“A friend of mine who knew I needed some help suggested I reach out to the [Bridges to Health] Community Health Worker in my area. I came to Vermont about 6 month ago with my partner Maria* and her nephew, Jorge*. We had solid work for a month but the relationship with the employer soured. We are looking for consistent repair and maintenance work but some weeks I only have work for two days and Jorge might just work one day. There are times when we don’t have enough money for food. The Community Health Worker brought us to a food shelf where we can go to make sure we have enough to eat during the weeks that we don’t have a lot of work. I also had some aches and pains and didn’t know what to do. The Community Health Worker got me an appointment at a free clinic [for the uninsured] and recently was able to help my partner Maria* and her nephew Jorge* with their medical needs as well. She also supported me and Jorge to get our driver’s license which means we now have a Vermont identification card and can drive where we need to for work, food and health needs. My brother just joined us here in Vermont so I am hoping she can support him with medical and other needs too. If it wasn’t for the Community Health Worker, we wouldn’t know about or be able to access any of the community resources we now know about. We are so grateful for her help while we look towards a better future.” *Pedro – migrant worker in service industry
“My partner and I have been in Vermont for over 5 years. When we first arrived, and especially when I got pregnant the first time, I didn’t know what to do when faced with health needs. Due to a language barrier, lack of knowledge of services, and without transportation, I needed help every step of the way. Over time, both of us got our driver’s licenses and we moved from one county to another a few years ago. At first, even though it was three hours round trip, we kept going to the same pediatrician, clinic, and dentist because we knew where to go and were already established patients. The distance was hard though because we were both working 60 plus hours a week and had to take our daughter out of school for the full day to go to the pediatrician. We reached out to a Community Health Worker who helped us get a pediatrician close to home and to connect to local health services. When I got pregnant this year, I had heard about an insurance program for pregnant women through Migrant Justice but didn’t know how to apply. A Community Health Worker helped me apply gathering the required paperwork and in understanding the many pages of paperwork that arrived. She also helped me make my first appointment and a referral to WIC. I didn’t receive a call from WIC after the referral so she assisted in contacting them again. I like to be independent. It makes me feel good to be able to navigate services on my own and we do our best to do so. We both speak and understand much more English than when we first arrived so we feel comfortable signing in at a clinic and making follow up appointments. We also both drive so can get to where we need to go. We use an translator app that we can hold over documents in English to translate it into Spanish. But we still struggle to make or change appointments over the phone and we get so much health related paperwork in the mail that we still sometimes need help from the Community Health Worker. Our health is important to us and we don’t want to misunderstand anything or miss important appointments.” *Laura – migrant worker in dairy industry
Pedro and Laura share in common a desire for a better life than they left behind but each is unique. They have their own personal and familial histories, their own cultural health beliefs and experiences navigating health systems, and divergent work-family contexts: all of which influence their opinions, concerns and preferences as well as their needs and desired outcomes.
Each time a client or a parent of a client reaches out to us requesting assistance it is because they feel unable to independently navigate a health related need – usually connected to uncertainty and barriers accessing one or more aspects of a health and/or social services system in Vermont. Bridges to Health takes a person-centered approach seeking to understand each person’s unique story, the social and physical context in which they currently live and how that intersects with their current and ongoing needs and opportunities to access services towards a desired outcome. Frequently, after assessing and prioritizing needs to begin supporting an individual in a household that is new to us, we are connected to others in the household. We apply the same person-centered approach to each new client taking into account what we have learned over time about the household.
In the case of Pedro, he was a new arrival to Vermont. He had few social connections and no experience navigating health and social services in Vermont much less the United States. For him and his household, the initial primary concern was having enough good to eat while in between jobs. The Community Health Worker, aware of community resources accessible to him based on his current situation, connected him to the food shelf providing interpretation so he could fully understand how to utilize the resource. The personal introduction gave him and his household the knowledge and confidence necessary to begin accessing the service independently. Weeks later, when facing a health issue, his first barrier was awareness of what was available to him. Again the Community Health Worker, gathered information about his unique context and as an uninsured individual with limited English skills with an acute but not emergent health issue, connected him to the local free clinic. Pedro and Jorge both let the Community Health Worker know that they were struggling with getting a drivers license in Vermont. They had drivers licenses from their home countries but due to limited English skills needed an interpreter for the Vermont road test. Recognizing the relationships between economic success, access to health and health related needs (like food) and having a driver’s license, the Community Health Worker served as an interpreter and both successfully got their license. When Pedro’s partner, Maria, approached the Community Health Worker with breast pain, the Community Health Worker explained the options available. Maria decided she wanted to seek out care at the local free health clinic so the Community Health Worker helped her make an appointment and provided in-person interpretation to assist with new patient paperwork. When Maria was referred to the local hospital for a mammogram and was concerned about the cost, the Community Health Worker let her know about and helped her sign up for You First; a Department of Health Program, that covered the cost of the mammogram. Pedro, with his new Vermont driver’s license, was able to drive her to her appointments. The Community Health Worker helped communicate the results of the normal mammogram and next steps.
For Laura, she and her partner had become familiar with the health care system over the years and have increasingly become independent. When she initially reached out, she identified wanting help getting established with local care. The Community Health Worker collected information about where they had accessed care in the past and explained the local options including financial assistance options for uninsured members of the family. Laura and her partner, both uninsured, decided to get established at the Community Health Center where they could receive a discount while deciding to establish their insured daughter at a private practice. They requested help with the paperwork and the initial appointment. They expressed confidence and a desire to navigate services independently so the Community Health Worker steps in only to support in the areas where they struggle or to offer connections to any new programs. For ongoing needs, like prenatal care, the Community Health Worker reaches out routinely to see how the pregnancy is progressing, ensure Laura is attending the recommended schedule of appointments and to identify any new concerns or needs Laura has.
With both households our approach was similar; centered on the person and open to serving whomever in the household was facing barriers to services at any give time. We tailored our response to identified needs and barriers based on information gathered from the individuals and household and our knowledge of how to navigate services and programs they are eligible for that met the needs and priorities they have expressed. Each person was treated with dignity and respect, provided information about their options, asked about barriers to services, and supported in being as independent as possible while moving together towards desired health related outcomes.