Magdalena Fernandez, Regional Migrant Health Coordinator, Mid-Atlantic James O’Barr, Regional Migrant Health Coordinator, Northeast East Coast Migrant Stream Forum, October 19 th,

 Role of Regional Migrant Health Coordinators  Summary of 2011 Assessment Data  Barriers to Care ◦ Effects of State Immigration Laws  Technical Assistance Needs of MHCs ◦ Adapting Patient Centered Medical Home  Recommendations  2012 Wall of Wonder 2

 Support MHCs in meeting 330g program expectations  Collect and disseminate information  Identify underserved farmworker populations  Support program development for new sites  Monitor federal and state legislation  Facilitate and support continuity of care from state to state 3

Migrant Health Regional Profiles Assessment of the Eastern Stream of Migrant and Seasonal Farmworkers Regional Migrant Health Coordinators, East Coast James O’Barr, Northeast Magdalena Fernandez, Mid-Atlantic Erin Sologaistoa, Southeast Available on the National Center for Farmworker Health website: 5

State Anti-immigrant Laws Fear of Arrest, Deportation Lack of Transportation Finances Language Lack of Knowledge 6 Source: 2011 Assessment of the Eastern Stream of Migrant and Seasonal Farmworkers, Mid-Atlantic, Northeast and Southeast Migrant Health Profiles

 Cited as top barrier to accessing care ◦ Harder to reach farmworkers ◦ High levels of fear and distrust ◦ Growers reluctant to allow access to workforce ◦ Fear of driving without a license further limits mobility ◦ Decreased enrollment in enabling services and benefits  Discrimination ◦ Reports from GA and AL that road blocks have been set between clinic sites that appear to target patients ◦ Profiling by local law enforcement reported in several states 7 Sources: Impact of Immigration Laws on Access to Healthcare for Farmworkers in the Southeast, 2011 Assessment of the Eastern Stream of Migrant and Seasonal Farmworkers

 Fewer patient visits  Increased missed appointments  Increased severity of chronic diseases such as diabetes and hypertension  Increased stress associated disorders  Delayed entry into prenatal care  Decreased use of preventative care 8 Source: 2011 Assessment of the Eastern Stream of Migrant and Seasonal Farmworkers, Mid-Atlantic, Northeast and Southeast Migrant Health Profiles

 Decrease in number of workers ◦ Fewer workers migrating for fear of being detained  Shift in migration patterns ◦ Those who do migrate are changing paths to avoid traveling through AL, GA and SC  Changes in demographics ◦ Increase in number of families in Southeast ◦ Decrease in number of families in Mid-Atlantic ◦ Increase in Haitian farmworkers reported in GA, ME, NJ and NY Source: 2011 Assessment of the Eastern Stream of Migrant and Seasonal Farmworkers 9

 Over 80% of health centers surveyed in FL and GA reported that growers were experiencing difficultly in finding workers.  Reports of field and orchard crops left unharvested due to lack of workers  PA Department of Labor has expressed concern that m any migrants are not returning to PA due to fear of traveling through AL, GA and SC. Source: Impact of Immigration Laws on Access to Healthcare for Farmworkers in the Southeast, 2011 Assessment of the Eastern Stream of Migrant and Seasonal Farmworkers 10

 Anti-immigrant Laws  Outreach  Migrant Health Governance  Developing Lay Health Programs  Health Reform  Migrant Health 101  Farmworker Identification and Eligibility  Customer Service  Cultural Competence  Patient Centered Medical Home 11 Source: 2011 Assessment of the Eastern Stream of Migrant and Seasonal Farmworkers, Mid-Atlantic, Northeast and Southeast Migrant Health Profiles

 Unique challenges of serving migrant patients  Culturally and linguistically appropriate care  Access to “extended hours” of service  Transportation services  Remote access to medical records for continuing care 12

 Partnering between providers, outreach workers and promotoras in multiple locations  Emphasis on self management of chronic illnesses  Migrant Voucher Programs  More collaboration with other M/CHCs (electronic/telemedicine networks), and other partners such as health departments, private providers, hospitals  Widespread use of Migrant Clinicians Network’s Health Network 13

 Education and advocacy on immigration issues ◦ Emphasize public health risk and damage to agricultural industry  Improve cultural competency and community trust in health centers  Establish clear anti-discrimination policies in health centers  Educate farmworkers about their rights 14

 Provide training and technical assistance to improve effectiveness of Patient Centered Medical Home for migrant and seasonal farmworkers and to integrate outreach services into PCMH 15

Assessment of Migrant and Seasonal Farmworkers in the Eastern Stream Regional Migrant Health Coordinators, East Coast James O’Barr, Northeast Magdalena Fernandez, Mid-Atlantic Erin Sologaistoa, Southeast 16

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