Cherokee Health Systems Rural Outreach Project

To address these needs, Cherokee Health Systems proposed a collaborative health outreach project built on a network of primary care, behavioral health, postsecondary education, and social service providers. The network was designed to achieve two major goals: to improve access to care, and to improve the use of local health care resources.

The target service area included three rural counties—Hamblen, Grainger, and Jefferson—in eastern Tennessee. Individuals came to these communities to get jobs in the agricultural industry. This population was largely invisible to the local health care system; as a result, local health status reports and census counts did not reflect their needs. However, local organizations estimated that up to 20,000 Hispanics lived in the three-county area.

• Union-Grainger Primary Care Clinic, an integrated care site, provided primary care, dental, and behavioral health services.
• Appalachian Outreach, a poverty relief ministry, provided food, clothing, furniture, and referrals to other community services.
• Carson-Newman College provided internship opportunities for students in primary care clinic sites as translators and assisting clients with a variety of needs (i.e., food, shelter, clothing, English classes, computer classes, applying for entitlements, completing job applications).
• Hamblen County Central Services provided Hispanic health advocacy, outreach, and networking resources.
• Stepping Out Ministries provided outreach, selfimprovement workshops, and English and Spanish classes.

The project also partnered with the University of Tennessee Medical Center to offer prenatal care at the Union-Grainger Primary Care Clinic and doulas to provide support during labor and birth. All organizations involved in the consortium contributed Hispanic outreach staff members and provided translation services.

To overcome cultural and language barriers to care for area Hispanics, the project recruited and trained bilingual staff to provide translation and outreach services within the organizations involved in the network. By establishing trust with potential clients, project planners hoped that news of the program’s services would spread by word of mouth.

The outreach team organized “welcome wagon” gatherings, soccer games, and other community activities. At these events, staff members encouraged Hispanic residents to contact them to receive assistance in accessing health care, food, clothing, and shelter services. When Hispanic residents came to one of the network organizations for help, bilingual staff members were on hand to help them get the services they needed. Once trust was established, Hispanic residents were more than willing to use the resources available to them.

The project also offered training to bilingual staff with some health care experience so they could become certified nursing assistants and placed in primary care offices to assist providers with patient care. The project also hired bilingual registered nurses, translated all forms and educational handouts into Spanish, and staffed the call center for the toll-free telephone lines with bilingual information specialists.

The outreach team developed a map that showed the locations of service organizations equipped to provide culturally appropriate care to Hispanic residents and coordinated weekly transportation to a local dental clinic—staffed by a bilingual dentist. One of the best-received project activities was the production of photo identification badges for undocumented immigrants. Local police, banks, hospitals, the health department, and the department of human services used the ID badges.

At the beginning of the grant cycle, the network had one bilingual staff member. By the end of the grant period, the network had 17 bilingual staff members providing behavioral, primary care, dental, outreach, prenatal, and social services to area Hispanics.

HRSA’s Bureau of Primary Health Care has awarded a new grant to Cherokee Health Systems to establish a migrant health center. It plans to use a promotores model for providing health education services and improving Hispanic health status in the region. Cherokee Health Systems plans to continue collaborating with the consortium members for this grant as they serve as prime locations for sustaining Hispanic outreach activities.