1. Migrant and Community Health Centers : Occupational Health and Safety for Latino Workers Karen Mountain, MBA, MSN, RN Chief Executive Officer Migrant Clinicians Network Amy K. Liebman, MPA, MA Director of Environmental and Occupational Health Migrant Clinicians Network April 15, 2010

2. Migrant Clinicians Network MCN is the oldest and largest clinical network for the mobile underserved Founded in 1984 by clinicians working in migrant health The mission of MCN is to be a force for justice in healthcare for the mobile poor Over 5,000 constituents 157 federally funded Migrant and Community Health Centers Images © Alan Pogue

3. Need for relevant information about the Migrant and Seasonal Farmworker (MSFW) population MCN set out to develop a system for rapid access to data to aid health centers in planning and health care service delivery –Gather up-to-date, locally specific descriptive profiles of MSFW population –Provide a mechanism to determine future trends that can affect health services delivery –Can be self-sustaining and allow for collaboration between providers © Alan Pogue

4. Methodology 1.Develop a system to profile MSFWs from service agency data Compare client data regularly collected by state / local MSFW serving agencies to determine how it can be combined to benefit all programs 2.Identify Agricultural and MSFW Characteristics Change Factors Trends common to agricultural production and determinants of MSFW presence can be investigated at the local level to assist service design and delivery 3.Gather input from knowledgeable individuals to profile MSFWs / identify changes Sentinel Network Direct interviews at Stream Forums Focus groups

5. Results –The picture for MSFW is fairly consistent nationally: Immigration issues significant Increase in seasonal workers who no longer migrate –Some regional differences: More indigenous representation in the West with corresponding language challenges More individuals looking for agricultural work in the East –Challenges to meeting the need: Financial -- loss of complementary funding, such as Medicaid Cultural -- language differences and culture of health Photo © Earl Dotter © earldotter.com

6. Conclusions Need for real time, accurate information about MSFW populations Principal benefit identified by respondents was for planning/forecasting: –Short and long-term needs –Ability to be prepared –Ability to anticipate need Respondents willing to participate in data collection projects © earldotter.com

7. EPA National Strategies for Healthcare Providers: Pesticide Initiative Cooperative Agreements with EPA Office of Pesticide Programs to: –Improve OEM training of healthcare providers –Improve recognition and management of pesticide-related conditions MCN— Practice University of Washington— Education

8. Obstacles for Primary Care Providers/ Staff BUSY Unfamiliar terminology/ practice –Toxicology –Ergonomics –Taking an OEH history Public Health Paradigm –Prevention v. Curative Care –Connect disease to Exposure – Eliminate/Reduce Exposure Workers’ Compensation/ Legal system/ Reporting Office Based –Working w/employers? In the field?

9. Saving Lives By Changing Practices SIMPLE, Flexible, Effective –Partnerships with Health Centers MCN/Center Contract, Clinician Champion –Practical On-site Training for the Primary Care Provider –Resources (development and provision) –Connecting Primary Care to Occupational and Environmental Medicine –On-going Technical Assistance Goal: Change in Clinical Systems –Intake, screening –clinical policies –outreach/education for injury/exposure prevention © earldotter.com

10. EOH Screening Questions 1. (Occupation) Describe what you do for work. 2. (Activities and Cause) Are there any physical activities that you do – at work or away from work – that you feel are harmful to you? 3.(Substances/Physical Hazards and Cause) Are you exposed to chemicals, fumes, dusts, noise, and/or high heat at your work or away from work? Do you think these are harming you? Developed by MCN with guidance from the Occupational and Environmental Medical Residency Directors Association and endorsed by the Association for Occupational and Environmental Clinics, 2007.

11. Results through December 2009 Replicable and Sustainable EOH Model for Primary Care Implemented in 8 Migrant/Community Health Centers –Changes in clinical systems including: intake, screening, outreach and education –Primary care provider willingness to acknowledge and address occupational injury and exposure Improved primary care for the patient 60,000 Clinical Resources Distributed/30,000 Pesticide Educational Comic Books Distributed 2,000 Clinicians Trained Active Partnerships with 13 Organizations with Expertise in Occupational/Environmental Medicine and Agricultural Medicine

12. Coming Full Circle Clinic/Clinician Role in Public Health Opportunity for HRSA –Occupational Medicine at Migrant Health Centers Opportunity for OSHA –More involvement in the health/safety of agricultural workers –Surveillance Clinicians need a dynamic system that offers immediate and useful feed back

13. MCN MISSION To be force for justice in health care for the mobile poor www.migrantclinician.org