Nuevas Avenidas Mental and Behavioral Health Program The Nuevas Avenidas (New Avenues) Program established new routes to primary, preventative, and behavioral health care for medically underserved residents of Hidalgo County, Texas. The program combined the work of Community Health Workers (Promotoras) with accessible health care services, case management, grassroots organizing and service agency coordination.

Migrant Health Promotion Founded in 1983, Migrant Health Promotion works to change the circumstances, processes and practices that result in poor health for farmworkers and their communities. Migrant Health Promotion runs peer health education (Promotor(a)) programs in farmworker camps in Michigan and in the border colonias of South Texas focusing on diabetes prevention, health and nutrition for senior citizens, prenatal care for pregnant women, teen health, mental and behavioral health, children’s health, reproductive health, and more.

The Lower Rio Grande Valley The Rio Grande Valley, situated along the United States-Mexico border at the southern tip of Texas, has a population of one million people, approximately 90% of whom are Hispanic. The Valley is the permanent home of one of the largest concentrations of farmworkers in the United States. Residents face many challenges, including unemployment, low wages, immigration concerns, language and cultural differences and difficulty accessing health services. The Valley is home to about 2,000 colonias. Colonias are unincorporated neighborhoods developed outside of city limits and often lacking city services such as transportation, utilities and road signs.

Program Goals Over the course of the three-year program (May 1, 2006 to April 30, 2009), Nuevas Avenidas set out to accomplish the following:  Provide behavioral, primary, and preventative health services to at least 700 low-income, uninsured individuals previously isolated from appropriate services.  Demonstrate increased knowledge of and access to health services and resources in targeted colonias.  Demonstrate increased knowledge of mental and behavioral health issues and self-reported improvements in mental health.

Program Strategies Promotoras provided individual and group health education to their peers in the colonias and made referrals to health and social service agencies. Participating health facilities provided culturally and linguistically competent medical care, screening services and counseling to colonia residents referred through the program. A Program Coordinator/case manager monitored referrals, assisted with follow-up, and ensured the provision of services.

Who are promotores(as)? Promotores(as) are carefully selected community members who participate in health and empowering training so that they can promote health in their own communities. Share the language and culture of the target population. Respected in the community Interested in learning about health Bilingual Outgoing personality Familiar with area and/or services

 Administered needs assessments  Conducted individual health encounters  Organized group health education sessions  Made referrals for counseling and medical services  Coordinated health fairs  Led a community improvement project Nuevas Avenidas promotoras:

Group health education topics Depression Anxiety Substance abuse Domestic violence Teen violence and gangs Stress Mental illness Nutrition Suicide Child abuse & neglect Self esteem and self confidence Sexual assault and rape Physical activity Community organizing

Outcomes: needs assessments 1,801 individual health encounters 1,139 referrals to medical, counseling, or social services 552 visits by participants to subcontractor for medical or counseling services 512 individuals received case management 151 group health education presentations IN YEAR THREE: Program participants demonstrating ability to access mental and physical health services increased from 2% to 68%. Participants able to identify any symptoms of depression, stress, or anxiety increased from 84% to 95%. Average self-assessment of mental health based on a “feelings thermometer” increased 14%.

Challenges Changes in Consortium partners Sustainability Providing services with limited funds Stigma associated with mental illness Workplan adjustments Lack of public transportation

Data collection and reporting Be clear about your goals, objectives, and strategies. Create a monthly workplan. Monthly reports: measure progress toward your goals. Be clear about funders’ reporting requirements. Collect qualitative data. Analyze data to improve program. Get an early start on report-writing.

Making a difference The Promotoras report that the community is waiting for the information and is eager to learn. Large crowds gather for the mental health presentations. This is a new program; there hasn’t been a program before where community members could talk about the way they felt. They thought that being sad or depressed was a normal state, a way of life, and was unavoidable. The health sessions made them feel like they could do something about their depression. - Adalinda Gaytan, Program Coordinator

We can help Migrant Health Promotion’s Capacity Building Assistance Team can help you design, implement, and find funding for a Promotora program. Contact them at (734) ext. 11 or download resources from For more information about Nuevas Avenidas or any topic in this presentation, contact: Phillis Engelbert, Associate Director Migrant Health Promotion , ext. 12