Addressing Toxic Stress and Health Care Access in California Farmworker Communities: ACCESS Pilot Project Evaluation

Farmworkers in California experience disproportionately high rates of uninsurance and typically live in rural areas that lack sufficient health resources (California Hospital Association, 2024; Let's Get Healthy California, undated). In addition, more than four out of five farmworkers have reported experiencing at least one Adverse Childhood Experience (ACE) in early childhood (Brown, Flores, and Padilla, 2022). ACEs are stressful or traumatic events, such as neglect, abuse, and household dysfunction, that can trigger a toxic stress response in the body, leading to poorer physical and mental health into adulthood (Centers for Disease Control and Prevention, 2024). The ACCESS pilot project, a farmworker health access initiative, was funded by the California Department of Health Care Services through the UCLA/UCSF ACEs Aware Family Resilience Network to address toxic stress in farmworker communities and increase farmworker access to health care services through clinic and community connections.

Key Findings

Results from the ACCESS pilot project evaluation demonstrate that a peer-to-peer outreach and education model can build the capacity of farmworker leaders to meaningfully engage their communities in learning about toxic stress and ways to mitigate its negative health outcomes. Insights from a farmworker community health survey (N = 482) reveal that these communities still experience significant barriers to accessing affordable health care. As a result of these findings, we identified recommendations to support improved access to health care in this population.

Through this evaluation, we learned the following:

• The ACCESS training curriculum improved farmworker leaders' understanding of publicly funded health programs and services and increased their confidence to facilitate peer-to-peer community outreach and education.
• About half of farmworkers surveyed had no prior awareness of toxic stress, its negative health outcomes, or the strategies that mitigate toxic stress. However, nearly all said that they intended to put the strategies they had learned through the project into their daily practice.
• Among the farmworkers who had a place where they regularly accessed health care, nearly half reported that they received care at a community health center.
• One in five farmworkers surveyed reported lack of insurance coverage, often citing cost and work status as the main barriers.
• Of farmworkers who reported being uninsured, more than half were not interested in accessing the Medi-Cal program. Many cited barriers and fears related to their immigration status as reasons they were not interested in the program.

Recommendations for Future Work

Recommendation 1: Organizations interested in improving farmworker health and health access should use ACCESS resources to train additional farmworker leaders across the state on best practices for facilitating community conversations about toxic stress, strategies for mitigating toxic stress, and health care programs and services that can improve farmworker access to health care.

Recommendation 2: Community health education for farmworkers should address common barriers to Medi-Cal enrollment by providing accurate information about program eligibility and addressing common fears related to immigration status and the possibility of incurring medical debt.

Recommendation 3: Government agencies and other stakeholders interested in improving access to health care programs and services for farmworker communities should continue to invest in building the capacity of farmworker leaders to serve as program advocates and bridge builders.