Glenn Shor, Phd, MPP, Visiting Policy Analyst at the Center for Occupational and Environmental Health at the UC Berkeley School of Public Health.
This report was funded, in part, by The California Wellness Foundation, for UCSF Community Occupational Health Project, Barbara Burgel, Nan Lashuay, and Robert Harrison, 2004 - 2006.
A tool for health care providers and others to assist agricultural workers in accessing workers' compensation benefits. A Farmworker Justice/MCN resource.
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? This crosswalk is meant to assist centers to incorporate the needs of migrating patients into their PCMH. Each of the six standards are listed with the factors required for NCQA recognition. Recommendations for addressing the factors in migrating patients are included, along with resources available through MCN. Meaningful Use and Core Measure content is noted as it is also present.
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.
Migrant Health Newsline, Issue 1, 2013 by the National Center for Farmworker Health
How much do you know about your health center's Board of Directors? Do you know who makes up your health center board and what populations are represented? Your health center plays a vital role in the community it serves. Therefore, the members of a health center board should be a reflection of that community. As part of the Health Resources and Services Administration (HRSA) Program Requirements, migrant and community health centers must have a farmworker representative on the board if that health center serves the farmworker community. Many benefits exist to having a farmworker board member. Although finding, recruiting, and keeping a farmworker representative on the board may sound like a difficult task, in this issue of Migrant Health Newsline, you will learn why this is so important, how it can be done successfully, and you will read about a health center's efforts to do just that.
California Poison Control System developed an online game that focuses on poison prevention through the use of "look-a-like" pills and candy. There are other resources on the site. The game is available as an app on itunes and in the android marketplace. Search for 'Choose your Poison.'
This website and training material were developed to give communities and promotores ways to help farm workers learn how to protect themselves from pesticide exposure.
The project and all materials on the website were developed by the California Poison Control System in collaboration with the the Western Center for Agricultural Health and Safety at the University of California, Davis and the California Department of Pesticide Regulation.
This algorithm in English and Spanish can be used by health center program grantees as part of the intake process to identify farmworker patients. It incorporates HRSA’s 2012 revised definition of migrant and seasonal farmworkers.
Sherry L. Baron, MD, MPH, Sharon Beard, MS, Letitia K. Davis, ScD, EdM, Linda Delp, PhD, MPH, Linda Forst, MD, MPH, Andrea Kidd-Taylor, PHD, Amy K. Liebman, MPA, MA, Laura Linnan, ScD, Laura Punnett, ScD, and Laura S. Welch, MD
Background: Nearly one of every three workers in the United States is low-income. Low-income populations have a lower life expectancy and greater rates of chronic diseases compared to those with higher incomes. Low- income workers face hazards in their workplaces as well as in their communities. Developing integrated public health programs that address these combined health hazards, especially the interaction of occupational and non-occupational risk factors, can promote greater health equity.
Methods: We apply a social-ecological perspective in considering ways to improve the health of the low-income working population through integrated health protection and health promotion programs initiated in four different settings: the worksite, state and local health departments, community health centers, and community-based organizations.
Results: Examples of successful approaches to developing integrated programs are presented in each of these settings. These examples illustrate several complementary venues for public health programs that consider the complex interplay between work related and non work-related factors, that integrate health protection with health promotion and that are delivered at multiple levels to improve health for low-income workers.
Conclusions: Whether at the workplace or in the community, employers, workers, labor and community advocates, in partnership with public health practitioners, can deliver comprehensive and integrated health protection and health promotion programs. Recommendations for improved research, training, and coordination among health departments, health practitioners, worksites and community organizations are proposed.
Carlos Eduardo Siqueira, MD, ScD, Megan Gaydos, MPH, Celeste Monforton, Dr PH, MPH, Craig Slatin, ScD, MPH, Liz Borkowski, BA, Peter Dooley, MS, CIH, CSP, Amy Liebman, MPA, MA, Erica Rosenberg, JD, Glenn Shor, PhD, MPP, and Matthew Keifer, MD, MPH
Background This article introduces some key labor, economic, and social policies that historically and currently impact occupational health disparities in the United States.
Methods We conducted a broad review of the peer-reviewed and gray literature on the effects of social, economic, and labor policies on occupational health disparities.
Results Many populations such as tipped workers, public employees, immigrant workers, and misclassified workers are not protected by current laws and policies, including worker’s compensation or Occupational Safety and Health Administration enforcement of standards. Local and state initiatives, such as living wage laws and community benefit agreements, as well as multiagency law enforcement contribute to reducing occupational health disparities.
Conclusions There is a need to build coalitions and collaborations to command the resources necessary to identify, and then reduce and eliminate occupational disparities by establishing healthy, safe, and just work for all.
Sara A. Quandt, PhD, Kristen L. Kucera, PhD, Courtney Haynes, MS, Bradley G. Klein, PhD, Ricky Langley, MD, Michael Agnew, PhD, Jeffrey L. Levin, MD, Timothy Howard, PhD, and Maury A. Nussbaum, PhD
Background Workers in the Agriculture, Forestry, and Fisheries (AgFF) sector experience exposures directly related to the work itself, as well as the physical environment in which the work occurs. Health outcomes vary from immediate to delayed, and from acute to chronic.
Methods We reviewed existing literature on the health outcomes of work in the AgFF sector and identified areas where further research is needed to understand the impact of these exposures on immigrant Latino workers in the southeastern US.
Results Outcomes related to specific body systems (e.g., musculoskeletal, respiratory) as well as particular exposure sources (e.g., pesticides, noise) were reviewed. The most extensive evidence exists for agriculture, with a particular focus on chemical exposures. Little research in the southeastern US has examined health outcomes of exposures of immigrant workers in forestry or fisheries.
Conclusion As the AgFF labor force includes a growing number of Latino immigrants, more research is needed to characterize a broad range of exposures and health outcomes experienced by this population, particularly in forestry and fisheries.
Arthur L. Frank, MD, PhD, Amy K. Liebman, MPH, MA, Bobbi Ryder, BA, Maria Weir, MAA, MPH, and Thomas A. Arcury, PhD
Background The Agriculture, Forestry, and Fishery (AgFF) Sector workforce in theUS is comprised primarily of Latino immigrants. Health care access for these workersis limited and increases health disparities.
Methods This article addresses health care access for immigrant workers in the AgFF Sector, and the workforce providing care to these workers.
Contents Immigrant workers bear a disproportionate burden of poverty and ill health and additionally face significant occupational hazards. AgFF laborers largely are uninsured, ineligible for benefits, and unable to afford health services. The new Affordable Care Act will likely not benefit such individuals. Community and Migrant Health Centers (C/MHCs) are the frontline of health care access for immigrant AgFF workers.C/MHCs offer discounted health services that are tailored to meet the special needs of their underserved clientele. C/MHCs struggle, however, with a shortage of primary care providers and staff prepared to treat occupational illness and injury among AgFF workers. A number of programs across the US aim to increase the number of primary care physicians and care givers trained in occupational health at C/MHCs. While such programs are beneficial, substantial action is needed at the national level to strengthen and expand the C/MHC system and to establish widely Medical Home models and Accountable Care Organizations. System-wide policy changes alone have the potential to reduce and eliminate the rampant health disparities experienced by the immigrant workers who sustain the vital Agricultural, Forestry, and Fishery sector in the US. Am. J. Ind. Med.
By Amy K. Liebman, MPA, MA, Melinda F. Wiggins, MTS, Clermont Fraser, JD, Jeffrey Levin, MD, MSPH, Jill Sidebottom, PhD, and Thomas A. Arcury, PhD
Background Immigrant workers make up an important portion of the hired workforce inthe Agricultural, Forestry and Fishing (AgFF) sector, one of the most hazardous industrysectors in the US. Despite the inherent dangers associated with this sector, workerprotection is limited.
Methods This article describes the current occupational health and safety policies andregulatory standards in theAgFF sector and underscores the regulatory exceptions and limitationsin worker protections. Immigration policies and their effects on worker health and safety arealso discussed. Emphasis is placed on policies and practices in the Southeastern US.
Results Worker protection in the AgFF sector is limited. Regulatory protections are generallyweaker than other industrial sectors and enforcement of existing regulations is woefullyinadequate. The vulnerability of the AgFF workforce is magnified by worker immigrationstatus. Agricultural workers in particular are affected by a long history of “exceptionalism”under the law as many regulatory protections specifically exclude this workforce.
Conclusions A vulnerable workforce and high-hazard industries require regulatoryprotections that, at a minimum, are provided to workers in other industries. A systematicpolicy approach to strengthen occupational safety and health in the AgFF sector mustaddress both immigration policy and worker protection regulations.
CDC’s US-Mexico Unit (USMU) works to prevent the spread of infectious disease across borders and improve and promote the health of travelers, migrants, and other mobile border and binational populations. USMU’s main activities include collaborating on the US-Mexico Binational Technical Working Group, overseeing the operation of the Binational Border Infectious Disease Surveillance Program (BIDS), migrant health and binational tuberculosis programs, and international regulatory responsibilities. Their website on US-Mexico health provides a brief overview of the public health issues unique to the border region, our key partners, the guidelines for cooperation, and a resources page complete with health education/communication resources and publications.
To learn more, please visit http://www.cdc.gov/USMexicoHealth/index.html and check back for updates and a Spanish mirror site which should launch this summer.
Clinicians can use this form to collect information from patients about their prior use of non-traditional or alternative care providers and medications.
Health centers can also adapt the form and/or incorporate into their EHR.
PCMH Standard 2 Element B: Clinical Data, Factor 9: List of prescription medications with date of update for 80% of patients.
PCMH Standard 3 Element D: Medication Management, Factor 3: Provides information about new prescriptions to more than 80% of patients.
PCMH Standard 5 Element B: Referral Tracking and Follow-up, Factor 5: Asks patients about self-referrals and requests specialist reports.
The West Virginia Rural Health Research Center (WVRHRC) pursues a multi-disciplinary research effort directed to improve environmental health for rural populations. Collaborators from public health, geographic information systems, nursing, pharmacy, environmental science, health policy and other disciplines work together to conduct policy-relevant research to achieve this goal.
This study, conducted by the West Virginia Rural Health Research Center, identified the availability and characteristics of agricultural medicine training opportunities for health care professionals. Agricultural workers and their families face numerous threats to health and safety, and yet there is limited information on health care expertise in place to recognize and prevent threats, and to diagnosis and treat agriculturally-related injury and illness.
This is a nice example of a screen shot for documenting self-management goals in EHR and the kind of thing centers want to see as they develop their tools. This can be adapted any number of ways.
OneWorld Community Health Center created a demographic extended table and put it in on a medical record pop-up template for tracking self management goals. This grid can be displayed on other templates or the popup can be launched from other templates depending on the workflows.
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
Objectives. We assessed implicit and explicit bias against both Latinos and
This article from the American Journal of Public Health is on implicit bias.
Authors: Irene V. Blair, PhD, Edward P. Havranek, MD, David W. Price, MD, Rebecca Hanratty, MD, Diane L. Fairclough, DrPH, Tillman Farley, MD, Holen K. Hirsh, PhD, and John F. Steiner, MD, MPH
Objectives. We assessed implicit and explicit bias against both Latinos and African Americans among experienced primary care providers (PCPs) and community members (CMs) in the same geographic area.
Methods. Two hundred ten PCPs and 190 CMs from 3 health care organizationsin the Denver, Colorado, metropolitan area completed Implicit Association Tests and self-report measures of implicit and explicit bias, respectively.
Results. With a 60% participation rate, the PCPs demonstrated substantial implicit bias against both Latinos and African Americans, but this was no different from CMs. Explicit bias was largely absent in both groups. Adjustment for background characteristics showed the PCPs had slightly weaker ethnic/racial bias than CMs.
Conclusions. This research provided the first evidence of implicit bias against Latinos in health care, as well as confirming previous findings of implicit bias against African Americans. Lack of substantive differences in bias between the experienced PCPs and CMs suggested a wider societal problem. At the same time, the wide range of implicit bias suggested that bias in health care is neither uniform nor inevitable, and important lessons might be learned from providers who do not exhibit bias.
(Am J Public Health. 2013;103:92–98. doi:10.2105/AJPH.2012.300812)
This short article in an issue of JAMA addresses the issue of clinicians who are not fluent in the language of their patients working without an interpreter. It provides a practical list of situations where the clinician should be sure to have a skilled interpreter.
JAMA, January 9, 2013—Vol 309, No. 2, from http://jama.jamanetwork.com/
This is the first of several resources MCN is developing to aid health centers in addressing the unique healthcare needs of migrant patients within the Patient Centered Medical Home. In addition, MCN is developing tools and resources health centers can utilize as they seek PCMH recognition.
Open Access means that patients can get same-day appointments for acute care needs and rapid access to routine care needs. This resource describes what Open Access looks like for migrant patients.
NCQA Standard 1: Enhance Access and Continuity; Element A: Access During Office Hours
Farmworker Justice and MCN compiled state-by-state requirements for employers to provide workers compensation to agricultural workers. The document sites case law where applicable.
Family Psychosocial Screening also assesses a number of other risk factors for developmental and behavior problems. These include frequent household moves, single parenting, three or more children in the home, less than a high school education, and unemployment. Four or more such risk factors including mental health problems and an authoritarian parenting style (observed when parents use commands excessively or are negative and less than responsive to child initiated interests) is associated with a substantial drop in children's intelligence and subsequent school achievement . In such cases, children should also be referred for early stimulation programs such as Head Start or a quality day care or preschool program.
PCMH Standard 2, Element C: Comprehensive Health Assessment, Factor 2: Practice conducts and documents a health assessment including family, social, cultural characteristics.
University of Minnesota's Global Health training program is offering free short courses on immigrant and refugee health.
This web site houses a collection of information, contacts and resources to assist health practitioners in providing care to migrant farm workers. Although the primary intended audience is health care providers in Ontario, much of the information may be useful to other parties.