1. Low German Mennonite Farmworkers: Increasing Access to Preventive and Primary Health Care Services Kansas Public Health Association, Inc. 2006 Fall Conference

2. Introduction Kansas Statewide Farmworker Health Program (KSFHP) works to increase access to health care and help farmworkers stay healthy. KSFHP utilizes a voucher/case manager model to serve farmworkers through out the state, relying on a network of public and private health providers to deliver services.

3. Background/Need Farmworkers in Kansas are typically low income (under 200% of income), and uninsured. Traditionally farmwork in Kansas has been done by Latino migrant or recent immigrants from Mexico. Beginning in the late 1990s a new group of people began to come to Kansas to work in farmwork. They are Low German speaking Mennonites (LGMs) from colonies in Mexico. In 2005 they made up 39% of farmworkers served in KSFHP.

4. Background/Need In 2003, KSFHP partnered with the Mennonite Church U.S.A, Western District Conference to survey the LGMs to learn more about their culture, language and health needs.

5. Survey Exposed Significant Health Needs Only 3% of the LGMs had health insurance 26% of LGMs had never been to a doctor or clinic 41% were not planning their families 19% had not been to the dentist in the past five years (4% had never been) 48% had had six or more teeth removed

6. Healthy Kansas 2010-Social Determinants KSFHP staff recognized that low income, insurance status, language and culture were all issues impacting on access to care and we determined that while we could do little to address disparities through income, we could impact them through education and social support for the LGM farmworkers.

7. Goals/Objectives KSFHP determined that our focus with the LGMs would be on two of the three HP2010 Leading Health Indicator objectives : Increase the proportion of persons who have a specific source of ongoing care Increase the proportion of pregnant women who begin prenatal care in the first trimester of pregnancy

8. A New Model to Achieve Our Goals Through the addition of bilingual LG/English health promoters, KSFHP would be able to Provide outreach to the LGM community Educate LGMs regarding U.S. Healthcare system Educate regarding the importance of preventive care such as family planning and prenatal care Present KSFHP as a means to help them find a medical home that was affordable Provide support in access and follow up and to assure barriers (such as language) are identified and addressed.

9. Harvest of Health To provide health information in a language that LGMs could utilize, Harvest of Health, audio recordings on health topics in English, Spanish and Low German were developed and distributed to farmworkers and providers. To hear these audio recordings go to www.kdheks.gov/olrh/FWAudioEd.htm

10. Who Is Involved? KSFHP has relied on its partnerships with the farmworker community, the church, the network of public and private health providers throughout the state as well as early funding from foundations to implement the survey, pilot the health promoters project and develop the Harvest of Health project.

11. Progress As a result of the health promoter program and the a resulting Medical Expansion Grant, KSFHP has: Dramatically increased the number of LGM farmworkers accessing care through KSFHP. In 2002 359 LGMs were served, while in 2005 KSFHP provided health services to 1466 LGMs. Experienced an increase in LGM women accessing family planning, and Seen an increase in LGM women accessing early prenatal care.

12. Future Impact of HK 2010 Continued improvements in comprehensive access to care and application of social determinants understanding to removing barriers. Move beyond healthcare access to encourage healthy choices through health/wellness marketing. Immunizations-Educate and support LGM families to immunize children who are not up to date. Develop small groups to utilize aspects of the Chronic Disease Model to address Depression and Anxiety.

13. Application Increase use of preventive services and access to care through identifying and addressing barriers. In the case of non dominant cultural or language groups, a health promoter model may reduce barriers, and increase trust, knowledge, and provide encouragement for clients to utilize preventive health services and make healthier choices.