The U.S. health care system often is confusing to immigrants. Community-based health outreach projects demystify the health care system by employing local residents as outreach workers who bring services directly to communities.

RWJF supported several projects that trained local residents to reach into their communities, bringing culturally sensitive health information to immigrants in their own language. These projects educated immigrants about health topics, helped them navigate the health care system and sometimes provided basic health care services such as screening for chronic illness.

Lessons Learned
Some of these projects learned lessons that apply to similar community-based health outreach projects.

• Community health workers can reduce sociocultural barriers. Community health workers form an effective bridge between the immigrant or ethnic community and the health care organizations. (See Program Results on Opening Doors.)
• Training is key. The success of these projects is dependent on the quality of the training provided to community health workers. (See Program Results on Opening Doors.)
• Providers benefit, too. Health care organizations build consumer loyalty when they provide outreach and interpreter services. In one case, for example, a large percentage of patients who visited a medical center's two clinics that employed community health workers also elected to join the medical center's health maintenance organization. (See Program Results on Opening Doors.)
• Build relationships in the community early on. Projects that had a demonstrated commitment from community organizations before they began had less difficulty getting started and had to make fewer time-consuming modifications as their programs progressed. (See Program Results on Opening Doors and ID# 031226.)

Results From Individual Projects
Farmworkers
Many migrant farmworkers are undocumented immigrants. Three projects addressed their health needs.

• New Jersey. Community Health Care recruited migrant farmworkers in Cumberland County, N.J., to help improve the health of their fellow farmworkers. The migrant farmworkers-turned-health-promoters provided individual and group health care education and referrals for individuals with diabetes, hypertension or HIV, and made follow-up visits to all farmworkers newly identified with these diseases. They also organized recreational, cultural, and educational activities to reduce levels of stress and boredom that can lead to substance abuse among farmworkers. (See Program Results on ID# 027974.)
• Miami. The Nuestra Decision Project trained and deployed male farmworkers as family planning health promoters in their communities. The men visited homes, led educational group sessions, and assisted their neighbors to gain access to community health resources for family planning, prenatal care, children's health, and care for men. The project saw an increase in women entering prenatal care in their first trimester, men accompanying their partners to these visits and bringing their children to the clinic, women seeking family planning services, and men seeking health care services for themselves. (See Program Results on Opening Doors.)
• Florida. The State of Florida implemented a system of tuberculosis (TB) outreach, screening and treatment among the migrant farmworker population in North Florida, with a replication in South Florida that did not work particularly well. During a three-year period, project staff treated 93 percent of farmworkers in North Florida with active TB. Outreach workers educated migrant workers and local health care providers. A plan to track workers when they crossed state boundaries was not effective. (See Program Results on ID#023611.)

Projects in California

• Asthma education along the Mexico border. In 2002, the Spirit of Caring Mobile Health Clinic expanded its services to include asthma education, screening and treatment for children and families, many of them immigrants, in the Chula Vista Elementary School District in Southern California, near the Mexico border. (See Program Results on ID# 042092.)
• Schools in San Francisco. Health outreach workers in San Francisco saw school registration as an opportunity to reach immigrants who frequently are underserved by health services. The initiative placed bilingual, bicultural field workers in the registration centers to offer health screening and community resources as part of the registration process. This strategy achieved multiple objectives: it found children with immediate health needs, linked families with primary care, and documented the health needs of the population. (See Program Results on ID# 019621.)
• Laotians in Northern California. Shasta Community Health Center in Redding, Calif., developed a dedicated appointment and communication line in the Mien language of the local Laotian immigrant population. Two interpreters and an outreach worker established a unique alliance with the community's shaman, the traditional spiritual healer, to whom doctors refer cases that are spiritual in nature. As a result of these actions, the immunization rate of two-year-old Southeast Asians in Redding increased from 36 to 93 percent and hospital emergency room visits by Southeast Asian families decreased 20 percent. (See Program Results on Opening Doors.)
• Latinos in South Central Los Angeles. Bilingual health promoters, recruited from the local community, reached some 20,000 community members, many of them immigrants, through community health education activities in Los Angeles schools, local parishes, health fairs and community centers during a three-year period. Esperanza Community Housing Corporation trained the health promoters, with funding from RWJF. (See Program Results on ID# 037474.)

Projects in Other Locations

• Links between a medical center and community center. The Seattle-based Community House Calls project addressed the gap in cultural practices between individual providers and institutions, and immigrants. Bilingual, bicultural members of the health care team helped Cambodians and East Africans navigate the health and social services systems. They worked both as interpreters in the hospital and as outreach workers assisting families in the community. To publicize what it learned, Community House Calls created an online database, EthnoMed, which offers information on culture, language and health. (See Program Results on Opening Doors.)
• Asian immigrants in Philadelphia. The Chinese Health Information Center connected Asian immigrants in Philadelphia's Chinatown with health care services including insurance benefits, health screening, medical translation and parenting workshops. (See Program Results on ID# 031226.)