The authors present findings from farmworker leader trainings and a health access survey conducted by the ACCESS pilot project, a farmworker health access initiative. Results show that a peer-to-peer education model prepares farmworker leaders to teach their communities about toxic stress and ways to mitigate its negative health outcomes. Insights from the farmworker survey reveal barriers to health care access among the population.

Addressing Toxic Stress and Health Care Access in California Farmworker Communities

ACCESS Pilot Project Evaluation

Ingrid Estrada-Darley, Alejandro Roa Contreras, Cristina Alvarez, Cristina Glave, Yoselín Mayoral, Elena Josway, Elvira Herrera, Yunuen Ibarra, Leslie Pech, Karen Lizarraga, et al.

ResearchPublished Apr 15, 2025

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.

Key Findings

  • 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

  • Organizations interested in improving farmworker health and health care 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.
  • 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.
  • 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.

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Citation

RAND Style Manual

Estrada-Darley, Ingrid, Alejandro Roa Contreras, Cristina Alvarez, Cristina Glave, Yoselín Mayoral, Elena Josway, Elvira Herrera, Yunuen Ibarra, Leslie Pech, Karen Lizarraga, Brandon Toji, Suguet López, Peter Mendel, and Nicole K. Eberhart, Addressing Toxic Stress and Health Care Access in California Farmworker Communities: ACCESS Pilot Project Evaluation, RAND Corporation, RR-A2152-5, 2025. As of April 30, 2025: https://www.rand.org/pubs/research_reports/RRA2152-5.html

Chicago Manual of Style

Estrada-Darley, Ingrid, Alejandro Roa Contreras, Cristina Alvarez, Cristina Glave, Yoselín Mayoral, Elena Josway, Elvira Herrera, Yunuen Ibarra, Leslie Pech, Karen Lizarraga, Brandon Toji, Suguet López, Peter Mendel, and Nicole K. Eberhart, Addressing Toxic Stress and Health Care Access in California Farmworker Communities: ACCESS Pilot Project Evaluation. Santa Monica, CA: RAND Corporation, 2025. https://www.rand.org/pubs/research_reports/RRA2152-5.html.
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This research was funded by the UCLA/UCSF ACEs Aware Family Resilience Network (UCAAN) through a contract with the California Department of Health Care Services (DHCS) and carried out within the Quality Measurement and Improvement Program in RAND Health Care.

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