1. ©2000 Breast Cancer Outreach Strategies: Models that Work For the Farmworker Population National Center for Farmworker Health, Inc. Presented by: Alicia Gonzales-Leadership Development & Training Center Director & Monica Saavedra-Embesi-Migrant Health Education Coordinator @2006 NCFH

2. National Center for Farmworker Health National Non-profit Organization, Est. 1975 Located in Buda, TX Provide training & technical assistance to a network of federally funded Migrant and Community Health Centers Primary Constituents Other interested organizations

3. @2006 NCFH Mission Statement To improve the health status of farmworker families through the innovative application of human, technical and information resources.

4. @2006 NCFH NCFH Focus Areas 1. Leadership Development & Training On-site consultation and facilitation Leadership and skills-building training Health promoter and health based trainings Migrant health orientation & training Translation & patient ed. Material development 2. Network Development & Expansion § Call for Health Program-1-800-377-9968 3. Migrant Health Network Support § Resource Center & Library § Houses collection of bilingual patient ed materials and FW specific resources

5. @2006 NCFH Leadership Development & Training Leadership Development & Training Center Health Education Focus: Development Experience Health Curricula Breast Cancer Oral Health HIV Diabetes Patient Education Materials Promotora Training

6. @2006 NCFH Commonly Used Outreach Strategies w/FW’s Popular education is engaging and empowering. It works to transform not only the lives of the participants, but the whole society. Popular Teaching Strategies Incorporate the following outreach strategies into your education delivery: Group activities Brainstorming Role-playing Games Ice-breakers Testimonials Theater Foto-novelas Use of Lay Health Promotor models Health Navigation Program

7. @2006 NCFH Model Programs Rural Women’s Health Project-Florida Women’s Center of Jacksonville-Jacksonville, FL The Rose-Houston, TX Cancer & Chronic Disease Consortium-El Paso, TX Multicultural Human Dev. Corporation-Lincoln, NE Kentucky Cancer Program-Louisville, KY Delaware Breast Cancer Coalition-Wilmington, DE Cultivando la Salud-Buda, TX

8. @2006 NCFH Model Program Cultivando La Salud A Breast and Cervical Cancer Education Program

9. @2006 NCFH About the Cultivando la Salud Program (CLS) 1 out of 11 R & D projects funded across the U.S. by CDC (1999-2002) Proved successful and rec’d continued funding from SGK Focuses on Breast and Cervical Cancer Development of low literacy and culturally appropriate educational materials Promotora Program Model Reaches hard to serve populations Proven to be effective in increasing B & C cancer screening

10. @2006 NCFH Cultivando la Salud: Breast and Cervical Cancer Program Overview Develop, test, replicate and disseminate a breast & cervical cancer program that will build on the promotora model. Build capacity within health centers through training & technical assistance to implement the program. Develop and carry out educational strategies to increase knowledge of breast & cervical cancer and improve skills and behaviors that influence screening. Evaluation component

11. @2006 NCFH  To increase breast and cervical cancer screening among migrant and seasonal farmworker women aged 50 and older.  To increase capacity for Migrant and Community Health Centers. Program Goals:

12. @2006 NCFH Evaluation Underwent extensive testing in the development, implementation, and completion phases Conducted over 15 Focus Groups Pilot tested surveys, materials, and implementation Trained over 30 organizations

13. @2005 NCFH PROGRAM DEVELOPMENT

14. @2006 NCFH

15. CLS Tools & Resources

16. @2006 NCFH Replication Package Program Manual Breast & Cervical Cancer Training Curriculum “Tool Box” to be used by Promotoras to provide education to Farmworkers Components include:  Lesson Plans  Flipchart  Video  Pamphlets

17. @2006 NCFH Program Manual (For Program Planners) “HOW-TO” Manual Background and Program Description Goals and Objectives Program Implementation Overview of the Program Materials

18. @2006 NCFH Program Manual (Continued) RESOURCES Promotora Job Description Recruitment & Training Management & Maintenance of Promotora Programs Contact Forms Staffing Plan and budget Evaluation and Sample Evaluation Tools

19. @2006 NCFH B & C Training Curriculum Lessons: Introduction to the Training Role of the Promotoras Reaching Farmworker Women Finding Breast Cancer Early Barriers to Breast Cancer Screening Finding Cervical Cancer Early Barriers to Pap Test Screening Teaching Methods Practice Session Using Program Materials Resources and Referrals Evaluation

20. @2006 NCFH Promotora Tool Box Video Flipchart Lesson Plans Breast Model

21. @2006 NCFH Video Spanish Only Portrays FW Women 50 and over at work and home Takes the viewer step by step for the CBE, Mammogram, Pap Test, and highlights the BSE The FW women engage in a barriers discussion Testimonials

22. @2006 NCFH Flipchart Comprehensive & Flexible tool Bilingual Script for Promotora; graphics for woman Barriers, Exams, and Testimonials

23. @2006 NCFH Lesson Plans Step-by-Step on how to conduct a session Comprehensive lesson plans 3 options based on time: a, b, and c

24. @2006 NCFH CLS PROGRAM FOUNDATION PROMOTORA MODEL

25. @2006 NCFH PROMOTORAS IN THE FIELD

26. @2006 NCFH Role of Promotoras in Cultivando La Salud Provide B&C cancer education to women in cohort through one on one home visits Identify & help women overcome barriers to screening Motivate women to get screened Provide referrals to local screening providers Assist them in making and keeping their appointments Served as link between the client and screening service Offer other assistance as needed

27. @2006 NCFH Educational Components Promotoras conducting door-to-door outreach in farmworker areas/colonias Using program materials, group presentations & one-on-one contacts Referrals to B&C screening providers Follow-up

28. @2005 NCFH Why the CLS Program?

29. @2006 NCFH Evidence Evidence based results Tested in the community with community members Farmworker specific Use of the promotora model

30. @2006 NCFH Screening Completion- Women in Cohort Site 1 Eagle Pass, TX Intervention Site 2 Anthony, NM Comparison Site 3 Merced,CA Intervention Site 4 Watsonville, CA Comparison Mam Cohort with follow-up 36.8%30.8%58.3%28.8% Pap Cohort with follow-up 32.4%22.4%76.9%25.0% CLS Program Results 20002

31. @2006 NCFH ****Intervention Effect**** InterventionComparisonp value Mammography Completion N=307 40.8%29.9%.049 Pap Test Completion N=170 39.5%23.6%.025 CLS Program Results 2002

32. @2006 NCFH Current NCFH BC Activities CLS Nationwide Trainings 2 day-Train the Trainer Direct Hands on Promotor Training CLS Hays County Intervention Use of Promotor Model Rural Hispanic Community Breast Cancer Outreach & Referrals for Screening Call for Health Program 800-bilingual toll free line Provides referrals and $ assistance for qualifying FW patients in need of screening or treatment

33. @2006 NCFH Contact Information Alicia Gonzales, Leadership Development & Training Center Director 512-312-5469 gonzales@ncfh.org Monica Saavedra-Embesi, Migrant Health Education Coordinator 512-312-5468 saavedra@ncfh.org www.ncfh.org 1800-531-5120

34. @2006 NCFH FIN Gracias