Health without Borders

Evidence-level

Promising (About evidence-level criteria)

Description

The Health without Borders (HwoB) project was implemented by the Ben Archer Health Center (BAHC) of Luna County, New Mexico. The project is serviced through 2 of BAHC's clinics that are located in the village of Columbus and the city of Deming. Nearly 1/5 of Luna County is made up of first-generation immigrants, so language continues to be a barrier to getting education and healthcare. Only 11% of the population has earned a 4-year college degree or higher, and 1/3 are without health insurance.

At the start of the project, HwoB's goal was to improve access to coordinated healthcare and its overall effect on Luna County's residents. Based on the Comprehensive Public Health Management Plan for the Luna County – Palomas, Chihuahua Binational Corridor report, HwoB narrowed its efforts to diabetes prevention and control, behavioral healthcare, and immunization coverage. Contributors to the report were recruited to join in partnership with HwoB, along with the following organizations:

• Ben Archer Health Center
• NM Office of Border Health
• NM DOH Region 5/Deming LPHO
• Deming Senior Center
• Binational Health Council
• Andrew Sanchez Center
• Southern New Mexico Promotora Committee
• Southern New Mexico Diabetes Outreach
• Luna County Health Council
• Juvenile Drug Court
• Juvenile Justice Continuum Services
• New Mexico Children Youth and Families Division (CYFD)
• Court Appointed Special Advocates (CASA)

This project received support from a 2012-2015 Federal Office of Rural Health Policy Rural Health Care Services Outreach grant. After funding ended, the immunization, diabetes prevention and control, and behavioral health efforts have continued.

Services offered

Immunization

A 2011 community needs assessment discovered that there was a general lack of understanding about the safety of vaccines. Many of those questioned were unaware of their necessity, and healthcare providers were not recommending that patients get vaccinated. HwoB took action by sending promotoras door-to-door to offer vaccines on a personal level. They also held immunization events to promote awareness and offer immunizations outside of the clinic setting.

This RHIhub video gives a closer look at how HwoB delivers immunizations in Luna County.

Diabetes Prevention and Control

In 2009, diabetes was the 6th leading cause of death in the state of New Mexico and the 5th in Luna County. In response, HwoB:

• Ran a diabetes prevention program for children called Just for Kids
• Screened diabetic patients for depression using the Patient Health Questionnaire (PHQ-9) and gave referrals for behavioral health services
• Organized home health parties for patients at risk of developing diabetes
• Launched a community exercise campaign that included activities like the bicycle Ciclovia events to engage the community in healthy living practices
• Hosted diabetes management and prevention classes for community members

Behavioral Health

BAHC strives to use innovative approaches to meet the needs of the rural population along the U.S./Mexico border through these efforts:

• Early Childhood Intensive Home Visiting
• Mental Health First Aid
• Circle of Security
• Comprehensive Community Support Services (CCSS)
• National Health Service Corps
• Eye Movement Desensitization and Reprocessing (EMDR)
• Integrated Primary Care and Behavioral Health
• Telehealth
• School-based services

Many people in Deming and Columbus have had a close family member murdered in border violence and have since developed Post-Traumatic Stress Disorder (PTSD). Below are steps HwoB took to address the effects of violence:

• Purchased equipment and trained 6 therapists in Eye Movement Desensitization and Reprocessing (EMDR), a psychotherapy method that teaches alternative methods for coping with trauma
• Started and monitored support groups to help PTSD victims heal

Results

Through the 3-year grant period, HwoB saw improvements in immunization, diabetes, and behavioral health in Luna County.

Immunization Results:

• 1,500 immunizations were administered
• 1,262 adults received flu and pneumonia vaccinations
• 200 diabetes patients were screened for depression
• 132 children received childhood and flu vaccines

After the initial grant funding period, the door-to-door immunization campaign was sustained through funds from the New Mexico Immunization Coalition and HRSA Maternal & Child Health, Healthy Start Program. The campaign was integrated into BAHC's Welcome Baby Healthy Start Program in 2015.

During the 2017-2018 campaign:

• 447 households received educational materials on immunizations and other health topics
• 117 vaccines were administered to children
• 206 immunization records were reviewed
• 749 chronic disease education classes provided to Luna County residents

Diabetes Prevention and Control Results:

• Baseline health measurements of patients improved, including Body Mass Indicator (BMI), blood pressure, and Hemoglobin A1C
• Fruit and vegetable consumption increased
• Participation in physical activity and strengthening exercises increased

From 2016-2017, BAHC staff provided 847 chronic disease education classes to Luna County residents.

Behavioral Health Results:

• Overall use of behavioral health services throughout Columbus and Deming Counties increased
• 284 new behavioral health cases were seen at the BAHC in the year prior to the grant. During the grant period, 935 new patients were seen

The Health without Borders program is featured in RHIhub's Community Health Worker Toolkit.

Challenges

• Providers had difficulty acclimating to the data entry methods required for the diabetic patient depression screenings
• Technological challenges arose when aligning the clinics' electronic health records with the new depression screening procedure
• Regularity and timeliness of appointments was difficult to maintain for binational, unemployed, or seasonal employees
• There were often language barriers between English and Spanish speakers
• The United States' multifaceted healthcare system made it confusing for Mexican immigrants who were accustomed to a more streamlined system
• Due to poverty, patients had a hard time balancing the cost of preventive versus critical care. Unless services were subsidized or free, they tended to postpone clinic visits until an emergency deemed it necessary

Replication

• Provide support and training to healthcare staff who are hesitant about adopting new electronic methods
• Share data with your project's collaborative members in order to leverage funding and create sustainability for your program
• Tailor non-traditional means to meet the needs of your community, such as HwoB's door-to-door immunization campaign

Contact Information

Kara Bower, Project Coordinator
Ben Archer Health Center
575.373.3096
kbower@bahcnm.org