Bridges to Health
- Need: To reduce barriers to accessing healthcare for immigrant farmworkers in the rural areas of Vermont.
- Intervention: Bridges to Health uses care coordination and health promoters to reduce barriers to accessing healthcare on an individual level. The program offers targeted technical assistance to address systemic barriers at health access points in areas with high numbers of immigrant farmworkers.
- Results: Some barriers to accessing healthcare have been reduced or removed for immigrant farmworkers in certain counties.
Evidence-levelPromising (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 comprises the Bi-State Primary Care Association, the University of Vermont (UVM) Extension, and the Open Door Clinic (ODC). In 2018, the consortium grew to include Vermont Care Partners, which supports a network of state-designated mental health agencies. These organizations provide a care coordination program built off the community health worker (CHW) model. The program works to reduce barriers for accessing healthcare experienced by immigrant 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 immigrant farmworkers to healthcare services and mental health education and resources. Immigrant farmworkers and farmers receive support navigating the local healthcare system, while health access points receive policy and protocol guidance as well as cultural competency education 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 immigrant 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 immigrant 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 immigrant 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 were 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 Care Services Outreach grant. Bridges to Health received a 2012-2015 FORHP Rural Health Care Services Outreach grant to provide services in six Vermont counties. In 2015, Bridges to Health expanded services statewide.
In 2018, Bridges to Health was the recipient of additional FORHP funding to add a mental health focus to its outreach program. Health promoters have received training on mental health screenings and referrals to engage farmworkers in guided conversations about strategies to reduce non-clinical stress and anxiety. Program coordinators offer capacity building opportunities and technical assistance to the state's designated mental health agencies and healthcare organizations with integrated mental health services to increase understanding about mental health and illness in the Latino community, with a focus on stigma, idioms of distress, and implications for treatment. Bridges to Health continues to promote systems across all types of health entities, including mental health agencies, to ensure language access is offered at all points of contact for patients with limited English proficiency.
- Educate immigrant farmworkers and their employers on health services available in the community
- Assist with scheduling health 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 systems and education that will reduce barriers to healthcare access for immigrant farmworkers
- Improve and distribute local health access guides in both English and Spanish that include accessible mental healthcare services
- Make referrals to other services and programs as necessary
- Assist with building sustainability of language access services at health centers and hospitals
- Offer mental health screenings and referrals to mental health specialists
- 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 immigrant farmworkers' barriers to accessing healthcare among healthcare providers, immigrant farmworkers, and farmers
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 2016 Vermont Primary Care Sourcebook.
Bi-State Primary Care Association is also featured in RHIhub's Care Coordination Toolkit Program Clearinghouse.
- The small number of farmworkers accessing care at any given health site combined with ongoing staff turnover means continuous training and challenges with continuity of linguistically appropriate interactions.
- With immigrant farmworkers in the statewide service area comprising only about 1,000 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, little buy-in from farmers and health centers, staffing difficulties, and winter weather that makes travel difficult.
In order to grow the program, try to partner with agencies that have staff with similar knowledge and engage in community outreach. This helps build capacity within the program and does not duplicate resources.
Invest time and training into long-term volunteers and interns who can offer a variety and/or depth of services that complement the work that the program offers.
Health access points need to be met where they are so that everyone can come to a place of understanding and be empowered to make incremental improvements.
Documents developed by the Bridges to Health consortium are available for use by other organizations for increasing immigrant farmworkers' access to healthcare. Please note these are for your information and should be adapted appropriately for your program:
Bilingual English and Spanish Survey
A survey in English and Spanish for farmworkers to provide feedback on health outreach services
Farmworker Important Contacts Cards
A patient form in English and Spanish 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
A form for the care coordinator to use to document information during a client encounter
Care Coordination Protocol for Health Promoters
A protocol that provides best practices for health promoters when distributing health education materials or coordinating healthcare
Contact InformationKate Simmons, Director of Operations
Bi-State Primary Care Association
802.229.0002 Ext. 217
Community health workers
Farmers and farmworkers
Limited English proficient
July 7, 2015
Date updated or reviewed
October 18, 2019
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.