When Leticia Mata applied for a job at the Healthy Start program in the small Central Valley town of Newman, she didn't know what a promotora (health outreach worker) does. Trained as a social worker in Mexico, Mata lacked U.S. credentials and worried that her English was "not one hundred percent." However, she had the key quality that Director Maria Velasquez was looking for--a passion to help others in the community.

Four years ago, when Velasquez became director of the Newman-Crows Landing Unified School District's Healthy Start Family Resource Center, the school-linked services program looked great on paper. County agencies had signed letters of agreement and stationed staff at the school. There was a portable in which to see families. But one key thing was not happening: families were not coming in the doors. Mata and the other promotoras were the core of Velasquez's new strategy to reach out to families.

Neighbor to neighbor

For promotoras, training means learning about various agencies and services. They already know the community and its culture--because they live there. Many speak Spanish as well as English. They visit families' homes day or night to speak with them about specific health issues, beginning a human connection that makes families feel more comfortable about going to the center. Leticia Mata proudly asserts, "We are the ones who open doors for people."

Promotoras' visits introduce families to a variety of programs. Currently, for example, Mata is visiting five new mothers as part of a county health department home-visiting program. She visits each mom once a week for an hour, asking about how the family's doing, whether they've been going to health care appointments, whether they need any information or equipment for the baby. She shares information about what's available at the family resource center, encourages parents to come to the FRC's parenting classes, and offers a ride if it's needed.

Connections to services

Now, thanks to the efforts of the 50 paid and volunteer promotoras working out of the family resource center, the portable is often crowded with people. The FRC offers application assistance for breast cancer exams, holds twice-a-month immunization clinics, provides mental health services, and conducts classes on prenatal health, English, car-seat safety, and more.

And the promotoras do more than bring families to the FRC. For example, last summer promotoras reached out to families of incoming kindergartners with phone calls, letters, and home visits. They helped families fill out registration packets and get required immunizations and physicals. Velasquez says that without that support, 241 children in migrant farmworker families might not have been able to start school on time.

Seeing strengths

As a family resource center committed to the principles of family support, the Newman FRC wants to go beyond providing services to "empowering people so they can do for themselves," Velasquez explains. And residents trust promotoras because "a promotora is a neighbor, a friend. She has the corazón (heart) to help you right there and then, not when the office is open between 8 and 5."

Velasquez started by inviting mothers to join her for a "second cup of coffee" after dropping off their children at school. With a warm chuckle, Velasquez remembers telling them, "You have nothing to do. I'll give you something to do." From the very beginning, Velasquez saw these community members as neighbors capable of helping neighbors.

The line between promotoras and community members, paid staff and volunteers, is deliberately blurred at the Newman center. Velasquez tells her volunteers, "You are all promotoras." That is, you all have the strength and ability to help others as well as receiving help. This "strengths-based approach" corrects the traditional view of service-providers, seeing the community as full of problems that need fixing.

When Mata visits a woman in her home, she directly counters the negative messages that she hears: You cannot--because you are poor, a woman, an immigrant. She educates them about their rights and informs them of services. And when there are opportunities to drive home the point, such as filling out an application, she hands the person the pen and says encouragingly, "Here, you can do it yourself."

Passing the message on

Margarita, a woman who found help and treatment for clinical depression through Mata's encouragement, says with gratitude, "I feel important and can do something for myself." Although she has since moved to another city, she returns to the Newman FRC to tell others in the community how to get help, to find strength to keep going in life. "I would really like to pass the message to all the women. It's important to have a resource like this one...to manage our lives."

Many women like Margarita and the others who dropped in for that cup of coffee have continued on working as promotoras or volunteers at the New-man Healthy Start FRC. Through their efforts, the center has a clothing center, built, staffed and run by volunteers, which provides clothing to students and their families. There are dance classes and a fitness program for parents. There are gifts for families with new babies.

Taking action

And when community involvement and action are required, the promotoras and volunteers help spread the word. Whether it's a back-to-school night or a successful campaign for city funds for a dial-a-ride program, the promotoras get the word out. And community members have responded--marching in Sacramento to increase awareness about breast cancer in the Latino community, sitting on school district English Language Learner advisory boards, and advocating for a larger family resource center.

Says Velasquez proudly, "I let them run the show."

The research shows...

• Teaming promotoras with school-linked service providers at Newman-Crow's Landing Healthy Start Family Resource Center has resulted in better grades for students, improved attendance, and students staying in the same school longer.

• In an evaluation of the Texas Health and Human Services Colonias Initiative, evaluators from Texas A&M University found that promotoras increased neighborhood participation in community resource centers by an average of 68 percent.

• In a study of Arizona's Border Health Strategic Initiative (Border Health SI!), which worked with Latino families on the issue of diabetes, the Arizona College of Public Health found that promotoras' work led to increased physical activity and decreased soft drink consumption.

Resources:

• Community Health Worker/ Promotoras Network,
  a statewide network, Maria Lemus, 510-231-9954, MHOLL67174@aol.com

• North Central Area Health Education Training Center and Promotoras Program, with a promotora training curriculum (Lexington, KY), Rosa Martin, 859-281-6086, rosa.martin@kctcs.edu
  

• Newman-Crow's Landing Family Resource Center,
  209-862-0295