Bridges to Health
- Need: To reduce barriers to accessing healthcare for migrant farmworkers in the rural areas of Vermont.
- Intervention: Bridges to Health uses care coordination and health promoters to reduce the barriers to accessing healthcare and provides services and education.
- Results: Some barriers to accessing healthcare have been reduced or removed for migrant farmworkers in certain counties in Vermont.
Promising (About evidence-level criteria)
Bridges to Health ("Puentes a la Salud" in Spanish) is a consortium facilitated by the Bi-State Primary Care Association of Vermont and New Hampshire and made up of the Bi-State Primary Care Association, the University of Vermont (UVM) Extension, and the Open Door Clinic (ODC). These organizations provide a care coordination program built off of the community health workers (CHW) model. The program works to reduce barriers for accessing healthcare experienced by migrant farmworkers in Vermont, 95% of whom are uninsured farmworkers. Barriers to accessing healthcare by this population include cultural and linguistic isolation, lack of transportation, lack of knowledge of where to go for care, documentation status, and lack of health insurance.
CHWs and a Community Outreach Nurse work together, connecting migrant farmworkers to healthcare services and health literacy education. Migrant farmworkers and farmers receive support navigating the local healthcare system, while healthcare providers receive cultural competency education and guidance so they can better understand and serve patients with limited English proficiency who primarily identify as Hispanic/Latino.
The staffing models of the project vary according to regional differences. The CHW model is used by UVM across most of the state because it is the most effective and efficient outreach strategy that addresses both the distribution of farmworkers across large regions and the challenges hiring bilingual, bicultural staff in rural Vermont.
UVM Vermont Migrant Education Program staff were already doing farm outreach, had the trust of migrant farmworkers, and were able to communicate effectively with them. The scope of work for these bilingual staff was increased to include work as CHWs to assist migrant farmworkers by teaching them about local health services and offering care coordination, thereby reducing barriers to care for farmworkers who otherwise would not receive desired healthcare services.
In the county where the ODC is located, there are enough farmworkers to have a bilingual community outreach nurse based out of a clinic that can provide the majority of needed healthcare services. The nurse goes out to farms and provides care to uninsured migrant farmworkers, educating both farm owners and farmworkers on healthcare options and services. The ODC also has bilingual front desk staff whom patients call when more extensive services are needed.
Collaboration with other organizations, health centers, and universities has been critical to the successful implementation of Bridges to Health because it builds on the capacity that is currently available. Through the Area Health Education Centers and UVM, additional services and materials have been developed.
The VT Farm Health Connection, a predecessor program to Bridges to Health, received a 2009-2012 Federal Office of Rural Health Policy (FORHP) Rural Health Outreach grant. Bridges to Health has been furthering access to care for migrant farmworkers with funding from a 2012-2015 FORHP Rural Health Care Services Outreach grant to provide services in six Vermont counties. In 2015, Bridges to Health received a FORHP Rural Health Care Services Outreach grant to expand from 6 counties to statewide over the next 3 years. Program coordinators plan to continue working with Federally Qualified Health Centers and hospitals, coordinating healthcare services and promoting systems to ensure language access at all points of contact.
- Educate migrant farmworkers and their employers on health services available in the community
- Assist with scheduling medical appointments
- Coordinate interpretation and transportation services
- Offer case management that includes support navigating registration paperwork, financial assistance applications, billing, and follow-up care
- Provide feedback to healthcare entities in order to improve cultural competency of providers and reduce barriers to healthcare access for migrant farmworkers
- Develop and distribute local health access guides in both English and Spanish
- Make referrals to other services and programs as necessary
- Assist with building sustainability of language access services at health centers and hospitals
- Increased capacity at UVM and the ODC to provide outreach to over 200 farms, including the development and distribution of bilingual healthcare access guides across all regions of the state
- Increased percentage (now 98%) of referred patients who successfully accessed care, due in large part to the high-touch care coordination effort
- Increased knowledge about and capacity to address migrant farmworkers' barriers to accessing healthcare among healthcare providers, migrant farmworkers, and farmers
- Successful collaborations with college students and healthcare providers who volunteer in their professional areas, including Spanish language students for translation services and medical, nursing, and dietetics students and professionals for their healthcare knowledge and services
To see the impact in numbers of farms and farmworkers reached through the grant cycles, view Vermont Migrant Farmworkers: Partners Working in Collaboration to Ensure Access to Health Care in the Vermont Primary Care Sourcebook.
Bi-State Primary Care Association is also featured in RHIhub’s Care Coordination Toolkit Program Clearinghouse.
- There is an ongoing challenge of training healthcare entities, teaching them to respond appropriately on how to remove barriers to healthcare access for migrant farmworkers. The small number of farmworkers accessing care at any given health site combined with ongoing staff turnover means that the training needs to continually occur.
- With migrant farmworkers in the statewide service area comprising only about 1,000-1,200 people, it is difficult to convince a healthcare system that it is efficient and effective to prioritize changes and funds for such a small population.
- The sustainability component is very challenging for a care coordination program of this type because it serves mostly individuals who are uninsured and that means a lack of revenue and a reliance upon grants.
- Other challenges include federal and state policies on immigration, fear within the target population, buy-in from farmers and health centers, staffing, and difficulties that come with the rural nature of the service area, in particular winter weather that makes travel even more difficult.
- While Bridges to Health has definitely raised awareness about the barriers to accessing healthcare experienced by migrant farmworkers and opportunities for improvement, translating that awareness into practice has been difficult.
In order to grow the program, try to partner with agencies who have staff with similar knowledge and engage in community outreach. This helps build capacity within the program and does not duplicate resources.
Because change does not happen overnight, people need to be met where they are so that everyone can come to a place of understanding.
Documents, developed by the Bridges to Health consortium, are available for use by other organizations for increasing access to healthcare for migrant farmworkers. Please note these are for your information and should be adapted appropriately for your program:
Bilingual English and Spanish Survey
A bilingual English and Spanish survey for farmworkers to provide feedback on health outreach services
Farmworker Important Contacts Cards
A bilingual English and Spanish patient form for farmworkers so they can provide important information in the case of an emergency
A Quick Guide to Working with Interpreters
A resource that explains how to effectively work with interpreters
Position Description for Migrant Health
A description of a Migrant Health Promoter position as advertised on a human resources website. It includes the job skills and responsibilities as well as the qualities of the successful candidate
Client Encounter Form
A form for the care coordinator to use to document information during a client encounter
Care Coordination Protocol for Migrant Health
A protocol that provides best practices for Migrant Health Promoters when distributing health education materials or coordinating healthcare
Community health workers
Farmers and farmworkers
Limited English proficient
July 7, 2015
September 1, 2017
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.