Environmental and Occupational Health

CommuniCare Health Centers (CommuniCare) is a private, non‐profit community health organization providing health care services to the culturally diverse, low‐income, uninsured, and under‐insured populations of Yolo County and parts of Solano County in California.CommuniCare has worked with MCN to design an environmental and occupational health invention in their extensive perinatal program. CommuniCare first incorporated exposure screening questions into their initial intake encounter. This encounter lasts one hour and is conducted by health educators. The information is compiled for the attending Certified Nurse Midwives (CNM) who use the information to determine risk status and plan the patient’s prenatal care. After piloting a series of questions and assessing the wording and effectiveness, CommuniCare incorporated the following three screening questions into their intake process:

• What kind of work do you do?
• What kind of work do members of your household do?
• Are you now, or have you previously been exposed to pesticides, solvents, or other chemicals, dusts, fumes, radiation, or loud noise?

If the patient presented with a specific problem the following questions were asked:

• Do you think your health problems are related to your home or other location?
• Do you think your health problems are related to your work?
• Are your symptoms better or worse while you are at home or at work?

CommuniCare also altered the format of their charts to allow for space to document responses to the screening questions. If the screening noted possible risks, the charts were flagged and the CNM conducted a more thorough environmental and occupational history. CommuniCare also implemented a system to facilitate reporting and consulting with or referring patients to an Occupational-Environmental Health Specialist. In addition, CommuniCare made resources such as the California Birth Defects Monitoring System and the Pregnancy Risk Information Line more readily available to clinicians. In addition to these clinical systems changes, CommuniCare also incorporated patient education into the initial prenatal visit and the post partum visit. MCN facilitated a specific training for the health educators to help them with the integration of the pesticide screening questions into their intake process and understand ways to promote pesticide safety education with their patients. CommuniCare health educators received MCN’s comic book, Lo Que Bien Empieza… Bien Acaba, to use during the initial visit. Designed for women of reproductive age, the comic book discusses the problem of pesticide exposure, health effects of exposure, and ways to prevent it. To use in the post partum visit, MCN gave CommuniCare, Aunque Cerca… Sano, a comic book to help farmworker families minimize the risk of pesticide exposure. Focusing on children, this comic book explains the problem of pesticide exposure, the health effects associated, and methods for prevention.