A UVM blog Migrant Health: Ear to the Ground

ASSESSMENT OF ACCESS TO, UTILIZATION OF, AND UNMET NEEDS SURROUNDING MENTAL HEALTH AND RELATED SUPPORT SERVICES FOR MIGRANT FARMWORKERS

Executive Summary: Findings, Recommendations, and Estimated Annual Costs

Full Report here: https://www.uvm.edu/d10-files/documents/2025-05/Migrant-Farmworker-Mental-Health-and-Wellness-Assessment-Final.pdf

Naomi Wolcott-MacCausland, MS. Migrant Health Programs, UVM Extension & Dan Baker, PhD. Associate Professor Emeritus, Community & International Development, UVM

December 2023

MAJOR FINDINGS

Work place conditions, compounded by social and structural determinants, cause migrant farmworker stress while also limiting opportunities to maintain positive mental health and wellbeing.

Workplace safety concerns, long hours with not enough time to sleep, working in bad weather, and fear of losing their job create a stressful working environment for migrant farm workers who frequently live where they work. They live in geographically, linguistically, and culturally isolated places across the state and have limited opportunities to leave the farm due to work schedules, transportation barriers and, for dairy workers in northern Vermont, fear of encountering border patrol.  The impetus to come to Vermont is connected to political, economic, social and environmental conditions in their countries of origins and most often they are leaving close family and friends behind in hopes of being able provide financial stability that would otherwise be unattainable. Being far from family and friends is a top stressor as is the fear of losing the ability to support family who have come to rely on them due to deportation for undocumented farmworkers and for seasonal farmworkers, the fear of not being offered a job the following year.

Jamaican farmworkers are underserved across the mental health continuum.

Though Jamaican workers have helped to sustain Vermont’s fruit and vegetable farms for decades, few organizations provide services tailored to their unique circumstances and needs. There is limited research and programmatic data related to the mental health of seasonal farmworkers in Vermont who come through the H2A visa program.  Even though they benefit from legal status, they face many of the same barriers as Latino workers seeking to access off farm services and activities. These include limited transportation, cost, limited awareness of services, and lack of culturally aware staff. Survey data and the focus group data indicate there is interest in access both to mental health support services and off-farm recreational activities.

Availability of, access to, and utilization of mental health promotion activities and counseling services tailored to migrant farmworkers has been inconsistent due to reliance on grant funding, raising issues for sustainability and reliable, trustworthy patient care.

Over the last decade, there have been an assortment of grant funded, time bound mental health initiatives that addressed mental health needs among migrant farmworkers across the mental health continuum.  The list includes Mental Health First Aid training for farmworker outreach staff, clinical mental health counseling services in Spanish, a Screening, Brief Intervention, Referral and Treatment (SBIRT) pilot, on farm and virtual mental health and wellbeing promotion activities, and COVID Support VT mental health outreach and multilingual resource development. Additionally, there have been tools made available to outreach staff in Vermont such as El Viaje Mas Caro booklets and an accompanying training, playlists of short self-care activities in Spanish and English that can be done at home, and mental health lessons for migrant youth working on their own on farms. These initiatives and resources, regardless of farmworker engagement and interest, have largely not been sustained beyond the grant funding due to limited capacity among farmworker serving organizations. With each short-term grant funded project, farmworkers face a lack of predictability about the availability of needed services and soft funded programs experience staff turnover, which in turn negates years of work to build trusting relationships within the farmworker community in addition to eroding ability to form long-term community-based partnerships.

There are extremely limited accessible and sustained options for mental health services for migrant farmworkers within the health care system in Vermont.

Community Health Centers (FQHCs), Free Clinics, and Designated Mental Health Agencies (DAs) are service providers that often are a free or low-cost option for uninsured, lower income adults. All offer some mental health services. These safety net clinics and Designated Agencies have the potential, and often desire, to meet the needs of migrant farmworkers but currently are unable to sufficiently do so. Constraints within Designated Agencies to meet the needs of migrant farmworkers include staffing, funding, inability to provide transportation, lack of bilingual/bicultural staff and limited experience serving the population in either an outpatient or outreach capacity. Within the 16 safety net health care organizations in Vermont (free clinics and FQHCs), only the Open Door Clinic and Little Rivers have any outreach and engagement strategies to reach migrant farmworkers. As with the Designated Agencies, most safety net organizations in Vermont do not comprehensively address issues of outreach, cost, transportation, and access to bilingual/bicultural providers; four elements identified by farmworkers and farmworkers serving organizations as essential to create accessible mental health care services so that they are well utilized.

Migrant farmworkers who have utilized mental health counseling services in the past three years were primarily referred through interactions with people within trusted organizations that engage in outreach with the community rather than through standardized screenings.

As noted previously, only two health clinics across the state engage in any type of outreach with migrant farmworkers; a key component to breaking down barriers to serve migrant farmworkers. Though mental health screenings have identified a number of individuals who could benefit from clinical services, most farmworkers who have engaged in mental health counseling did so because of conversations with trusted members of farmworker serving organizations including the Open Door Clinic, UVM Migrant Health Programs, UVM Migrant Education Program and the advocacy organization Migrant Justice,.  Farmworkers who participated in focus groups this year, highlighted the importance of having the support of trusted outreach staff who maintain confidentiality to confide in, receive support from, and to connect farmworkers community members to needed mental health services.

Migrant farmworkers and their family members will utilize mental health counseling services if they are free, provided by Spanish speakers and transportation issues are addressed.

Spanish speaking farmworkers who participated in the 2023 focus groups voiced a need for clinical care while highlighting the increased likelihood of mental health services utilization if services are available with a Spanish speaking clinician and are low cost. 2022 service provider meeting participants highlighted transportation as one of many significant barriers to farmworkers accessing services. Other barriers identified included a lack of bilingual and/or bicultural outreach staff among community-based health and wellbeing organizations and lack of culturally and linguistically adequate programming that can address barriers to services and the intersection of alcohol use and dependence. 

When a few hours a week of free (grant funded) telemental health counseling was offered to farmworkers in Spanish in 2021, the number of unique individuals who connected with clinical mental health services increased by 171% with a 283% increase in number of visits per patient. The following year, when an additional bilingual/bicultural counselor was hired through grant funds with more telehealth capacity, the number of unique individuals increased by an additional 74% with another 125% increase in number of visits per patient.  Despite the demonstrated demand for clinical service provided by Spanish speaking counselors, grant funding earmarked for mental health counseling for farmworkers reduced significantly in September. The number of farmworkers accessing services has declined as a result.

There is a need for mental health counseling for children and youth by Spanish speaking counselors who understand the complexities of the migrant experience.

The numbers of migrant farmworker children and young farmworkers have increased significantly in the past few years. The vast majority have experienced family separation and challenging journeys by land across one or more borders. They are living in rural Vermont where there are few to no other peers their age who look like them, speak their language or understand their cultural background. Many are covered by the Immigrant Health Insurance Plan, an insurance that does not cover services at Designated Mental Health Agencies. Beyond that financial barrier, there are no Spanish speaking clinicians who serve children within the DA system.

Migrant farmworkers are interested in opportunities to engage in on-farm and community-based education and activities that can contribute to positive mental health at an individual and community level.

When barriers are addressed, farmworkers have participated in programming that promotes positive mental health such as support groups and virtual and in-person wellbeing activities. They have expressed a strong desire for more opportunities. Seventy three percent of 96 respondents in a recent UVM survey indicated they were interested in learning about personal practices to manage and reduce stress. Farmworker focus group participants this year responded positively to ideas of regional wellness days that would offer an opportunity to explore a range of wellbeing activities while simultaneously offering a social experience. While there was a strong concurrence that a peer counseling model utilizing farmworker community members would not be successful, there was interest in training to be better able to respond to mental health needs of fellow community members.

RECOMMENDATIONS

Support national and state level policies, initiatives, and programs that improve workplace conditions for migrant farmworkers.

• Support comprehensive immigration reform that provides legal status to migrant farmworkers across the agricultural industry.
• Initiate a process that invites participation from farmworkers, farmers, advocates and service providers to develop and implement Vermont-scale farm workplace standards that address farm safety, health, housing and work environment.
• Increase oversight of workers’ compensation utilization to ensure access to health care services, coverage of medical expenses and compensation for work time missed.  
• Promote comprehensive farm safety training and access to Personal Protective Equipment for new employees as well as ongoing refreshers and expanded training for all employees.
• Support worker housing improvement initiatives.
• Support access to workplace English classes.

Stabilize funding for farmworker health outreach programs across the state increasing capacity to respond to physical, mental, and social health needs across the continuum.

• Increase and fully fund the required number of outreach staff within existing health-focused farmworker serving organizations to ensure capacity to attend to the wide range of physical, mental, and social needs across all corners of the state. Ensure positions include tailored outreach to Jamaican farmworkers. Existing farmworker serving organizations with a health focus include the Open Door Clinic, Migrant Health Programs of UVM Extension, and Little Rivers Health Care.
• Offer training for outreach staff across farmworker serving organizations and farmworkers on how to recognize and respond to mental health needs of community members.
• Incorporate on-farm mental health education to increase awareness of the importance of attending to mental and social health while also working to reduce stigma.
• Organize regional mental health promotion events in collaboration with community-based organizations that have expertise in mental health and wellbeing programming. Ensure identified barriers to participation such as transportation, cost, and language access are addressed.
• Offer on-farm and/or online trainings in stress management techniques.
• Create and maintain an up-to-date, accessible list of farmworker serving organizations that includes scope of work, contact information, and referral process.  
• Develop professional development/learning opportunities for farm owners, service providers, including school counselors, to learn more about the migrant farmworker population, mental health challenges and how to address systemic and individual barriers to care.

Fund a statewide telemental health model to improve and sustain access to clinical mental health services that address barriers to care and that meets the linguistic and cultural needs of farmworkers for short term and long-term needs and crisis response.

• Identify and fund a statewide health entity that has the interest, commitment, capacity and experience to oversee the program. Potential organizations include Vermont Care Programs and Invest EAP.
• Hire part time clinicians who speak Spanish, and ideally Patois, who have an understanding of the migrant experience, the flexibility to serve workers outside of traditional business hours and who can serve children/youth. If bilingual/bicultural clinicians are embedded within a Designated Agency, ensure they can serve migrant workers regardless of where they live in Vermont. Should be able to accept Medicaid and IHIP insurances.
• Ensure low barriers to access services. Low barriers include free services, an online platform to connect to services, no email required, minimal registration requirements, and no required screenings until a relationship has been established.
• Provide headsets and phone stands to patients as needed for those who have access to Wi-Fi and want to participate from home but live in homes with limited privacy.
• Partner with farmworker serving organizations, local health organizations and community-based organizations to identify free and private off-farm locations to participate in telehealth, with coordinated transportation if needed.
• Partner with the Vermont Migrant Education Program and schools to support access to counseling during the school day from a private location.

Support health care policies that can contribute to increased access to low-cost mental health services.

• Support policy changes to make licensure for mental health clinicians and provision of services across state and country borders easier to increase availability of bilingual and bicultural providers.
• Support policy changes to the Vermont Immigrant Health Insurance Plan to cover mental health services provided by Designated Mental Health Agencies.

Annual Programming Costs to Respond to Assessment Recommendations

Telemental Health Program
Spanish speaking Adult Mental Health Clinician	20 clinical hours per week plus 4 hours of admin/coordination time @ $150/hour	$187,200
Spanish speaking child/youth clinician	6 hours per week plus 1 hour of coordination time @ $150/hour	$54,600
Clinician with understanding of/connection to Jamaicans	4 hours per week plus 1 hour of coordination time @ $150/hour	$39,000
Headsets and phone stands	50 of each	$1,750
Transportation	40 appointments	$4000
TOTAL	$280,800

Farmworker Health Outreach – Addressing Physical, Mental, & Social Needs
Spanish Speaking Community Health Workers	Equivalent of 4 FTE full time, year round	$312,000
H2A focused Community Health Workers	Equivalent of 1.33 FTE (10-month position plus 6-month position)	$103,740
Community Health Worker Program Coordinator	.7 FTE	$68,796
Phones	Cell phones	$5,880
Mileage/Transportation		$34,200
Supplies	Health outreach supplies, printing, postage	$14,000
Training/PD		$20,000
Direct total		$558,616
Indirect (estimate)		$117,309
TOTAL		$675,925