Rural Health Care Coordination: University of Vermont Extension 

GHPC recently spoke to Naomi Wolcott-MacCausland, migrant health coordinator for University of Vermont (UVM) Extension’s Bridges to Health program, about efforts to coordinate care and COVID-19 response for the roughly 1,500 migrant farm workers located throughout the state at any given time. UVM Extension, together with the Open Door Clinic, provides direct services to migrant farmworkers in Vermont and strategizes with Finger Lakes Community Health (New York) on ways to improve and sustain programming.  

To date, what has been the biggest accomplishment or win in your program?  

Internally, something that has been successful for us has been being able to build off this grant to receive funds for the community health worker program. The model that we selected for the care coordination grant is called the Pathways HUB. We are using a modified version because the existing model focuses on methods for reimbursement, and we work with a population that is predominantly uninsured and nobody pays us to serve them. But the core components of that model — identifying needs for an individual, looking at what is a successful outcome for each one of those needs, and tracking the work has gone into helping someone meet that need — has been really useful for us because it allows us to show the depth of the work that we have done. 

The population we work with faces significant barriers, and systems in Vermont are not set up to serve them. They cannot independently pick up a phone and call most health clinics because the health clinics do not consistently have an interpreter or because they are only here five months of a year, they may run out of their medications, and they cannot get into primary care because they cannot fill out the paperwork. The Pathways model provides us a process and structure when working with clients, as well as a reporting mechanism to say, we served 50 unique people, but successfully completed 150 pathways. This model will continue to be useful to us beyond the life of this grant. 

What is a tip that you would share with an organization launching a similar program? 

There is a lot of work that goes into preparing the grant application and the work plan that sets the stage for what those three years are going to look like. It can feel nice to go into a grant feeling that you already fleshed out a lot of the details. But inevitably, things happen, and you are not able to meet the timeline that you anticipated for one reason or another. Certainly, COVID-19 disrupted a lot of things. Communications with external organizations were more challenging because everyone was at capacity. The biggest tip may be to use that work plan as your framework, but to recognize that you may need the flexibility to reevaluate things. There are different ways to reach that end goal, and you may have to be adaptable. With the pandemic, people now know more than ever about the need to be nimble and responsive to how things unfold on the ground. 

How do you see participation in the Federal Office of Rural Health Policy’s grant program impacting your broader health improvement efforts? 

Since UVM Extension and the Open Door Clinic started doing health outreach work in Vermont 12 years ago, our aim has always been to work toward achieving health equity for migrant farm workers. Over the years, the patient population has changed and the needs have changed. With individuals staying longer, there are more chronic health issues that come up, more families that have been coming, and more needs around pregnancies. Given the timing of this particular grant, we were able to build off our original plan and do more community-based work around COVID-19 response, including bringing mobile testing kits to the field and coordinating vaccine clinics. The funding from this grant gave us more time to build insight into the population we were working with, and we were able to then write a grant for community health workers, which allowed us to bring on full-time staff across the state who were able to move beyond this grant to address some of the access to care issues and support social needs. This grant gave us more capacity to then build bigger, better programming to meet what our initial goal has always been, which is really to meet the comprehensive needs of those with whom we work.  

What will your organization be doing more of or differently to emerge stronger from the pandemic? 

An area that we have consistently struggled with in Vermont is access to bilingual mental health professionals. The public health emergency led organizations to being more comfortable in considering telehealth for different components of their work both during the pandemic and for the future, as well. 

Within mental health, there was also a willingness to think about this broader conversation about expanding telehealth. We were able to explore what it would look like to bring on a bilingual clinician that we could share across organizations. This would eliminate some of the barriers that we have seen forever with farm workers, related to transportation and work schedules. The limited access to bilingual clinicians further inhibited us from overcoming some of the stigma around even accessing mental health. But we tried this, and it resulted in quite a lot of patients taking advantage of this resource. It is now something that we are working on as part of our long-term strategy in our sustainability plan. 

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