Increase Access To Care for Agricultural Workers Program
Promising Practices Award
2023

Since the inception of the Increase Access to Care for Agricultural Workers (IAC) Program in 2015, NCFH has seen a variety of great promising practices implemented at health centers that have contributed to the increase in the number of Migratory and Seasonal Agricultural Workers (MSAWs) and their families served nationwide. Health centers across the country continue to serve this vulnerable population by adapting their service delivery and finding innovative ways to conduct outreach. Each year NCFH showcases these promising practices and recognizes health centers for their commitment to this population. We are excited to share this year’s award winners, ReGenesis Healthcare (SC) and Keystone Rural Health (PA).
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ReGenesis Healthcare, based in Spartenburg, SC, is being recognized for their commitment to serving MSAWs and addressing the changing needs of the MSAWs in their community. ReGenesis has practiced hiring culturally representative and appropriate professionals that are dedicated to meeting the unique needs of the MSAW population by hiring a Spanish speaking medical director that acts as a primary care provider for their MSAW patients. This provider has built trusted relationships in their community. Additionally, ReGenesis offers an afterhours evening clinic specifically for MSAWs that was originally offered during peak season and due to demand is now available year-round.  
From left to right: Christina Castillo, AFWP Outreach Representative, Melisa Hammett, FNP-C/Medical Director of the AFWP, Marlon Hunter, CEO, SaraCrystal Rodriguez, AFWP Outreach Representative

​Keystone Rural Health, based in Gardners, PA, is being recognized for their innovative use of technology to improve their outreach efforts and better reach their MSAW population. Keystone has adopted two mobile application tools and a program called “AppSheet”. The two mobile application tools support their outreach team’s mobile patient registration, screening, immunization, and pharmacy services. The applications also support Keystone’s large-scale event planning, mapping, and stores important data and information. AppSheet is a cloud based mobile data collection application that can be used without internet connection which helps their outreach team with in-the-field data collection in rural areas. The application is also HIPPA compliant.  ​
From right to left: (front row) Grant Meckley PA-C, AWP Program Director, Maria Perez, Office Manager,(back row) Julia Camerieri, Outreach Coordinator, Tania Alvarez (back), Medical Assistant, Jennifer Gonzalez, Medical Assistant, Dr. Melanie Finkenbinder MD, Medical Director
Congratulations ReGenesis Healthcare and Keystone Rural Health! 
                                                                                     
Past recipients include: in 2018--Altura Centers for Health (CA) and Sea Mar Community Health Centers (WA), in 2019--Family HealthCare Network (CA), 2020 Ampla Health (CA), 2021--Salud Family Health Centers (CO) and Sun River Health (NY), and in 2022 Golden Valley Health Centers (CA).

Questions? Contact koeneman@ncfh.org  
Promising Practices & Strategies
 Since the inception of the Ag Worker Access Campaign, we have seen a variety of great promising practices (unique, out-of-the-box ideas) implemented at health centers (HCs) that have contributed to the increase in the number of Ag workers and their families served nationwide.  The following are strategies were shared by Ag Worker Access Champions from throughout the U.S. as one of their many contributions to the Ag Worker Access Campaign initiative.  We hope these strategies will assist your increase access efforts, and would greatly appreciate you sharing your successful strategies with us, to include here as well.
OUtreach & Marketing
  • We build strong relationships w/our Ag Workers & families 
  • Focus groups w/farmers to get ideas that help create strategies to increase access to care 
  • Outreach 
    • Outreach staff based at all health center sites
    • Clinical outreach to Camps 
    • Use of Promotoresto outreach to farmworkers
    • Enhanced outreach and follow up 
    • Reach out to H2A employers 
    • Delegating activities to coordinators so director can outreach to other partners, crew leaders, providers
    • Using a Mobile unit to provide health education 
    • Host annual health fairs to attract migrant families
    • Providing outreach with transportation
    • Increased participation in community events (Mexican Consulate, Department of Health and Environmental Control & churches)
  • Marketing
  • Use of pre-season door hangers w/outreach worker & clinic hours/contacts
  • Development of an outreach video to showcase the potential impact of outreach to farmworkers
  • Personally & individually promote services. Don’t count on a flyer
    • Networking 
Community partnerships & collaborations
  • Dental & optometry partnerships
  • Create partnerships with health care providers to offer continuity of care
  • Formed a new relationship w/the Education Commission that offers FREE summer camp to FW children
  • Collaboration w/other agencies & programs: university students 
  • Working in collaboration with local departments of health
  • Outreach events with partner organizations to provide HIV testing & health screenings in the FW camps
  • Attend health fairs
  • Partnership with Mexican and Guatemalan consulate 
  • Partnership with NC Growers Association!
  • Formed partnerships with local ag worker outreach organizations to expand our clinical capacity and scope
  • Attended Farm Bureau meetings
  • Partner w/medical school to have local clinics
  • We host mobile clinics at our farms in collaboration with University of Connecticut medical students
  • Health fairs with legal services 
  • Recruit & train summer interns for sponsor organization in order to increase their capacity and conduct more outreach 
  • Mobile clinics & telehealth services w/El Futuro (Latino mental health provider organization)
  • Advocate and lobby for camp access w/sheriffs, growers, & attorney generals
  • Conduct research regarding pesticides & cognitive development of FW youth for future resources
  • Collaborate with health centers to offer trainings to their patients 
  • Creating local partnerships to increase healthy food access
  • Outreach with local farms
  • Medical-legal partnerships/referrals
  • Partnership with PCA voucher Program 
  • Provide referrals & resources for other social services agencies
health center operations, data collection & utilization
  • Case management 
  • Have an employee assistance program to pay for specialty, medical equipment, transportation and other incidentals
  • Making “ID” cards for workers to facilitate the registration process whenever they seek care
  • Implement/improve sliding fee scale 
  • Applied for grants for new vehicles for transports
workforce development
  • Staffing
    • New staffing 
    • Increased staff to facilitate more service
    • Hiring health coaches to provide mental health services
    • Hire more field CHWs & increased wages for department
  • Training
    • Increase staff training on health education & cultural competency
    • Recruit & train summer interns for sponsor organization in order to increase their capacity and conduct more outreach 
    • Learn how to negotiateMedicaid rate on different specialties
  • Other
    • Increasing exposure to Ag worker health for medical students, pre-meds, residents, and other aspiring health professionals
addressing social determinants of health (SDOH)
  • Strengthening state level organization to help ID resources & break down social barriers (legal services, Farmworker Justice)
  • Providers go to migrant camps to answer questions and address simple health problems
  • Transportation Access
    • Transportation for establishing a good working connection with farm owners, evening appointments
    • Provide transportation to health center
    • Provide transportation to appointments at partner clinics and hospitals, and specialist doctors
    • Provide transportation for migrant children to provide medical & dental services
    • Purchased vehicles for our outreach program to facilitate transportation to medical & dental appointments
  • Access to health care services
    • Offer dental, medical, behavioral, and specialty services to Ag worker patients
    • Offer services accessible to ag workers based on needed hours, locations, languages
    • Designate blocks on Primary Care Provider’s schedule to see MSFWs on a daily basis
    • Offer dedicated medical provider to Ag workers during health center late evening clinics
    • Prioritize farmworkers when scheduling appointments 
    • Increased services to Ag workers: mental, health nutrition, peds, dental, OB/GYN, ultrasounds – All Services
    • Provide medication delivery 
    • Linkage from migrant farm worker services to HIV Program services
    • Accessible Locations
      • We have deployed the use of our mobile units to go to the farms or camp to provide services to the Ag workers in addition to that we also designated a specific outreach worker to provide outreach services to the Ag workers!
      • Providing mobile clinics where ag workers live and work - medical and dental
      • Expanded Outreach clinics to new locations
      • Flu shot clinics at farms
      • Health screening & education during lunch & dinner hours at job site
      • Telemedicine
        • Implementing telehealth behavioral health services 
        • We increased access to behavioral health to our Haitian patients using telehealth
      • Free field screenings during harvest season
      • Mobile STI/HIV testing & health education 
      • Mobile dental clinic for kids
    • Accessible Hours of Operation
      • Adjust hours of service to meet Ag worker needs
        • Extended clinic service hours
        • Evening clinics
        • Night clinics
        • Saturday clinics
      • Seasonal late clinic
      • We provide evening clinics on sight, legal, behavioral, social services 
      • Visit camps at least 2 nights every week and during lunch time 
  • Language Preference or Limited English Proficiency:
    • Available after-hours nurse line in multiple languages
    • Advocate with partners to improve language access & culturally appropriate services
    • Provide translation/Interpretation services
      • Offer interpretation case management 
      • Interpret for farmworkers at dental clinic (transport & arrange appointments)
    • Bilingual providers
      • Access to free clinic with bilingual provider 
      • Bilingual behavioral health providers
    • Translate and read letters for them
  • Health Education
    • Connect farmworker with health resources 
    • Provide farmworker education in the workplace
    • Providers go to migrant camps to answer questions and address simple health problems
    • HIV peer adherence educators to support & educate newly diagnosed FW & link to care
  • Eligibility Assistance
    • Assist Ag workers with filling out applications for Medicaid & ACA for health care
    • Provide sliding fee program orientation
  • Access to media and emerging technologies:
    • Computers and Connectivity Project: Provide hotspots, computers, and iPads to farmworkers to have access to online resources and to connect with family back home
For questions or more info on Campaign, contact us at AgWorkerAccess@ncfh.org