2018 Joint CIG Dissemination Event

1. Leveraging Resources, Relationships, and Creativity to Address Migrant Health Needs Naomi Wolcott-MacCausland Migrant Health Coordinator University of Vermont Extension 2018 Joint CIG Dissemination Event

2. Leveraging Resources, Relationships, and Creativity to Address Migrant Health Needs Dairy Central America Vermont MEP Medical Interpreting Huertas Bridges to Health 2018 Joint CIG Dissemination Event

3. Addressing Migrant Health Needs Introduce yourself! Name A sentence about your work Share any current connection to migrant health 2018 Joint CIG Dissemination Event

4. Addressing Migrant Health Needs Accessing health care services Think about the last time you received health care services. Write down each decision and action needed from deciding to seek out health care services through following a treatment plan and/or billing. Knowledge needed? Skills needed? 2018 Joint CIG Dissemination Event

5. Addressing Migrant Health Needs Barriers to Health Care Services Systemic • Language access • Cultural competency (ag life; indigenous; rural; latino/a; immigrant • Ineligibility for health insurance • Complex health care system • Inconsistency in sliding fee across FQHCs • Inconsistency in free care across hospitals • Complex paperwork and billing • Discrimination Individual • Fear • Language ability • Cost • Knowledge of health care system • Transportation • Shame/stigma about asking for services • Different cultural health beliefs • Work conflicts • Power dynamic with employer 2018 Joint CIG Dissemination Event

6. Addressing Migrant Health Needs • Bridges to Health works statewide to ensure equal opportunities to health for immigrant farmworkers through increasing access to culturally and linguistically appropriate health care services in local communities. • Model 1- ODC: Health Outreach, Care Coordination, & Clinic Services • Enabling Services/Care Coordination • Care Coordinator & Outreach Nurse • Free Clinic – variety of health services – 1 County • Referrals for additional needs • Model 2- UVM Ext: Health Outreach & Care Coordination • Enabling Services/Care Coordination • Coordinator + Promoter/Recruiters - 13 VT Counties • Referrals to established health entities 2018 Joint CIG Dissemination Event

7. Addressing Migrant Health Needs • Bridges to Health • Technical assistance • Language access policies, implementation, and feedback • Mental Health Focus • Mental Health Outreach Strategy • Mental Health Promotion Activities in field • Mental health screenings and referrals for treatment • Targeted Training and TA • Designated Mental Health Agencies • Imbedded Social Workers (FQHCs/PPNNE/Free Clinics) • Protocol & Policy review and feedback • Training for Outreach workers • Mental Health First Aid 2018 Joint CIG Dissemination Event

8. Addressing Migrant Health Needs • Migrant Education Program/Bridges to Health Marriage • Recruiter/Promoter Model • Why it works • Trusted, established relationships • Bilingual staff • Mutually beneficial • Maximization of outreach effectiveness and leveraging resources • Reduction of barriers: language, transportation, cost, knowledge of health care system • Promotion of systemic changes at health access points • Sustained impact for MEP students regardless of continued funding • Modified CWH/Promoter model contextualized for VT farmworkers • Increase in # of workers accessing care • Increase in independence of workers • Increase in # and variety of health access points • Improved language services at health entities 2018 Joint CIG Dissemination Event

9. Addressing Migrant Health Needs • ACTIVITY • Rate current stress level on scale of 1-10 • Choose a panel from the activities table that resonates with you • Grab colored pencils (please share ) • Color silently for 3 minutes • Rate stress level again 1-10 • Share why you chose that particular panel as well as any change in stress level with your table • Choose table member to report out to full group 2018 Joint CIG Dissemination Event

10. Coloring • Therapeutic potential* • reduce anxiety and stress • restore or create focus • be present/mindful • *limited empirical research with mixed results

11. Addressing Migrant Health Needs • Community Collaborations & Partnerships • Increases Capacity To Offer More Services • Health Education • Kitchen Gardens • Free Health Screenings • Addresses Social Determinants of Health • Food Security • Transportation • Access to Health Services • Social supports/networks 2018 Joint CIG Dissemination Event

13. Addressing Migrant Health Needs El Viaje Mas Caro/The Most Costly Journey Comics as a way to broach conversations of mental health and wellbeing Innovative Community Collaboration: Free Clinic Outreach Nurse – Open Door Clinic Migrant Health Coordinator- University of Vermont Extension Anthropology Professor – University of Vermont Self Proclaimed Comic Nerd – Vermont Folklife Center Cartoonist and Educator - Marek Bennett's Comics Workshop 2018 Joint CIG Dissemination Event

14. Addressing Migrant Health Needs • El Viaje Mas Caro/The Most Costly Journey • Recurring themes: Stress, anxiety, sadness as a result of…. • Language barrier & communication issues • Isolation • Sacrifice for the family and a future (”getting ahead in life”) • Distance from family and home community • Separation from children/spouse • Relationships with employers • Cultural differences • HealthcareNeeds • Fear/Documentation Status • Traumaticexperiences • Border Crossings 2018 Joint CIG Dissemination Event

15. Addressing Migrant Health Needs • El Viaje Mas Caro/The Most Costly Journey • Storytelling to acknowledge difficult lived experiences • Beneficial to the storyteller • Opportunity to reflect and process • Validation of experiences and related emotions • Beneficial to the reader • Connectivity despite isolation • Possible exploration of coping mechanisms • Tool for outreach worker • Accessible interesting medium • Touches on mental health indirectly • Wide range of themes 2018 Joint CIG Dissemination Event

16. Addressing Migrant Health Needs • El Viaje Mas Caro/The Most Costly Journey 20 booklets by 26 storytellers & 15 local artists 2018 Joint CIG Dissemination Event

17. Addressing Migrant Health Needs • ACTIVITY • Read comic assigned to your table • Assign a note taker • As a group, identify themes connected to wellbeing (physical, emotional, spiritual wellness) • Discuss ways, if any, this comic or similar ones could be incorporated into your interactions with immigrant OSY in a beneficial way • Use large white poster board to compile list of ideas • Select three ideas and share with larger group 2018 Joint CIG Dissemination Event

18. Addressing Migrant Health Needs El Viaje Mas Caro/The Most Costly Journey • Levels of engagement with farmworkers • Distribution of series • Distribution of individual comics as they relate to people personally • Panels about coping strategies as handouts for coloring activity • Gateway to casual conversations about mental health and wellbeing • Intentional use within (mental) health promotion activities • Incorporation into education lessons (ESL, Writing, Reading, Mental Health) 2018 Joint CIG Dissemination Event

19. Addressing Migrant Health Needs El Viaje Mas Caro/The Most Costly Journey • Training tool for service providers • Outreach workers • Primary care providers • Mental health professionals • Teachers • Administrators 2018 Joint CIG Dissemination Event

20. Addressing Migrant Health Needs • El Precio de Quedarse/The Price of Staying • Mental health training for outreach workers • Therapeutic Use of Cartoon Booklets • The Benefits of Mind-Body Medicine • Providing Support in the Context of Trauma • Mental health promotion activities with workers • Creation of space within activities to read together and • reflect on similarities, differences, and coping skills 2018 Joint CIG Dissemination Event

21. Addressing Migrant Health Needs Participant poll: Who can name the 5 mental health topics with the GOSOSY Mental Health Lessons? How many participants have used at least 1 Mental Health Lesson with students? How many have used all of the Mental Health Lessons with students? Mental Health Alcohol Use Stress Anxiety Depression 2018 Joint CIG Dissemination Event

22. Addressing Migrant Health Needs Using Comics to Complement GOSOSY Mental Health Lessons • As a pre-activity • Select comic that you think connects with the topic you want to explore • Preselect a few panels that you may want to discuss. • Give student the choice of reading on own or out loud with you. • Ask the student what s/he thought about the story. Allow time to reflect. • Explain that to you, XYZ (the topic you want to explore) stood out when you read the comic and ask student to identify anything that the storyteller shared that connects to XYZ. • Open the comic book to panels that student has mentioned or you have pre-selected and ask student what s/he thinks about what the storyteller has shared. Share with the student that XYZ effects many people including some of your students. • Let him/her know that XYZ is a topic that you’d like to explore more. If there is • time, transition into the selected Mental Health Lesson. If not, set up a day and • time in the future. 2018 Joint CIG Dissemination Event

23. Addressing Migrant Health Needs Using Comics to Complement GOSOSY Mental Health Lessons • As a post-activity • Select comic that you think connects with the mental health lesson you already completed with the student. • Preselect a few panels that you may want to discuss • Give student the choice of reading on own or out loud with you. • Ask student what s/he thought about the story. Allow time to reflect. • Ask student if s/he thinks the storyteller struggles with XYZ (topic of the lesson) and to discuss his/her why or why not. • Reinforce concepts of the lesson asking about any symptoms the storyteller may or may not have based on the specific examples as well as the experiences the storyteller shared. • Ask the student what suggestions s/he would have for the storyteller if s/he is struggling with XYZ. 2018 Joint CIG Dissemination Event

24. Addressing Migrant Health Needs 2018 Joint CIG Dissemination Event

25. Addressing Migrant Health Needs Using Comics to Complement GOSOSY Mental Health Lessons Think – Pair – Share – Share Think about other ways to use comics in conjunction with GOSOSY Mental Health Lessons Pair with someone who is not at your table (stand up – move around!) Share your idea for using the comic with lessons Share with me! by writing your idea(s) on a sticky note in my idea corner! 2018 Joint CIG Dissemination Event

26. Addressing Migrant Health Needs Wrap up discussion Questions? Comments? 2018 Joint CIG Dissemination Event

27. Addressing Migrant Health Needs Thank you to the storytellers for trusting us with their stories and allowing local artists to bring these stories to life. All illustrations in this presentation are excerpts from El Viaje Mas Caro Artwork by: Shashwat Mishra Michael Tonn Glynnis Fawkes Michelle Sayles Kevin Kite Kane Lynch Tillie Walden John Carvajal Marek Bennett Iona Fox Stephanie Zuppo Rick Veitch Ezra Veitch Angela Boyle Greg Giordano 2018 Joint CIG Dissemination Event

28. Addressing Migrant Health Needs THANK YOU! Naomi Wolcott-MacCausland nwolcott@uvm.edu https://www.vermontfolklifecenter.org/elviajemascaro-eng 2018 Joint CIG Dissemination Event