melanie Tervalon; Jann Murray-Garcia 

This webinar is the first in a series of seven in our Clinician Orienatation to Migration Health.

DATE RECORDED: Wednesday, February 13, 2013
PRESENTED BY: Deliana Garcia, MA, International Research and Development, Migrant Clinicians Network

To view the recorded version of this webinar, click here.

Download Resource

University of Minnesota's Global Health training program is offering free short courses on immigrant and refugee health.

The purpose of this course is to prepare providers to diagnose and treat acute pesticide poisoning and to increase their awareness of health problems associated with chronic pesticide exposure. While the focus of the course is on workers in agricultural settings, the course contents are also applicable for treating all pesticide related illness.