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

The ACCESS pilot project - a farmworker health care access initiative - was developed to address toxic stress in farmworker communities and increase farmworker access to health care services through clinic and community connections. The authors present findings from farmworker leader trainings conducted by the ACCESS pilot project to understand leaders' preparedness for educational outreach in farmworker communities across California. They also present results from a farmworker community survey that explored health access in farmworker communities and the impact of the educational outreach intervention. The evaluation was conducted to inform local and statewide conversations on how to improve health and health access for farmworkers through programming and policy interventions. Farmworkers in California experience disproportionately high rates of uninsurance and typically live in rural areas that lack sufficient health resources. In a prior study, more than four out of five California farmworkers surveyed reported experiencing at least one Adverse Childhood Experience (ACE) in early childhood. 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 outcomes in adulthood. 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 reveal that these communities experience significant barriers to accessing affordable health care.