Salud Para La Gente

Connection to Moving Health Care Upstream

A young mother brings her small son, suffering from asthma, to a clinic for the first time. The boy also has a skin irritation and a rash. His mother, a young Hispanic farm worker who speaks little English, tells the intake worker that she is living in a shelter near her work and the boy is living separately with extended family, miles away from her.

They cannot live together because the house they were renting was in dangerous disrepair. The health screener takes note and connects the woman with legal services. That leads to action against the landlord, repairs of the egregious conditions at the house for which the woman had a signed and binding lease and the reuniting of the boy with his mother in a healthier living space.

Welcome to integrated community health care in Watsonville, CA, where Salud Para La Gente (Healthcare for the People) and the Watsonville Law Center team with other community-based organizations to provide care and support to help hard-working, low income farmworker and related industrial worker families get by in California’s affluent Central Coast region.

Our Community & Need

For 40 years, Salud clinics have been a main source of low-cost, high quality healthcare for Santa Cruz and Monterey counties. A grant available to members of MHCU’s Improvement Network allowed Salud to form a unique collaboration with a non-profit legal aid office, a student assistance and family counseling program, and an organization that provides financial education and capacity building. The collaboration is focused on the holistic needs of the children and families that come to the health clinic in Watsonville. It’s one of two full-time Salud facilities along with eleven specialty and school-based clinics. About half of the patients they see are under 18. Many are children who live with limited adult oversight as their parents struggle to keep up with more than one job and seasonal work.

About 90 percent of the people they serve are Latino, including many who are Mexican immigrants, and indigenous people from Mexico who often speak a language, other than English or Spanish. Salud Para La Gente’s Chief Executive Officer, Dori Rose Inda, is an attorney and former social worker who founded Watsonville Law Center and developed the Agricultural Workers Access to Health Care Project. The current director of Watsonville Law Center, Henry Martin, says housing and transportation are huge issues affecting these families, and as recent immigrants with little formal education, they often need help to better understand their rights as workers and as consumers.

“Our community members live very stressful lives,” said Ms. Inda. “Each of the organizations we work with has its own doorway into the community. Our shared challenge is to create an experience for our patients that feels seamless and meets their physical health needs while also addressing the aspects in their lives- their work, home and school- that affect their health. Our goal is to identify and address the root causes of poor health through wrap-around services that help keep families intact, keep young people in school and out of gangs, enable a safe work and living environment, and ensure access to other protective laws and basic rights.”

“We see a lot of women and children who are in harmful living situations. We want to provide both the medical and social support they need, in a structured way. We’re developing a system where pediatricians are trained to listen and refer parents to educators who help parents identify developmental delays. A navigator screens further and connects patients with the expanded health care team.

Martin said a big problem for farm workers is wage theft and denial of responsibility for care when employees are injured. Affordable housing is also a challenge, “Each of the partners is engaged in really advanced work in their field on behalf of our clients and patients, which sometimes makes it harder to integrate what we are doing,” he explained.

Other partner organizations include Pajaro Valley Prevention and Student Assistance (PVPSA), which promotes safe schools, anti-violence programs, and student success; and Santa Cruz Community Ventures, a credit union affiliate that helps with household finance, consumer education, tax assistance and small loan support. PVPSA’s director comes out of the county health department and brings an exciting vision that connects student success to family health and safety. Future partners could include the police department and other agencies or funders.

“We are a learning collaborative working to give the community a voice in figuring out what other kinds of structured support they need. Health screening leads to disclosure about family circumstances, education and other issues. We’re designing as we go and determining what works best,” Ms. Rose Inda said.

“And, we’re trying to figure out scaling. Design and testing is slow but we’re looking to create a system that others can learn from and adapt. The MHCU network has been an invaluable resource. Five years out we hope we’ll have a model that enables us to assess the circumstances of our patients’ lives and provide a bundle of services for them to choose from to help them flourish in their daily lives,” Rose Inda said.

Lessons Learned

This pilot has illustrated the need for learning among staff, patients and stakeholders for success. We learned that our community was uncomfortable when asked questions about the social determinants of health at the clinic. Changing cultural knowledge about health within the community is a key step in building the success of the program because participants need to understand that their health is impacted by issues that may seem to them unrelated to the doctor’s office. This change is necessary for patients to actively take part in the program.

The challenges have included:

• Identifying and signing up participants to access the full cross-sector services. We learned that there were two levels of work we need to be doing: 1) changing the cultural knowledge about health, and 2) assessing readiness for change in families. Families are very concerned with meeting their immediate needs and are overwhelmed by the circumstances of poverty, which makes it a challenge to think about wellbeing and the services offered through this program that can improve their health. Each family is at a different point of readiness. We are working into design supporting patient readiness to identify a family’s socio-contextual needs and choosing to access assistance with those needs. For example, a family facing stability of housing or relationship insecurity may not be ready to receive financial education about budgeting, even if their screening responses indicate a need.
• Finding the best system and platform to share information between partners while protecting patient privacy and meeting the other privacy laws each partner works under, is a challenge and has slowed progress. Our research illustrated there are two sides to the question of HIPPA compliance, one being the health center’s, which can be met by the partners signing a business associate agreement (BAA), and the other for the partners, because they do not meet the requirements of IT infrastructure they are agreeing to when they sign the BAA. We now understand that Salud needs to own and hold the patient co-management platform so that our partners can sign on and share and access info, and are not being held to HIPPA compliant rules for their IT infrastructure.
• We have struggled with not having staffing to provide consistent patient services and service coordination. The partners’ commitment of leadership has not yet translated into resources that allow for sufficient staffing. Relying on interns creates inconsistency in access and communication.
• A design model is foreign to staff and we have struggled to ensure they understand the design concept of the program and that it is not yet focused on implementation and scale.

Our Community Partners

Collaborators directly associated with this work include:

Salud Para La Gente
Pajaro Valley Prevention and Student Assistance
Santa Cruz Community Venture
Watsonville Law Center

For More Information

If you would like more information, please see these resources:

Healthy Families Flyer
Logic Model for our Work
Flow Chart
Screening Tool (English)

Contact Us

For more information please contact Dori Rose Inda at [email protected], Henry Martin at [email protected], Maria Cadenas at [email protected] or Erica Padilla Chavez at [email protected].