NATIONAL ADVISORY COUNCIL ON MIGRANT HEALTH (NACMH)
Meeting
February 9 - 10, 2009
Parklawn Building Rockville, MD  20857

• printer-friendly minutes from February 9 - 10, 2009 meeting

MEETING PARTICIPANTS

Council Members:

Federal Staff: 

Presenters:

Guests:

Capt. Laverne Green, Senior Advisor, Office of Minority and Special Populations, Bureau of Primary Health Care, Health Resources and Services Administration
Susan Rogus, National Heart, Lung, and Blood Institute, National Institues of Health
Jessica Sitko, HRSA Scholar

MONDAY, FEBRUARY 9

CALL TO ORDER AND WELCOMING REMARKS

• Dr. Rogelio Fernandez - Chair

The Chair called the meeting to order at 8:50 a.m. and welcomed all Council members and HRSA representatives. After a round of introductions, he asked Dr. Weaver to introduce Dennis Williams, Deputy Administrator of the Health Resources and Services Administration (HRSA).

WELCOME TO MARYLAND

• Dr. Dennis Williams, Deputy Administrator, Health Resources and Services Administration

Dr. Williams welcomed the Council on behalf of HRSA Administrator, Dr. Elizabeth Duke. He noted that each new administration brings new priorities, new directions, and new ways of doing business. Dr. Williams acknowledged the delay in appointing a new Secretary of Health and Human Services (HHS) and informed the Council that Charles Johnson had been asked to stay on as Acting Secretary during the interim. Mark Childress was on board as the new Chief of Staff, and a handful of new political appointees were still being processed. Dr. Williams noted that the approval of new Council members was taking longer than usual due to the transition.

Dr. Williams stated that this was an exciting time for the health care system, and the landscape was likely to change dramatically over the next four years. He emphasized that advisory councils would play a pivotal role, and he reminded Council members that NACMH served as HRSA’s eyes and ears for issues related to special populations.

Dr. Williams informed the Council that the next few years would bring improvements in HRSA’s ability to serve special populations. Summarizing the provisions of the House and Senate versions of the stimulus bill, he noted that the House bill included $500 million for Community Health Centers and about $1 billion for renovation and repairs and purchase of health information technology (HIT). The House bill also included funds for National Health Service Corps (NHSC) clinicians, nurses, and training of primary care physicians and dentists. The Senate bill included similar funds for repairs and renovations, but it did not include provisions for services. The differences would have to be worked out in committees. Dr. Williams noted that there would be significant oversight regarding how the funds were spent and how many jobs they created. With the help of the Council and all grantees, HRSA hoped to do a good job.

Dr. Williams noted that the stimulus funds would support one-time expenditures; they would be in addition to regular appropriations, which support ongoing programs. Once the stimulus bill passed, Congress would begin working on the omnibus appropriations bill for Fiscal year (FY) 2009. The new administration was in the process of preparing the President’s budget proposal for FY 2010, and HHS would submit its appropriations request to Congress in the near future.

Dr. Williams stated that healthcare was likely to be a major feature of both the recovery plan and the appropriations, and the Bureau of Primary Health Care (BPHC) was ready for the challenge. He noted that the HRSA-supported community health care system grew faster in the past eight years than in the first four decades of the program; it is now the largest primary care network in the nation, serving 56% more patients than the largest private provider. The system now includes 1,200 health centers, with more than 7,000 permanent, seasonal, and mobile locations across the country that serve 1 out of every 20 people living in the U.S. today.  Special populations comprise 16% of the health center client base; a third of those patients  are MSFWs.

Dr. Williams emphasized that the Council’s voice was important to HRSA. Its recommendations were reflected in the FY2009 budget pending congressional approval, which includes $5 million for enabling services for migrant health clinics, and $15 million for expansion of oral health, mental health, and pharmacy services. Although the expansion grant funds were not specifically targeted to special populations, Dr. Williams noted that similar grants had helped health centers increase their migrant health patient base by more than 15% since 2002. Noting that the Council had repeatedly emphasized the critical need for more accurate demographic information on the migrant population, Dr. Williams informed the Council that HRSA allocated $92,000 for an interagency agreement that would enable the Department of Labor to expand the National Agricultural Worker Survey (NAWS) by increasing the number of migrant worker contacts and the number of survey questions.

Dr. Williams stated that the projected workforce shortage was the greatest challenge facing the health center system, and rural areas would be impacted more severely than other areas. Dr. Williams noted that an additional 27,000 primary care physicians would be required for the physician/patient average in rural areas to reach the national average. The Bureau of Health Professions recently reported a shortage in 200 health professions, and a 2007 national survey found that only 2.9% of medical students intended to practice outside of a major metropolitan area. The aging of the current workforce compounds the problem. More than one-third of the physicians in the U.S. are likely to retire in the next 10 to 15 years, and the average age of the nursing workforce is the highest it has been since HRSA began tracking that profession. Dr. Williams noted that HRSA-supported health centers added 13,000 frontline primary health care professionals in the past six years, but 5,000 to 6,000 clinical positions remain to be filled after the most recent expansion. He stated that HRSA would host a national summit later this year to address this issue, and he emphasized that the Council would be an important resource. Because 92% of migrant workers are Spanish speakers, HRSA recognizes that its workforce development plan should include bilingual training.

Dr. Williams informed the Council about the recent launch of the HRSA-funded Health Workforce Information Center (www.healthworkforceinfo.org). Operated by the University of North Dakota School of Medicine and Health Sciences, the Center will provide user-friendly, online access to the latest information on health workforce programs and funding sources; workforce data, research, and policy; educational opportunities and models; best practices; and related news and events. The Center will provide e-mail updates, and information specialists will provide customized assistance online, by phone, or by fax. 

Dr. Williams thanked Council members for their service and opened the floor for discussion.

Discussion

Responding to a question from John McFarland, Dr. Williams confirmed that oral health was included in the new expansion grants and was a high priority for Dr. Duke. He noted that a high proportion of health centers now provide oral health services.

Dr. Fernandez expressed appreciation for the $5 million in funding for enabling services. Dr. Williams stated that this was a good start; he hoped that HRSA could build on it in the future.

Mike DuRussel asked Dr. Williams how HRSA promoted community health centers to medical students. Dr. Williams outlined several mechanisms, including the NHSC’s scholarship and loan repayment programs for physicians who agree to serve in underserved areas and HRSA’s loan repayment program for nurses. He noted that many health centers have established relationships with medical schools in their communities. In response to a question from Jose Lopez, Dr. Williams described the Bureau of Health Profession’s pipeline program that provides grants to interest high school students in the health professions. Dr. McFarland and Dr. Fernandez described high school programs in Arizona and Fresno, and Dr. Williams noted that the Doctor’s Academy program in Fresno might be eligible for HRSA funding. Dr. Weaver noted that the Workforce Center was designed to serve as a national resource and encouraged Council members to submit information on potential model programs.

Dr. Fernandez thanked Dr. Williams for his presentation and turned to a review of the agenda for this meeting and the minutes of the previous meeting. The Council approved the agenda with no changes. Emma Segarra moved to approve the minutes of the November, 2008 meeting. The motion was seconded by Diana Sanchez and passed unanimously.

Dr. Weaver noted that the Institute of Medicine was conducting a summit on the oral health workforce, which was co-sponsored by HRSA. He reminded the Council that health centers are designated as health professional shortage areas (HPSAs); as such, they are eligible to compete for NHSC resources.  Unfortunately, many health centers do not post their vacancies on the NHSC list, and some vacancies are posted without a profile. He urged Council members to encourage their health centers to list their vacancies with the NHSC. Dr. Williams also speculated that the stimulus plan would include requirements to spend funds quickly; this would favor centers that were ready to take advantage of the opportunities that may arise.

Dr. Fernandez noted that most health centers in his area did not score high enough to be eligible for NHSC resources. Dr. Weaver stated that the scoring was determined by four criteria: shortage of clinicians; poverty level of the population to be served; rate of infant mortality or low birth weight (whichever statistic is higher); and distance or time to access the clinic. Dr. Weaver recommended that centers review the score they receive due to the automatic HPSA designation to determine if it accurately reflects the reality of their center.

Dr. McFarland asked what percentage of scholarship or loan repayments requests are approved. Dr. Weaver said he would provide the information by the end of the meeting. Noting that additional scholarship and loan repayment funds might be available through the stimulus bill, he reiterated his advice about the importance of being prepared to act quickly.

BUREAU OF PRIMARY HEALTH CARE (BPHC)/OFFICE OF MINORITY AND SPECIAL POPULATIONS (OMSP)

• Marcia Gòmez, M.D., NACMH Designated Federal Official; Senior Advisor on Migrant Health, OMSP

Dr. Gòmez provided an update on the Bureau’s programs for special populations. She began by noting that  the Council’s recommendations were reflected in the new initiatives described by Dr. Williams, and she urged the Council to continue to advocate strongly on behalf of MSFWs.

Addressing the issue of farmworker demographics, Dr. Gòmez noted that Capt. Lopez and Mr. Macrae had found additional funding to enable Migrant Clinicians Network (MCN) and the National Center for Farmworker Health (NCFH) to conduct additional research that would help health centers identify and understand the migrant populations they serve. Dr. Gòmez informed the Council that MCN would make a presentation at the next Council meeting in May.

Dr. Gòmez informed the Council that Shelly Davis, Co-Executive Director of Farmworker Justice, lost her fight with cancer in December. A moving tribute to her life was held at the Western Stream Migrant Forum in January. Dr. Gòmez noted that Pamela Rao of MCN would take over the work that Ms. Davis had been doing on pesticides and other issues.

Dr. Gòmez apologized for the delay in appointments of new Council members. She informed the Council that Susana Castro and Michael DuRussel had been nominated to serve as Chair and Vice Chair, respectively. Dr. Gòmez noted that the nominees for both vacancies on the Council are executive directors of migrant health centers (MHCs); their appointments would ensure that clinicians are represented on Council. Dr. Gòmez reminded the Council that three positions would become open in November 2009 and urged members to suggest potential candidates.

Dr. Gòmez called the Council’s attention to several items in the binder for the meeting, including a letter from the California Primary Care Association (PCA) with recommendations regarding the term for the Council chair and the number of meetings per year, and a letter from Oscar Gòmez, executive director of Farmworker Health Services, thanking the Council for the opportunity to make a presentation at the February 2008 meeting and for including the issues he raised in the Council’s recommendations to the Secretary.  She also noted that the binder included the complete text of the enabling services Program Information Notice (PIN), as well as a table summarizing the status of the Council’s recommendations from the past eight years.

Dr. Gòmez stated that the National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC) was interested in adding health questions to the National Agricultural Workers Survey (NAWS). She encouraged Council members to submit suggestions for issues that should be addressed through the NAWS.

Dr. Gòmez informed the Council that she and Gladys Cate had met with the Agency for Children and Families (ACF) regarding Migrant Head Start. She noted that a new working group was being formed to discuss how agencies within HHS can work together to better serve the migrant population, and she encouraged the Council to make recommendations that she could carry to the working group. Dr. Gòmez acknowledged that Andrea Weathers had significant expertise regarding Head Start issues. Dr. Weathers noted that children are not currently included in the NAWS data and suggested adding questions about children.

Referring to the Council’s recommendation that funding be maintained for the national cooperative agreements, Dr. Gòmez informed the Council that non-competing grant applications for cooperative agreements will be due in March 2009.

Dr. Gòmez noted that the 2002 Presidential Initiative was focused on expanding the health center network. The focus is now shifting to ensuring that those new health centers can survive. Going forward, the national cooperative agreements would be providing more hands-on training and technical assistance to support the sustainability of health centers.

Dr. Gòmez stated that she and Ms. Cate would be participating in site visits to new health centers to ensure that they were meeting the needs of special populations.  

Dr. Gòmez noted that the executive director of the Latino Behavioral Health Institute had asked OMSP to develop workshops on migrant mental health issues for the Institute’s annual conference. She asked Council members to recommend issues that should be addressed in these workshops.

Capt. Lopez thanked Dr. Gòmez and Ms. Cate for their dedication and hard work, and Dr. Fernandez thanked Dr. Gòmez for her support during his term as chair. He added that the table summarizing the Council’s recommendations would be helpful when developing new recommendations.

UPDATE ON POLICY AND OTHER ISSUES

• John Ruiz, Director, Health Systems, National Association of Community Health Centers

Mr. Ruiz welcomed the Council members to Washington and provided an overview of the current policy environment and future directions for migrant health services. He focused his presentation on four issues: access, quality of services, data, and collaborative relationships

Mr. Ruiz stated that the historic nature of the recent election had been overwhelmed by the economic crisis. Noting that the stimulus plan and the president’ mandate to revamp the health care system would result in dramatic changes for health centers, he urged the Council to remain focused on the issue of access.

Mr. Ruiz reviewed the key provisions of the State Children’s Health Insurance Program (SCHIP) reauthorization bill that was recently passed by Congress. He noted that legal immigrants would no longer be required to wait five years before enrolling; in addition, the prospective payment system was now included in the program. These changes would result in more reimbursements for health centers. The bill also directed the Secretary of HHS to revisit and coordinate discussions around portability and interstate compacts. Mr. Ruiz noted that the stimulus package included language related to interstate compacts and might include funding for demonstration projects. He urged the Council to strengthen its relationships with the policy and program community, because these groups could assist in monitoring pending legislation.

Turning to a discussion of immigration reform, Mr. Ruiz noted that the Secretary-designate for the Department of Labor had spoken in favor of immigrants. The guest worker/H2A visa program was revised by the previous administration to incorporate changes that favor growers. Mr. Ruiz expected that those provisions would be reversed. If not, the policy community must address that issue because immigration policy affects the makeup of the agricultural workforce.

Mr. Ruiz stated that NACHC was focusing its efforts on access. The goal of its access plan for 2015 was to double the size of the health center program, including proportional growth of the migrant health program.

Mr. Ruiz acknowledged that the new enabling services PIN was a direct result of the Council’s work, in collaboration with the policy community. The president’s initiative during the past eight years was focused on expansion, yet UDS data show that health centers only reach about 22% of MSFWs. Mr. Ruiz stressed the importance of focusing on access so that health centers could obtain funding to improve the quality of their services and provide outreach programs to identify and meet the needs of MSFWs in their catchment areas. In order to ensure that funds are directed appropriately, it is essential to know what services health centers currently provide and what they need. The UDS and NAWS are important sources of data to answer those questions. Mr. Ruiz emphasized that the opportunity to participate in developing questions for the next NAWS would help the Council obtain the information it needs to help the Secretary manage the migrant health program.

Mr. Ruiz noted that NACHC’s access plan included strategies to address Medicare and the Medicare cap. He emphasized that technology was also important, and the stimulus package would include significant funds for HIT. Mr. Ruiz stated that the migrant health program illustrates the importance of portability, which affects all Americans. The Council and NACHC could be an important source of information on how to deal with mobile populations.

Looking forward, Mr. Ruiz advised the Council to focus on issues related to patients, including immigration reform; strengthening the base appropriations; and obtaining data on troubled programs in order to provide the technical assistance they need to remain viable. He suggested that the Council’s communications with the Secretary should focus on access and should emphasize the importance of including farmworkers in the stimulus package and ongoing appropriations. Mr. Ruiz emphasized that the new administration and the economic stimulus program provided important opportunities, and he urged the Council to take advantage of its status as an established body to open up lines of communication with the new Secretary. 

Mr. Ruiz urged the Council to strengthen its relationships with the policy and program community, the national collaborative agreement grantees, and other federal agencies that serve MSFWs, such as the Department of Education and the Department of Housing. He noted that the Kaiser Health Policy report and websites for NACHC and other organizations were good sources of timely information.

Mr. Ruiz stated that he was looking forward to seeing the Council in San Antonio. He thanked Council members for their work and opened the floor for discussion.

Discussion

Dr. Weathers asked Mr. Ruiz if he thought the Council should hear from a wider range of people. Mr. Ruiz replied that the Council’s primary focus should be on the migrant health program, but he encouraged it to invite experts in other areas to make brief presentations.

Rosita Castillo thanked NACHC and Mr. Ruiz for providing insights that were helpful in developing the Council’s recommendations. Mr. Ruiz noted that the migrant health program had expanded in recent years, and the quality of services had improved. The Council is in a strong position to play a leading role in preparing the system for the significant growth that will occur in the next phase.

Dr. Fernandez asked how the Council could make the case that additional funding for ancillary staff would allow programs to reach farmworkers who are not currently being served, when many centers are already operating at maximum capacity. Mr. Ruiz said that he would take that question to the research staff at NACHC, and he identified several key questions:  What do we need to do to serve more MSFWs? Do we need more access points, or do we need to expand existing operations? Does the HRSA strategy work for farmworkers? If not, the Council needs to use its expertise to inform that strategy.

Ms. Castillo noted that her clinic serves a highly mobile, primarily male population, and many single males do not utilize preventive services. Mr. Ruiz agreed that it was important to determine how to reach a larger population, especially since the program was moving away from the model of mobile services.

Mr. DuRussel noted that the Council wanted the migrant health program to get its share of the stimulus funds, but it also wanted to use the funds in the right way. Dr. Fernandez stated that sustainability was the key issue. Mr. Ruiz suggested using the one-time funds provided by the stimulus package for outreach services, which are usually the first to be cut.

Dr. Weathers stated that her research found that many MSFWs do not know where to go, and/or they do not have transportation to get there. Many are new workers, or have moved to new locations. She suggested that an information campaign could help to increase awareness of the migrant health program. Dr. Gòmez stated that this was a major rationale for the enabling services grant.

Dr. Gòmez thanked Mr. Ruiz for his presentation and welcomed Bobbi Ryder, who made her presentation via conference call.

PRESENTATION BY NATIONAL CENTER FOR FARMWORKER HEALTH

• Ms. Bobbi Ryder, CEO   

Ms. Ryder gave the Council a preview of her proposed research on the use of the Uniform Data System (UDS) to analyze trends in the migrant health program. John Ruiz and Anne Nolon assisted with this work. Ms. Ryder emphasized that this was a work in progress and that she valued the Council’s input and suggestions.

Ms. Ryder prefaced the discussion of her research with a brief overview of the UDS, including the types of data that are collected, who is required to report, the reporting period, and how UDS data are used. She noted that the UDS is a reporting requirement for four HRSA primary care programs: Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Public Housing for Primary Care. Data are collected at the grantee, state, and national levels. As of 2004, health centers receiving funds for special populations were required to report data on those populations, but only for selected tables. Data on special populations are now available for calendar years 2004 through 2007.

Ms. Ryder stated that the UDS provides national data to ensure compliance with legislative and regulatory requirements, improve the performance of specific health centers, and report overall program accomplishments. UDS data also help HRSA identify trends over time so it can establish targeted programs and identify effective services and interventions. UDS data are compared with national data to determine disparities between the U.S. population at large and the individuals and families who rely on health centers for primary care.

Ms. Ryder stated that the UDS website (http://bhc.hrsa.gov/uds) provides a great deal of information,  including rollup reports, a schedule of grantee technical assistance conference calls, training manual and Help Desk contacts, and instructions for sampling, completing, and submitting reports. The website also provides current and archival reports at the state, regional, and national levels. 

Ms. Ryder noted that MHC rollup reports include the following tables:

• Table 3A Patients by Age and Gender
• Table 3B Patients by Race/Ethnicity/Language
• Table 4 Patients by Socioeconomic Characteristics (poverty, insurance source, and selected patient characteristics)
• Table 5: Staffing and Utilization
• Table 6: Selected Diagnoses and Services (e.g., selected infectious diseases, respiratory diseases, other medical and childhood conditions, mental health and substance abuse conditions, diagnostic and preventive, and dental services)

Ms. Ryder reviewed the MHC rollup report for calendar year 2007. She emphasized that the UDS provides hard data that can be used to support the need for MHC services and determine funding allocations. For example, data from Table 3 showing that 78% of MHC patients are best served in languages other than English could be used to substantiate the need for translation services.

Ms. Ryder noted that the system would soon have four years of accumulated data on special poppulations, which would make it possible to compare trends in disparities and articulate distinctions. Individually, each special population represents a small percentage of health center patients, but taken together, they represent nearly 23% of patients. Ms. Ryder stressed the importance of allocating funds appropriately to ensure that the needs of all patients are met.

Ms. Ryder pointed out that the selected diagnoses reported in Table 6 do not include occupational-related illness and injury, which is an important category for migrant health. However, this information is available at the health-center level. Ms. Ryder stated that the new performance measures promoted by BPHC presented a compelling opportunity for grantees to conduct practice-based research.

Ms. Ryder turned to a discussion of her proposed research. The goal of her study is to determine how farmworker-specific UDS data could be used to increase access and improve quality and efficiency related to cost. She developed 13 proposed research questions, which she intends to share with the Farmworker Health Network (FHN) after obtaining input from the Council.

Ms. Ryder presented four of her proposed questions and the data source, probable use, and recommendation for each:

1.      The Basics: What is the distribution of users by age and gender and the split between migratory and seasonal farmworkers?

• Data Source: Table 3A and Table 4
• Probable Use: OMSP and TA providers understand and identify migrant-relevant performance measures and quality improvement needs.
• Recommendation: Study distribution by grantee, by state, and by region to monitor changing trends and proactively anticipate need.

2.      Finding New Grantees: How many CHCs report seeing farmworkers but do not receive 330G funding? Who are they, and how many farmworkers do they serve? (Dr. Gòmez interjected that she had information related to the first question, which she would share with the Council and the FHN)

• Data Source: Table 4 (Farmworkers Reported) and population estimation data
• Probable Use: TA providers and HRSA identify potential new applicants for 330G funding in areas of highest population density.
• Recommendation: Complete population estimation work and convene an interagency work group to cross reference and analyze.

3.      Distribution of Population: Are there MHCs that have more farmworkers in their area than what they are funded to serve? If so, what is their penetration rate?

• Data Source: Table 4 (Users), funding data, and population estimates
• Probable Use: TA providers and HRSA prioritize TA and financial resources to increase MHC capacity and patient access in areas of highest population concentration.
• Recommendation: Complete population estimation work and convene an interagency work group to analyze and identify unmet need.

4.      Health Center Capacity: How does “health services utilization” by farmworkers compare to the services utilized by other, non-special populations?

• Data Source: Table 5 (Utilization & Staffing) for farmworks, other Special Populations, and all others
• Probable Use: Identify differences in availability and utilization of services to increase capacity of MHCs and inform resource allocation.
• Recommendation: Compare farmworker data to universal data (minus other special populations data) regarding staffing patterns for mental health, dental, and enabling services staff. OMSP and FHN to discuss findings and formulate recommendations.

Ms.Ryder reiterated that she would appreciate suggestions from Council to help finalize the research questions, and she opened the floor for discussion.

Discussion

Dr. McFarland emphasized that data drive all decisions, and he felt that Ms. Ryder’s proposed study was on track. He noted that Table 5 probably includes duplicate numbers. For example, medical and dental patients are not always different individuals. He asked if any of the reports could provide unduplicated numbers. Ms. Ryder stated that this question illustrated the need for a national MHC data warehouse that would collect information such as user and encounter data, billing data, and primary and secondary diagnoses. Dr. Gòmez noted that utilization is not patient-specific.

Roberto Gonzales stated that the Council should continue to emphasize the need for culturally and linguistically competent providers in areas where farmworkers are located. Ms. Ryder agreed that this was very important. The challenge is to find data to support the recommendation.

Dr. Fernandez thanked Ms. Ryder for her informative presentation and adjourned the meeting for lunch.

PRESENTATION BY THE NATIONAL HEART, LUNG AND BLOOD INSTITUTE (NHLBI), NATIONAL INSTITUTES OF HEALTH (NIH)

• Ms. Matilde Alvarado, Coordinator for the Minority Health Education and Outreach Activities   

Ms. Alvarado presented an overview of the NHLBI’s Salud Para Su Corazon (SPSC) project, which was designed to reach high-risk groups and eliminate health disparities. She emphasized that NHLBI was committed to sharing knowledge with key stakeholder groups and valued the Council’s input. Ms. Alvarado noted that a partnership with HRSA-funded health centers that began in 2002 had been an invaluable mechanism for implementing the project.

Ms. Alvarado stated that the SPSC project began in 1994 in response to the growing prevalence of cardiovascular disease in Latino communities. SPSC is a community-based initiative that was developed for and by Latinos. To date, three generations of well-defined projects have been implemented in a variety of settings, using tested materials and strategies. The poject is science-based, focused on health needs, collaborative, culturally sensitive and linguistically appropriate, community-driven, and flexible.

Ms. Alvarado emphasized that promotores are the core of the program. Their ability to reach and connect with communities enables them to influence values and impact behavior change. Through the SPSC project, promotores become change agents and role models, and they serve as extenders of care.

Ms. Alvarado noted that SPSC was based on a model of “learn, teach, empower.” The program’s primary resource is a training manual, Your Heart, Your Life (YHYL). The manual was first published in 2000 and was revised in 2008. Other materials include picture cards, a recipe book, and booklets on topics related to heart health. All materials are culturally appropriate and easy to read. The project has also produced a DVD with videos and novellas.

The YHYL manual consists of 12 interactive educational sessions that address topics such as cholesterol, weight, diabetes, heart-healthy eating, smoke-free living. Each session includes demonstrations, handouts, picture cards, physical activity, and hands-on activities. An appendix provides instructions for cooking demonstrations and food displays; tips on forming a walking club; and a bingo game.

Ms. Alvarado described three strategies for implementing and evaluating the SPSC program:

1. Train-the-trainer: Trained promotores train other promotores on how to use the manual. Evaluative measures: number and percent of changes in knowledge and skills of promotores.
2. Community education: (a) Teach the manual to the community. Evaluative measures: number and percent of changes in knowledge, attitude, and behavior. (b) Teach the manual and conduct heart health screenings. Evaluative measures: number and percent of changes in knowledge, attitude, and behavior and the number and percent referred and follow-up with provider.
3. Lifestyle and clinical management to help patients manage risk factors and make lifestyle changes. Evaluative measures: number and percent of changes in knowledge, attitude, and behavior, the number and percent of changes in clinical values, the number and percent of patients taking medications, and the number and percent of patients contacted for followup.

Ms. Alvarado presented an overview of the history of the project. The pilot project was conducted from 1994 to1998 in the Washington metropolitan area and targeted populations that were monolingual, low socio-economic status, low acculturation, and low literacy. An impact evaluation showed that the pilot project succeeded in raising awareness.

The first-generation projects were conducted from 1999 to 2001 in Chicago, IL, Escondido, CA, and Ojo Caliente, NM. El Paso, TX served as a mentor site. The projects focused on education and motivation, and they tested the feasibility of using promotores. The implementation strategy included training promotoras, conducting family risk assessments, and testing data-collection tools. The project evaluation found that the heart health knowledge of promotores improved from 10% at pretest to 55% at post-test.

The second generation projects were conducted from 2000 to 2002 in collaboration with Migrant Health Promotion. Four sites were added to the project: El Paso, TX; Providence, RI; Stockton, CA; and Relampago, TX. The focus of these projects shifted from education to behavior. The implementation strategy included family recruitment, heart health education, and support, referral, and follow-up by promotores. Pre- and post-tests found significant improvement in healthy behaviors such as physical activity, weight, and heart-healthy eating. These benefits extended beyond program participants, because participants shared information with their families, neighbors, and friends, including relatives in their country of origin. The primary factors that contributed to project success were personal motivation and team work among the promotores and support from community-based organizataions and NHLBI. Funding for the program and recruitment of participants were the major challenges.

Ms. Alvarado stated that a partnership with HRSA made it possible for CHCs to become involved in the third-generation projects, which have been conducted along the U.S.-Mexico border since 2005. A recent impact evaluation found significant improvement in both behavioral and clinical measures and identified several promising practices. Ms. Alvarado noted that the findings of the evaluation were published in the January issue of Preventing Chronic Disease.

Ms. Alvarado described current project activities, including development of a training center at Gateway Community Health Center in Laredo, TX, expansion of the project to Central Florida and Latin America, adaptation of project tools to other ethnic groups, and updating the educational materials. Future plans include continued expansion of the program, development of a project website, analysis and dissemination of project results, formation of a sustainability group, and development of a college-based credentialing program using SPSC resources.

Ms. Alvarado presented an extensive list of publications citing the SPSC project and training manual. She also presented a detailed diagram of goals, implementation strategies, and evaluation plans for using SPSC with small, medium, and large groups.

Ms. Alvarado reiterated that she would welcome suggestions and recommendations from the Council and opened the floor for discussion.

Discussion

Ms. Castillo commented that the project would be an excellent model for onging education via radio. Ms. Alvarado noted that the tools were designed to be used in different settings, from CHCs to radio and outreach activities, and she mentioned that a public television station in Chicago had used the novellas and other project materials.

Christina Ramos thanked Ms. Alvarado for her presentation and for documenting the importance and impact of promotores. Enedelia Cisneros commented that the SPSC tools supported family involvement in the education process and the program was very cost effective. Jose Lopez appreciated the fact that SPSC was a standardized program that could be customized to meet local needs. He felt that credentialing for instructors would be an important step.

Ms. Sanchez noted that the program addresses weight and other preventive health issues. Ms. Alvarado stated that the new model allows instructors to combine classes and deliver several sessions at once.

Dr. Fernandez asked how the Council could support the project. Ms. Alvarado suggested that the Council recommend offering the SPSC program at all migrant health clinics. Dr. Fernandez noted that evaluation data would support that recommendation.

SUBCOMMITTEE MEETINGS

The Council broke into subcommittees for the remainder of the afternoon to identify issues for the next set of recommendations.

RECAP FOR NEXT DAY 

• Ms. Castillo-Zavala - Co-Chair          

Ms. Castillo summarized the highlights of the information presented by Dr. Williams, Mr. Ruiz, Ms. Ryder, and Ms. Alvarado. Following her summary, the subcommittees reported on the issues they discussed during their meetings.

Public Policy and Advocacy

The subcommittee proposed that stimulus funds be used to establish an Educational Resource Center at every migrant health center serving. The resource centers would offer health and wellness information produced by and for Latinos, including videos, DVDs, books, brochures, and other materials. Resource centers would have an electronic bulletin board or TV monitor and would be gathering places for students, patients, and community members.

Migrant Health Services

The subcommittee noted that HIT would help address the need for portability of information and discussed what the migrant health program would need to do to be prepared to make use of this technology. The subcommittee also discussed the need to make specialty care more available and affordable for MSFWs and the need to increase the number of culturally appropriate providers.

Access, Resources, and Funding

The subcommittee stressed the importance of maintaining a focus on access. Committee members noted that access begins with the attitude of the clinic receptionist. The subcommittee also presented case examples that emphasized the importance of culturally appropriate enabling services and extended clinic hours.

Discussion

Dr. McFarland recommended that the Council look for a balance between large and small-scale initiatives. Noting that dental clinics are expensive, he suggested using stimulus funds to put a dental clinic in every health center.

Susana Castro emphasized the importance of flexibility in order to tailor programs to local needs.

Capt. Lopez suggested that the Council’s recommendations address concrete issues. He stated that the Bureau would communicate the Council’s concerns even if the recommendations were not finalized. Dr. Gòmez advised the Council to use broad language and allow the Bureau to fill in the details for implementation.

Responding to a question from Dr. Fernandez, Dr. Gòmez stated that health centers were working through NACHC and their PCAs to communicate their priorities for the stimulus package and budget appropriations. She urged Council members to keep their local PCAs informed of the needs of MSFWs.

Dr. Fernandez adjourned the meeting for the day at 4:30 p.m.

TUESDAY, FEBRUARY 10

DIALOGUE WITH COUNCIL MEMBERS

• Capt. Henry Lopez, Jr. - Director, OMSP 

Dr. Fernandez called the meeting to order at 9:00 a.m. and welcomed Capt. Lopez, who provided an update on the activities of OMSP.

Capt. Lopez noted that during his first year at OMSP he had learned a great deal about those who provide so much, yet are taken for granted. Emphasizing that the Council’s passion keeps the migrant health program going, Capt. Lopez stated that it was a pleasure to work with the Council, and an honor to work with his staff.

Capt. Lopez informed the Council that he had organized his staff into two teams to more effectively address the needs of special populations. Dr. Gòmez and Ms. Cate were given the leading role for migrant health issues.

Capt. Lopez emphasized his commitment to the Council and his desire to be proactive to obtain funds for the migrant health program. He urged the Council to look at the big picture and come up with plans that he could promote; the Bureau would take care of the details.

Capt. Lopez acknowledged that the new secretary would bring a new leadership team, but HRSA’s work would not change. He emphasized that the new administration wanted to hit the ground running and was looking for good ideas. The health centers would be a key part of stimulus package, and Capt. Lopez was committed to making sure that funds were used to put people to work in the migrant health program. He noted that the worst thing the Council could hear was, “You should have said something—we could have funded it.”

Capt. Lopez reported that OMSP met with the national cooperative agreements (NCAs) in September 2008 to develop a new strategic plan. As part of this strategy, the NCAs formed the Farmworker Health Network (FHN) in order to collaborate more effectively.

Capt. Lopez noted that special populations represent nearly 20% of the health center budget. One-third of the special population patients are migrant farmworkers, therefore, Capt. Lopez, Dr. Gòmez, and Ms. Cate had begun to accompany project officers on site visits to migrant health grantees.

Capt. Lopez expressed his commitment to providing the Council’s input during the development of Program Information Notices (PINs) and Program Assistance Letters (PALs), which establish policies and procedures for the health center program .

Capt. Lopez expressed his commitment to maintaining the Council’s face-to-face meetings and conference calls. He noted that he would like to set up a monthly conference call for the Council to maintain the momentum of its work. Dr. Gòmez noted that monthly conference calls would not entail more work for the Council. Rather, she would work with the subcommittees to use them more effectively. She emphasized that when she contacts Council members for feedback or comments, the issues they discuss should not be shared with those outside the Council. 

Capt. Lopez reported that he was taking steps to improve the process for submitting the Council’s recommendations to the Secretary and the timeline for approving travel plans.

Discussion

Jose Lopez asked how MHCs that are not represented on the Council could provide input and asked if a web portal could be developed to enable them to submit suggestions. Capt. Lopez stated OMSP informs MHCs of issues raised by the Council. Dr. Gòmez pointed out that the HRSA website includes an “Ask HRSA” link. Questions pertaining to migrant health that are submitted through that link are forwarded to her, and she asks the Council to respond. She also noted that Council members were permitted to solicit input from their community, but she cautioned them about taking on too much additional work.

Ms. Castillo asked whether the HRSA website would be available in Spanish. Capt. Lopez said he would check with the Office of Communications. Ms. Castillo also noted that Council members are often asked about policy issues. She urged Council members to refer those questions to Capt. Lopez or Dr. Gòmez.

Dr. Weathers asked how the Council could help OMSP. Capt. Lopez reiterated his request for big-picture ideas that he could promote to the Secretary and within HRSA. He encouraged the Council to be proactive and creative, especially with proposals for the stimulus funds.

Capt. Lopez thanked Council members for their work and encouraged them to contact him or Dr. Gòmez at any time.

COUNCIL DISCUSSION – FUTURE DIRECTIONS OF THE COUNCIL

• Dr. Rogelio Fernandez - Chair 

Dr. Fernandez noted that Dr. Gòmez had proposed making greater use of the subcommittees during the time between Council meetings so the Council could be more productive. He invited Council members to share their thoughts about the challenges and needs facing the migrant health program.

Ms. Cisneros stated that outreach and transportation services were essential to identify migrant farmworkers and provide access to services. Dr. Gòmez stressed that outreach staff must understand that MHP funding is targeted for migratory and seasonal farmworkers.

Dr. McFarland raised an issue that he described as “financial viability for farmworkers to access care.” He expressed concern that fee scales vary widely among CHCs and stressed the need for fees to be affordable and consistent, since MSFWs visit different health centers as they move. Dr. Gòmez stated that the MHCs provide services on sliding fee scales; she also noted that 80% of MSFW families should be eligible for free services.

Dr. Weathers expressed concern that the barriers to access and the size and nature of the MSFW population are not clearly understood. She proposed funding a Center for the Study of Migrant Health.  Such a center could conduct and archive research on the health of migrants, and thereby inform policy and program efforts for migrant workers and their families, as well as have a key role in supporting and training scientists interested in studying migrant health.   

Jose Gaytan noted that transportation is a challenge for many MSFWs. It would be helpful to have more doctors who provide services in the field.

Ms. Segarra stated that the migrant health program in Puerto Rico has excellent facilities that provide comprehensive services. Employers need more information about the clinics so they can inform their workers.

Mr. DuRussel expressed concern that more people would turn to agricultural work due to the economic downturn. He emphasized that clinic hours must be flexible to accommodate farmworkers’ schedules.

Dr. Fernandez stated that most health centers in California were at full capacity, which limits access. Construction of new facilities and additional physicians and dentists would help to alleviate the situation. Referring to changing migratory patterns, Dr. Fernandez emphasized the need to obtain accurate information on the number and location of farmworkers.

Jose Lopez described a company that brings farmworkers from Puerto Rico to New York that provides a physician for its workers.  The company is unwilling to allow its workers to utilize the local MHC, which offers more comprehensive services. Mr. Lopez also noted that it is difficult to attract providers to rural areas, and visa issues make it difficult to recruit foreign providers.

Dr. Weathers noted that half of the children served by MHCs in North Carolina were unaccompanied minors. She suggested that it would be important to determine how this trend would impact the migrant health program.

Ms. Castillo agreed that identification and tracking of migrant groups was very important. She noted that her area had a continuous influx of MSFWs from indigenous communities who were not accustomed to receiving medical services such as prenatal care or immunizations. Ms. Castillo suggested that each clinic should have a system to track the local MSFW population so it could tailor its services to meet their needs. To increase their sustainability outside of the growing season, MHCs should reach out to other underserved populations in the community, including the elderly, homeless, and unemployed.

Mr. Nimmo said his clinic was fortunate to have an excellent executive director who was aggressive about pursuing grants and accessing resources. He identified several challenges facing MHCs, including creating access, enumerating and identifying MSFW populations, and developing a uniform model of affordable care.

Mr. Gonzales stated his area needed additional providers, transportation services, and clinic hours that accommodate farmworkers’ schedules. He noted that he was working with the board of his clinic to extend the service hours for MSFWs. 

Ms. Canales reiterated the need for more doctors and dentists. She noted that the waiting list for dental appointments in Minnesota was longer than the growing season. Ms. Canales also expressed concern that private doctors who participate in the voucher program are unwilling to see farmworkers who do not have translators. She emphasized that children should not be translators for their parents.

Ms. Castro thought that the most important issues facing MSFWs were continuity of care and portability of medical records. She suggested that medical records be provided on CD so that patients could take them with them.

Ms. Ramos stated that some MSFWs in the Rio Grande Valley go to Mexico because medical care and prescriptions are cheaper and the local CHC has a long waiting list. She expressed concern that many people cannot afford passports, which will be required to cross the border after June. Ms. Ramos noted that outreach workers in Michigan overcame the challenge of locating migrant camps by working with health inspectors. She also described an effective strategy of using outreach workers to conduct patient surveys in the camps, which resulted in a high response rate.

Ms. Sanchez felt that dental care was the greatest unmet need. She noted that some health center dentists would not treat pregnant women because they were concerned about pre-term labor. Dr. McFarland responded that pregnant patients should not be denied access to dental services, especially in an emergency.

Ms. Castro raised the issue of patient satisfaction. She stated that patients will return to a clinic where they are treated well and they trust the providers; they will not return if they do not feel at home.  Dr. Gòmez responded that Jim Macrae was very concerned about this issue, and she informed the Council that HRSA was in the process of developing a patient satisfaction survey.

Dr. Fernandez noted that access, affordability, cultural competence, shortage of physicians, and immigration issues were recurring themes. The Council must do its part to make the Secretary aware of these problems.

PRESENTATION: “HONORING THE HANDS”

• Anne K. Nolon, CEO, Hudson River Health Center
• Nick Cannell, Videographer, Community Health Productions

Dr. Fernandez introduced former Council member, Anne Nolon, who presented her documentary on the migrant health movement. Ms. Nolon expressed appreciation for her time on the Council and introduced the “Honoring the Hands” project, which was undertaken to commemorate the 45th anniversary of the Migrant Health Act. Inspired by farmworker advocate Robert F. Kennedy, the film honors individuals who exemplify “those who can blend passion, reason, and courage in a personal commitment to the ideals of American society.” Noting that more than half of those interviewed for the project were 55 and older, Ms. Nolon stated that one goal of the project was to inspire new generation of leaders.

Ms. Nolon told the Council that “Honoring the Hands” was a multimedia project that includes a three-part documentary film and an interactive website (www.honoringthehands.com). The documentary film is divided into three segments, one for each of the three migrant streams (East, Midwest, and West). Reflecting Kennedy’s words, each segment consists of three sections: Passion (featuring leaders in migrant health), Reason (featuring growers), and Courage (featuring advocates for migrant farmworkers).

Ms. Nolon informed the Council that Nick Cannell was editing footage to create an additional segment honoring the history and work of the NACMH. She gave the Council a preview of this segment, which was still a work in progress.

Ms. Nolon introduced the Council to the website, which includes archival materials and photographs, video clips of interviews with project participants, and an interactive forum on Migrant Health trends, issues, policies, and legislation. She played a video clip from the website honoring farmworker advocate and former Council member, Rafael Martinez.

Council members were moved by the documentary and expressed their gratitude to Ms. Nolon and Mr. Cannell. Ms. Nolon distributed a copy of the DVD to all Council members and encouraged them to show the film at their board meetings and elsewhere in their communities. Council members felt that the film should reach a wider audience and suggested that Ms. Nolon contact PBS or Univision.

Dr. Fernandez thanked Ms. Nolon and Mr. Cannell for their hard work and dedication. He then adjourned the meeting for lunch.

REPORT BACK FROM SUBCOMMITTEES

Following the lunch break, the subcommittees gave more detailed reports on the issues they discussed on the first day of the meeting.

Migrant Health Services

Subcommittee members reviewed the issues that were discussed during the Council’s meeting in New Orleans, including comprehensive primary care services and the need to identify key elements of successful programs.

The subcommittee noted that HIT would play an important role in supporting portability of health records. Key issues were the feasibility and effectiveness of HIT models on a national scale.  The subcommittee also identified the need for workforce development and strategies to make specialty care more available and affordable.

Addressing workforce issues, Dr. Fernandez noted that fewer students were going to medical school, and fewer medical students were choosing a career in primary care. He stressed the need to develop the pipeline by interesting students in health care careers at an early age. The NHSC was an important part of that strategy.

Council members suggested that the stimulus package could be a good opportunity to fund HIT systems, which would be expensive. It would be important for systems to communicate across clinics, given the mobility of migrant populations. Jose Lopez compared HIT to ATM systems. He noted that when ATMs were first introduced, customers could only use machines at their own bank; now, ATMS are linked in networks around the world.

Dr. Gòmez cautioned that the government could not endorse any one HIT system. Council members suggested that they could express a concern about the potential lack of uniformity of HIT systems across health centers. One Council member suggested that open license software would be a potential solution.

Dr. Gòmez offered to invite the HRSA Office of Information Technology (OIT) to make a presentation at a future meeting. Council members agreed that this would be valuable. Dr. Gòmez stated that she would ask the Council to provide a list of technology issues that are of concern to migrant populations.

Access, Resources, and Funding

The subcommittee reiterated their view that patient satisfaction was an important element of access. If patients are happy with the care they receive, they will continue to come back and will encourage their friends and family to use the services.

The subcommittee recommended that stimulus funds be used to expand MHC services to reach more patients and reduce waiting times.

Public Policy and Advocacy

The subcommittee expanded on their concept of an Educational Resource Center for MHCs. They noted that the resource centers could provide training and tools for the promotora program. High school and college students and community members could produce written materials or public service announcements for local radio and TV. The resource centers could save doctors’ time and alleviate patients’ concerns by explaining procedures in advance.

Subcommittee members suggested that the resources could be available on the Internet, in libraries, and on DVD, as well as at a physical location at each clinic.

Capt. Lopez and Dr. Gòmez noted that HRSA had a wide range of free materials, many of which were available online. Council members suggested that each clinic could decide what materials would be relevant for their patients. Stimulus funding could be used to provide every MHC with physical space and equipment for a resource center. One Council member stated that a resource center should be a program expectation, and not an option.

COUNCIL DISCUSSION

The Council reviewed the draft letter that had been developed based on Council discussions and testimonies heard during the November 2008 meeting in New Orleans.  The letter contained the following recommendations:

1. Continue support of primary care services, build and expand the MHC model through identification and strengthening of the components that make it successful.
   
   
2. Expand and strengthen the National Health Service Corps to ensure workforce expansion and development among all disciplines in primary care.
   
   
3. Support increased collaborations and partnerships with other entities to ensure delivery of comprehensive primary care services and increase diversity of service.
   
   
4. Achieve portability of insurance coverage and clinical records for migrant and seasonal farmworkers and their families
   
   
5. Give MHCs the flexibility to serve smaller numbers and do not penalize grantees for not reaching target numbers due to issues beyond their control
   
   
6. Ensure that MHC board members, staff, and patients are aware that health care services provided by FQHCs are exempt from the Public Charge Law.

Dr. Gòmez suggested that the letter should provide concrete examples of what the Council wanted, as well as a rationale explaining how the recommendation would benefit the migrant health program. She urged the Council to think about its top priorities for the stimulus funds. Capt. Lopez recommended using more action words.

Ms. Castro, Dr. Weathers, Dr. Fernandez, and Ms. Castillo agreed to revise the letter to incorporate issues raised during this meeting and suggestions offered by Dr. Gòmez and Capt. Lopez.

Dr. Gòmez noted that the Council’s next meeting would be held in San Antonio, in conjunction with the NACHC conference. The Council agreed to meet on May 14-15, with return travel on Saturday, May 16. Dr. Gòmez said that she would look into obtaining funds for Council members whose conference registration fees were not already covered by their health center. 

Dr. Fernandez proposed that the Council hold its first meeting of FY 2010 in Washington, D.C. in November. This would enable the Council to meet with the new HHS Secretary and to attend the Western stream conference in January. Council members supported this idea.

BUREAU OF PRIMARY HEALTH CARE (BPHC)/OFFICE OF MINORITY AND SPECIAL POPULATIONS (OMSP)

• Mr. Jim Macrae, Associate Administrator for Primary Health Care

Capt. Lopez introduced Jim Macrae and commended him for his commitment to and passion for primary care.

Mr. Macrae expressed regret that planning for the economic stimulus package made it difficult for him to attend the Council’s meeting. Mr. Macrae stated that the stimulus would include funding for health center construction and renovation; it might also provide some funds for services and for NHSC expansion. To ensure accountability and transparency, the administration was launching a dedicated website to monitor how funds were spent (www.recovery.gov).

Mr. Macrae stated that dialog with the Council helped BPHC staff do their jobs better. He hoped that the Council had seen that HRSA responded to its recommendations, as evidenced by the new grant for enabling services. Mr. Macrae assured the Council that the Bureau was trying to respond to its concerns in other areas, such as the minimum number of patients served, the need for enumeration studies, and immigration issues. He noted that HRSA was holding firm on its position that the Section 330 law prohibits CHCs from inquiring about immigration status. Mr. Macrae also stated that the new SCHIP policy was an important opportunity for health centers.

Referring to the new administration’s emphasis on accountability, Mr. Macrae emphasized that BPHC needed the Council’s help to make sure that funding reaches MSFWs and their families. He assured the Council that he would keep the new Secretary informed of the migrant health program and the work of the Council.

Discussion

Dr. Fernandez told Mr. Macrae that the migrant health community was very excited about the enabling services grant and thanked him for pushing it through so quickly. Dr. Gòmez noted that 150 people participated in a recent technical assistance conference call regarding grant applications.

Responding to a question, Mr. Macrae stated that no stimulus funds were specifically allocated for the MHP.  HRSA was planning to apply the same formula as it uses for the Section 330 programs.

Ms. Cisneros reiterated the importance of funding for outreach and transportation services.

Ms. Castro emphasized that patients must be satisfied with the health care they receive and how they are treated at the clinics. Mr. Macrae noted that BPHC was conducting a national patient survey, with oversampling of special populations. The survey instrument included questions about whether the patient feels respected. Mr. Macrae stated that he would like to conduct a patient satisfaction survey and would welcome ideas from the Council. Dr. Weaver suggested that it would also be useful to conduct a provider satisfaction survey.

Responding to a questions about enumeration studes, Mr. Macrae stated that the administration was working on obtaining a more accurate count of MSFWs in the 2010 census. Ms. Ramos suggested using promotoras to conduct the census, because they are known and trusted in the community. Dr. Weathers stated that, in her experience, outreach workers were the only way for researchers to access the migrant population.

Jose Lopez noted that many clinics were converting to electronic health records (EHRs) and asked how patients would access their records when they migrate. Mr. Macrae stated that, as a first step, EHRs are now required to be interoperable so they can communicate with each other. HRSA was looking at establishing regional centers that would be linked with state systems. Mr. Macrae emphasized that any system created for HRSA must meet the needs of the populations that the health centers serve. HRSA needs the Council to provide feedback regarding what MSFWs need in the area of HIT.

Mr. Macrae noted that the health care priorities of the new administration would include many opportunities to move forward with the migrant health agenda. The top priority would be health care reform, but BPHC would also emphasize the importance of a health care home. Prevention and health disparities would be key issues, and HIT would be emphasized, with a push for electronic health records by 2014. Workforce development initiatives would include a renewed emphasis on promoting primary health care and associated disciplines.

Dr. Fernandez reiterated Dr. McFarland’s request for a dental clinic in every health center. Mr. Macrae noted that HRSA received 300 applications for the current round of dental health expansion grants.

Dr. Fernandez thanked Macrae for his presentation and for his dedication to the migrant health program.

LOGISTICAL INFORMATION

• Gladys Cate, OMSP

Ms. Cate reviewed the procedures for travel reimbursements and urged Council members to submit their forms as soon as possible.

The Council thanked Dr. Fernandez and Ms. Castillo for their service as Chair and Vice-Chair.

Dr. Fernandez adjourned the meeting at 5:09 p.m.

• Capt. Lopez will contact the HRSA Office of Communications regarding a Spanish version of the HRSA website.
  
  
• Dr. Gòmez will invite the HRSA Office of Technology to make a presentation on HIT at the Council’s next meeting in Washington.
  
  
• Dr. Gòmez will ask the Council to identify technology issues that are of concern to migrant populations.
  
  
• Dr. Gòmez will look into funding registration fees for the NACHC conference for those Council members whose registration is not already covered by their health center. 

NEXT MEETING: May 14-15, 2009, San Antonio, Texas