1. MSFW Analysis - WA National Center for Farmworker Health

2. Presentation Controls Legend Next slidePrevious Slide Data County Information Return to presentation Only buttons in lower right hand corner are operational MSFW Analysis - WA

3. Purpose The purpose of this presentation is to conduct spatial data analysis of MSFW enumeration data to enable health planners to target limited resources to areas of greatest MSFW need. MSFW Analysis - WA

4. Presentation Outline Introduction State Overview Service Delivery Gaps Other Data MSFW Analysis - WA

5. Introduction Acronyms MSFW Enumeration Profiles Studies Rationale for State Selections Data Sources MSFW Population Categories Rationale for MSFW Population Categories MSFW Analysis - WA

6. Acronyms MSFW Analysis - WA BPHC – Bureau of Primary Health Care CHC – Community Health Center (Section 330 grantee) HRSA – Health Resources and Services Administration MHC – Migrant Health Center (Section 330 grantee) MSFW – Migrant and Seasonal Farmworker NCFH – National Center for Farmworker Health NP – Nurse Practitioner PA – Physician Assistant UDS – Uniform Data System

7. MSFW Enumeration Profiles Studies In 1998, the Bureau of Primary Health Care (BPHC) and the Environmental Protection Agency jointly funded a study to estimate MSFW populations at the county level, and awarded a grant to the National Center for Farmworker Health (NCFH). NCFH subsequently contracted with Alice C. Larson, Ph.D., to research and develop state estimates for the MSFW population in ten states: Arkansas, California, Florida, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, and Texas. MSFW Analysis - WA

8. Rationale for State Selections Five states were chosen because they are home to the largest MSFW populations (California, Florida, North Carolina, Texas, and Washington). The other five states (Arkansas, Louisiana, Maryland, Mississippi, and Oklahoma) were selected because they were states for which minimal data was available, and they appeared to provide a broad sample of MSFW employment environments. MSFW Analysis - WA

9. Data Sources MSFW numbers are taken from the MSFW Enumeration Profiles Study - Washington, September 2000. MHC and CHC grantee site locations were taken from the BPHC web site (http://ask.hrsa.gov/pc/) in March 2003, and updated by the Washington Association of Community and Migrant Health Center Systems in March 2003.http://ask.hrsa.gov/pc/ User data was provided by the Health Resources and Services Administration (HRSA) and BPHC. MSFW Analysis - WA

10. MSFW Population Categories In this analysis, there are four county MSFW population categories: 0 to 499 500 to 999 1,000 to 1,999 2,000 and over MSFW Analysis - WA

11. Rationale for MSFW Population Categories The four MSFW population categories were selected based on assumptions about deriving a potential clinic user population number from a target population estimate. Potential clinics include existing CHC service sites or a new access point. A new access point is a new delivery site for the provision of comprehensive primary and preventive health care services. The two types of new access points are (1) new starts and (2) satellites. We assume that a target population will produce a 75% clinic user rate and that a clinic site requires 750 to 1,500 users (based on an average ratio of 750 users per PA/NP and 1,500 per physician). MSFW Analysis - WA

12. MSFW Population Category 0 - 499 Counties that have an MSFW population from 0 to 499 are assumed to have an MSFW target population sufficient only to support a user population that would account for less than 25% of the users of an existing CHC service site or a new access point. MSFW Analysis - WA

13. MSFW Population Category 500 - 999 Counties that have an MSFW population from 500 to 999 are assumed to have an MSFW target population sufficient to support a user population that would account for 25% to 50% of the users of an existing CHC service site or a new access point. MSFW Analysis - WA

14. MSFW Population Category 1,000 – 1,999 Counties that have an MSFW population from 1,000 to 1,999 are assumed to have an MSFW target population sufficient to support a user population that would account for 50% to 100% of the users of an existing CHC service site or a new access point. MSFW Analysis - WA

15. MSFW Population Category Over 2,000 Counties that have an MSFW population over 2,000 are assumed to have an MSFW target population sufficient to support a user population that would justify a new access point. MSFW Analysis - WA

16. Presentation Outline Introduction State Overview Service Delivery Gaps Other Data MSFW Analysis - WA

17. State Overview State Data State Map with Counties Perspective: Washington vs. Maryland MSFW Population MSFW Population – Data Map MSFW Population – Spatial Map MSFW Analysis - WA

18. Washington Data AREA - 67,290 square miles POPULATION (2000) – 5,987,973 TOTAL MSFW POPULATION – 289,235 COUNTIES – 39 counties (ranging in size from 55 to 5,360 square miles) CHC/MHC SITES – 7 Grantees and 57 sites CHC ONLY SITES – 66 Grantees and 22 sites MSFW Analysis - WA

19. Washington Counties Whatcom Okanogan Skagit Asotin Pend Orielle Klickitat Snohomish King Clallam Jefferson Ferry Stevens San Juan Island Douglas Chelan Kittitas Thurston Lincoln Grant Walla Adams Pierce Wahkiakum Cowlitz Garfield Columbia Franklin Whitman Spokane Yakima Benton Lewis Skamania Kitsap Clark Mason Grays Harbor Pacific MSFW Analysis - WA

20. Area Perspective: Washington vs. Maryland MSFW Analysis - WA

21. MSFW Population The migrant and seasonal farmworker population is estimated at 289,235. This number includes workers and their dependents. The largest concentration of farmworkers and their families is located in the south central part of the state. The next slide will present this data as an overlay on the county. Data source: MSFW Enumeration Profiles Study – WA, Larson, 9/2000 MSFW Analysis - WA

22. MSFW Total Population - 289,235 4,904 15,190 97 257 2,210 384 3 44,769 13,323 26,382 1,709 81,175 3,215 7470188 21 344 492 200 0 6,458 1,545 1,081 2,523 2,043 1,035 28 47 364 0 9,454 34,554 24,503 4,582 85 765 698 938 Data source: MSFW Enumeration Profiles Study – WA, Larson, 9/2000 MSFW Analysis - WA

23. MSFW Population The next slide will depict the state’s counties organized into four categories, based on the county’s MSFW population. In addition to the three categories already described, there is a category for counties with an MSFW population below 500. MSFW Analysis - WA

24. MSFW Total Population - 289,235 Data source: MSFW Enumeration Profiles Study – WA, Larson, 9/2000 MSFW Analysis - WA

25. Presentation Outline Introduction State Overview Service Delivery Gaps Other Data MSFW Analysis - WA

26. Service Delivery Gaps Analysis Process MHC Grantees CHC Grantees Grantee Delivery Area vs MSFW Population County Analysis by MSFW Population Category MSFW Analysis - WA

27. Analysis Process Service potential will be evaluated in the following order: MHC grantee in county CHC grantee in county MHC grantee in adjoining county CHC grantee in adjoining county MSFW Analysis - WA

28. MHC Grantees There are seven Migrant Health Center grantees in the state. These grantees provide services at 57 sites in 16 counties in Washington and 3 sites in Oregon. Data source: BPHC web site, 3/2003 MSFW Analysis - WA

29. MHC Grantee Sites and Service Counties Data source: BPHC web site, 3/2003 MSFW Analysis - WA

30. MHC Delivery Sites Coverage Data source: BPHC web site, 3/2003 MSFW Analysis - WA

31. Analysis of Counties with >2,000 MSFW Population There are three counties that have MSFW populations in excess of 2,000 that do not have an MHC grantee delivery site in the county. MSFW Analysis - WA

32. MSFW Population > 2,000 4,904 6,458 15,190 26,382 13,323 44,769 2,043 2,210 3,215 9,454 34,554 81,175 2,523 4,582 24,503 Data source: MSFW Enumeration Profiles Study – WA, Larson, 9/2000 MSFW Analysis - WA

33. MHC Grantee Delivery Sites Data source: BPHC web site, 3/2003 MSFW Analysis - WA

34. County Service Area with no MHC Douglas Lewis Klickitat Data source: BPHC web site, 3/2003 MSFW Analysis - WA

35. Douglas County MSFW Population 13,323 1 Douglas County adjoins three counties that have MHC grantees 2, and three grantee sites are close enough to provide services to a portion of the MSFW population of the county. Douglas 1 MSFW Enumeration Profiles Study – WA, Larson, 9/2000 2 BPHC Web Site, 3/2003 MSFW Analysis - WA

36. Lewis County MSFW Population 2,043 1 Lewis County adjoins two counties that have MHC grantees 2, but the nearest healthcare delivery site is almost 20 miles from the county line, not close enough to provide services to most of the MSFW population of the county. Lewis 1 MSFW Enumeration Profiles Study – WA, Larson, 9/2000 2 BPHC Web Site, 3/2003 MSFW Analysis - WA

37. Klickitat County MSFW Population 3,215 1 Klickitat County adjoins three counties (one in Oregon) that have MHC grantees 2, but only one site provides umbrella coverage in the county. There are limited services available to the MSFW population of the county. Klickitat 1 MSFW Enumeration Profiles Study – WA, Larson, 9/2000 2 BPHC Web Site, 3/2003 MSFW Analysis - WA

38. Analysis of Counties with 1,000-1,999 MSFW Population Of the four counties that have MSFW populations ranging from 1,000 to 1,999, only one does not have an MHC grantee delivery site in the county. MSFW Analysis - WA

39. MSFW Population 1,000 – 1,999 1,545 1,081 1,709 1,035 Data source: MSFW Enumeration Profiles Study – WA, Larson, 9/2000 MSFW Analysis - WA

40. County Service Area with no MHC Kittitas Data source: BPHC web site, 3/2003 MSFW Analysis - WA

41. Kittitas County MSFW Population 1,709 Kittitas County is almost completely surrounded by counties that have MHC grantees, and some healthcare delivery sites are close enough to provide services to a portion of the MSFW population of the county. Kittitas 1 MSFW Enumeration Profiles Study – WA, Larson, 9/2000 2 BPHC Web Site, 3/2003 MSFW Analysis - WA

42. Analysis of Counties 500-999 MSFW Population Of the four counties that have MSFW populations ranging from 500 to 999, one has an MHC grantee delivery site in the county, and the other three adjoin counties with MHC delivery sites. However, these delivery sites are too distant to provide adequate services to the MSFW population. MSFW Analysis - WA

43. MSFW Population 500 – 1,000 747 765 698 938 Data source: MSFW Enumeration Profiles Study – WA, Larson, 9/2000 MSFW Analysis - WA

44. County Service Area with no MHC Grays Harbor Whitman Columbia Data source: BPHC web site, 3/2003 MSFW Analysis - WA

45. MHC Coverage Grays Harbor Whitman Columbia Data source: BPHC web site, 3/2003 MSFW Analysis - WA

46. Potential MSFW Providers * * * * * * * * * * * A CHC is a potential service provider to the MSFW population of one county that has no MHC grantee MSFW Analysis - WA

47. CHC Grantees There are nineteen Community Health Center grantees in the state. All seven of the MHC grantees are also CHC grantees. The twelve additional CHC grantees provide health services at 66 sites in 22 counties. Data source: BPHC web site, 3/2003 MSFW Analysis - WA

48. CHC Grantee Delivery Areas Data source: BPHC web site, 3/2003 MSFW Analysis - WA

49. CHC Grantee Delivery Areas Data source: BPHC web site, 3/2003 MSFW Analysis - WA

50. CHC Serviced County Of the seven counties discussed that do not have an MHC grantee delivery site in the county, one of them has a CHC grantee in the county. MSFW Analysis - WA

51. Grays Harbor County Grays Harbor Data source: BPHC web site, 3/2003 MSFW Analysis - WA

52. Isolated Counties There are six counties that do not have an MHC grantee delivery site in the county. Although these counties adjoin counties with MHC or CHC delivery sites, in most cases these delivery sites are too distant to provide adequate services to the MSFW population. MSFW Analysis - WA

53. Isolated Counties Columbia Whitman Kittitas Klickitat Lewis Douglas MSFW Analysis - WA

54. Isolated Counties MHC/CHC Coverage Columbia Whitman Kittitas Klickitat Lewis Douglas MSFW Analysis - WA

55. Presentation Outline Introduction State Overview Service Delivery Gaps Other Data MSFW Analysis - WA

56. Other Data MHC Grantee Service Penetration CHC Grantee Service to MSFW Population MHC/CHC Service Penetration – Spatial Analysis Percent Minority Population Uninsured Population Below 100% Poverty Percent Uninsured Population Below 100% Poverty Percent Total Uninsured and Below 100% Poverty MSFW Analysis - WA

57. MHC Grantee Service Penetration The seven MHC grantees provided services to 88,723 users 1 during 2001, which represents over 30% of the estimated statewide MSFW population. The estimated MSFW population in the counties where the grantees provided health services is 260,049 2. The reported users represent over 34% penetration of this population. 1 UDS Reports - 2001, BPHC 2 MSFW Enumeration Profiles Study – WA, Larson, 9/2000 MSFW Analysis - WA

58. CHC Grantee Service to MSFW Population In addition to the services provided to the MSFW population by the MHC grantees, CHC grantees provided services to 1,255 farmworkers and their families 1. The resulting statewide service penetration rate for the MSFW population 2 is 31.43%. 1 UDS Reports - 2001, BPHC 2 MSFW Enumeration Profiles Study – WA, Larson, 9/2000 MSFW Analysis - WA

59. MHC/CHC Service Penetration * * * * * * * * * * * * * * * MULTIPLE COUNTY AVERAGE Statewide Penetration Rate 31.43% UDS Reports - 2001, BPHC MSFW Enumeration Profiles Study – WA, Larson, 9/2000 MSFW Analysis - WA

60. % Minority Population Data source: US Census 2000 MSFW Analysis - WA

61. Uninsured Population < 100% Poverty Data source: REACH 2000, NACHC MSFW Analysis - WA

62. % Uninsured Population < 100% Poverty Data source: REACH 2000, NACHC MSFW Analysis - WA

63. % Total Uninsured and % <100% Poverty Data source: REACH 2000, NACHC MSFW Analysis - WA

64. National Center for Farmworker Health

65. Washington Counties Whatcom Okanogan Skagit Asotin Pend Orielle Klickitat Snohomish King Clallam Jefferson Ferry Stevens San Juan Island Douglas Chelan Kittitas Thurston Lincoln Grant Walla Adams Pierce Wahkiakum Cowlitz Garfield Columbia Franklin Whitman Spokane Yakima Benton Lewis Skamania Kitsap Clark Mason Grays Harbor Pacific MSFW Analysis - WA

67. Data source: MSFW Enumeration Profiles Study – WA, Larson, 9/2000 MSFW Analysis - WA

68. Data source: REACH 2000, NACHC MSFW Analysis - WA

69. Data source: 2000 Census MSFW Analysis - WA