1. Building Health Liaisons Between Multiple Communities Loretta J. Heuer, Ph.D., R.N. Andrea Smith, BS Mari Lou Gonzalez, DLE Migrant Health Service, Inc. 810 4 th Avenue South Moorhead, MN

2. Demographics The U.S. Public Health Service estimates a total of 3.5 million migrant and seasonal farmworkers in the United States (http://www.migrantclinician.org/migrant_info/migrant.php)http://www.migrantclinician.org/migrant_info/migrant.php Each year, 20,000 to 35,000 migrant farmworkers travel to Minnesota to work in agriculture (CURA Reporter, 2001). Migrant Health Service, Inc., (MHSI) Voucher Program in Moorhead, Minnesota annually provides health care services to 7,000 farmworkers.

3. Demographics Migrant Farmworkers 50% Hispanic; 35% African-Americans; and 15% Asian, White, or other (Bureau of Primary Health Care Program, 2001). Median education level for the head of the household was six years (National Center for Farmworker Health, 2005). Annual wages of less than $6,250 (National Agricultural Workers Survey, 2000). Some workers live apart from their families, others travel with their families (National Centers for Farmworker Health, 2005).

4. Migrant Health Service, Inc. Background A non-profit agency that provides health care and education to migrant and seasonal farm workers and their families. MHSI has six seasonal and three year-round nurse-managed health centers located in rural Minnesota and North Dakota. MHSI employs four mid-levels, 28 nurses, 50 Bilingual Health Outreach Workers, and nine office managers. Over 450 community providers work with MHSI.

5. Migrant Health Services, Inc. Nine migrant nurse-managed health clinics in Minnesota and North Dakota.

6. Migrant Health Service, Inc. (MHSI) Diabetes Program Background In 1998, MHSI piloted a diabetes program in six rural, summer-only, nurse-managed health centers. In 1999, the Diabetes Program was revised and expanded to encompass eight nurse-managed health centers and two year-around sites. In 2000, Diabetes Lay Educator (DLE) were incorporated into the MHSI Diabetes Program.

7. The Diabetes Lay Educators 2003 - 2005 Grafton, ND - Laredo, TX Bathgate, ND - Crystal City, TX Minto, ND - La Joya, TX Moorhead, MN - Roma, Rio Grande, La Grualla, TX

8. Hiring Diabetes Lay Educators Diabetes Program staff recruited natural leaders from the migrant population to learn concepts of health education and to conduct support group meetings for migrant farm workers in Minnesota, North Dakota, and Texas. Advertised for the positions throughout MHSI. Word of mouth traveled fast and soon there were six individuals ready to take on the position of being a DLE. DLEs work on a contractual basis. Contract is renewed yearly.

9. DLE Job Description Schedule educational/support group meetings for diabetic clients while in Minnesota, North Dakota and Texas. Act as a liaison between clients and health providers to ensure quality services. In the community, take clients blood pressures, blood sugar, and monitor the management of their diabetes. Complete reports and necessary documentation at regular intervals. Perform duties essential to this position and the Diabetes Program.

10. DLE Training Initial training session was 2 days with the Altru Diabetes Center staff. Additional training sessions are held 2-3 times each summer. Continual education thru bi-weekly conference calls during the off season. Topics of Training: Etiology of diabetes, self-management of diabetes, complications of diabetes, medications, how to conduct support group meetings, and other topics as requested by the DLEs.

12. DLE Support Group Meetings At the Support Group Meetings: An area health care providers speak on a topic related to diabetes Clients blood pressure and blood sugar is taken. Test strips given as needed for attendance at meeting. Door prizes are given to motivate and educate the clients. Clients are asked to fill out evaluations at the end of the meeting.

14. DLE Experience Background Personal History Wapato, Washington Grew-up as a migrant Family worked in the apple, plums, peaches, and pears harvests Graduated from high school.in Washington Currently as a Diabetes Lay Educator Texas - Roma, Rio Grande Valley Minnesota – Moorhead, Hillsboro

16. DLE Experience Client Story Minnesota 52 year-old, male farmworker with diabetes and depression. Death of a son, strain on family relationship Emotional Support – Needs attention and someone to listen to him. Show appreciation and recognition as a person Social Support - Makes an effort to attend MHSI activities such as the Diabetes Cluster Clinic. Appreciative of services provided by MHSI staff and DLE.

17. DLE Experience Client Story Texas/Minnesota 51 year-old female nonworking due to her obesity and diabetes. Difficult for her to walk because of her obesity. Gastric bypass Emotional Support – Needs attention and someone to listen to her. Social Support - Makes an effort to attend MHSI activities such as the Support group meetings and Diabetes Cluster Clinics. Always treats MHSI staff and DLE with respect. Appreciative of services provided by MHSI staff and DLE.

19. DLE Experience Working as a DLE, I am able to: Learn about diabetes, cardiovascular, and obesity Educate clients in the support group meetings and home visits. Feel like I am helping the clients. Gain client trust and support resulting in feeling of comrade Feel like I am part of a group with the other DLEs (e.g. respect and trust). Teach MHSI staff and providers about the Mexican American culture and health care. In conclusion, a lot of respect and caring is demonstrated from the clients, MHSI staff, and providers because the DLEs are known as educators in the community.

21. Program Challenges Continuing education or updating of current diabetes information for the DLEs. Supervision needs to be conducted from a distance while the DLEs are in Texas. MHSI staff visit the DLEs in Texas to: Meet with them and address they issues they are encountering Attend support group meetings Conduct home visits with clients Meet with health care professionals Communication with the DLEs from a distance. Conference calls Continuing availability of funding for the program.

22. Conclusions Establishing relationships in Minnesota, North Dakota, and Texas is essential. Agencies at the community, state, and national levels. Political officials at the local, state, and national levels. DLEs: They have become advocates for their clients. They have taken on more responsibilities; they help clients with outreach in communities. Migrant Clients: They are able to have more continuity in their care. They have formed relationships with the lay educator that covers their area.

23. Conclusions Chronic Disease Registry: Information gathered from the DLEs is entered in the Chronic Disease Registry. National Rural Health Association (NRHA) Award for Outstanding Rural Health Program. In 2003, the NHRA recognized the program as an innovative community-based program that meets the health care needs of the rural Hispanic farm worker population in Minnesota, North Dakota, and Texas. National Association for Rural Health selected our program to be recognized in a book.

24. Questions?