The Kentucky migrant vocational rehabilitation program: a demonstration project for working with Hispanic farm workers.

The National Center for Farmworker Health (1995) has recognized farm work as one of the most dangerous occupations in the United States, ranked second only to mining in terms of occupational hazard. More recently, U.S. Department of Labor statistics have indicated that agricultural workers experience the highest rate of employee fatality and injury of any workers in the country (Moreno, 2004). Some of the most common farm work related injuries include back injuries, loss of limbs, heat stress, dehydration, dermatitis, eye problems, and pesticide poisoning, which can result in severe disabilities. A significant percentage of the agricultural workforce in the United States is comprised of migrant and seasonal farm workers, most of whom are immigrants of Latin American origin (U.S. Department of Labor, 2004). The occurrence of work-related disabilities among farm workers, including migrant farm workers, is substantial (National Center for Farmworker Health).

The Migrant Clinicians Network (n.d.) defines a migrant worker as "an individual who is required to be absent from a permanent place of residence for the purpose of seeking employment" (p. 2). Accordingly, many Hispanic/Latino farm workers in America meet the definition of a migrant worker. The term Hispanic represents a broad descriptive category, commonly used as a general term for an extremely heterogeneous grouping of ethnic origins (Flores & Carey, 2000). Hispanic/Latino migrant farm workers in the United States are primarily Mexicans or Mexican-Americans (Leon, 1996). In terms of race/ethnicity, Mexican/Mexican American populations are generally represented among Hispanic/Latino populations in both literature and Census classifications. Accordingly, throughout this article the ethnic designations of Hispanic and Latino are used interchangeably, with specific reference given to Mexican/Mexican Americans, where applicable.

According to The Council of State Governments' (CSG) Executive Committee Resolution on Federal Job Training for Migrant and Seasonal Farm Workers (2003), over 3 million people earn their living as migrant or seasonal farm workers in the United States. Of those workers, the vast majority is Hispanic with Mexican origin or heritage, and Kentucky is consistent with this national trend (Ibarra, 2000). Throughout the 1990s, migrant workers, primarily men from Mexico, have entered Kentucky to harvest tobacco, work at thoroughbred farms, and take service jobs at restaurants, hotels and other service establishments. The state estimates that 70 percent to 80 percent of the farm workers in Kentucky are Hispanic, with the majority of Hispanic migrant workers residing in the state illegally (Poynter, 1999a, 1999b).

In 2000, the Kentucky Migrant Vocational Rehabilitation Program (KMVRP) was initiated as a collaborative effort between the Kentucky Office of Vocational Rehabilitation (OVR), the University of Kentucky's Graduate Program in Rehabilitation Counseling (UK-GPRC), and the federal Agribility project. The KMVRP is a demonstration project that has developed and implemented a vocational rehabilitation intervention model for migrant farm workers with disabilities. Many of the rehabilitation consumers served by the KMVRP reside in rural areas within the state. In addition to concerns related to cultural issues (e.g., language and communication styles, lifestyles and values, etc.) and adjustment to new environments, service delivery to Mexican/Mexican American migrant farm workers in rural areas involves at least three concurrent obstacles that have a distinct bearing on vocational rehabilitation. First, there tends to be fewer qualified professional rehabilitation counselors in rural areas. Accordingly, recruitment of professionals with Mexican/Mexican American backgrounds represents a persistent difficulty. A second issue relates to problems with transportation and the geographical proximity of services. A primary challenge in rural areas lies in getting the services to the people or the people to the services. The citizenship status of many Mexican migrant farm workers creates a legal barrier that prevents obtaining a driver's license, thereby curtailing access to services. Third, disability terminology and the state/federal criteria for service eligibility, especially with regard to the implications in employment-restricted rural areas, may conflict with the way in which Mexican/Mexican Americans tend to view and interpret disability (Rivera & Cespedes, 1983; Roessler & Rubin, 1998). The interventions and outreach activities developed and implemented by the KMVRP offer practical and wide-scale application for rehabilitation educators and practitioners serving Mexican/Mexican American migrant workers, as well as other Hispanic/Latino consumers, in both urban and rural areas.

The purpose of this article is twofold. First, the purpose is to provide an overview of Hispanic/Latino (viz. Mexican/Mexican American) migrant workers. Unfortunately, the limitation of space does not allow for an in depth discussion of all relevant cultural aspects. Second, the purpose is to present the KMVRP as a demonstration project for working with migrant workers, especially farm workers with disabilities. The effectiveness of program services, based on the principles of cultural sensitivity training, innovative outreach efforts, pre-intervention capacity building, and the development of working relationships with individual consumers and key community businesses and human service providers, is illustrated. This article provides (a) an overview of the Hispanic/Latino migrant farm worker population, (b) a discussion of cultural sensitivity in rehabilitation planning and services with the Hispanic/Latino migrant farm worker population, and (c) a description of the KMVRP. Discussion and implications for rehabilitation counseling practice are presented.

Overview of Hispanic Migrant Workers

In 1990, the U.S. Department of Health and Human Services (1990) determined there were approximately 3.5 million migrant and seasonal farm workers in the United States. According to Moreno (2004), in 1997, 81 percent of all farm workers were foreign-born, and 77 percent of all farm workers were born in Mexico. The U. S. Department of Health and Human Services (2003) has undertaken a current enumeration project, which is being conducted on a state-by-state basis. To date, a few state profiles have been completed, with a project completion date presently undetermined. However, according to the National Center for Educational Statistics (2004), "the Hispanic population in the United States is growing rapidly and will soon become the largest minority group, surpassing the Black population by 2005" (p. 1). In Kentucky, as in many states, the number of Hispanic migrant farm workers has increased dramatically in the past decade (Poynter, 1999a, b; Rural Migrant News, 2004). According to the Kentucky School Boards Association (2004), "the Latino population has doubled over the last three years, with 99 percent of the migrant population in Fayette County [Kentucky] being Mexican" (p. 2). Further, in 2004 the Kentucky School Boards Association reported, "the last numbers...[indicate] Hispanic migrant students made up 22 percent of the migrant population. Five years ago, that would have been less than 1 percent" (p. 1).

Most Mexican/Mexican Americans are mestizos, differing from other Hispanic groups in terms of their country of origin (e.g., Mexico), with a mixture of racial roots (e.g., Spanish and Indian). Although Mexican Americans represent the majority of the population in border cities, they still hold minority status, both socioeconomically and politically (Flores & Carey, 2000). A National Agricultural Workers Survey (NAWS) conducted by the U.S. Department of Labor found that while a majority of farm workers have a residence in the United States, 42 percent continue to have their homes outside of the country, primarily in Mexico (National Agricultural Statistics Service, 2002). NAWS data, and the Current Population Survey conducted by the Census Bureau, demonstrate that hired farm workers are predominantly Latino, young, unmarried, poorly educated, and noncitizens. Current data suggests these population characteristics that have remained largely unchanged throughout the 1990s (U.S. Department of Agriculture, Economic Research Service, 2000).

With respect to the national population of Hispanic migrant workers, a large proportion of these individuals have less than a ninth grade education and many speak little or no English (Migrant Clinicians Network, n.d.). The median educational level for the head of a migrant household was the sixth grade in 1986. A decade later the educational level remained virtually unchanged (Leon, 1996). In more recent terms, the National Center for Education Statistics (2004) reported, "Hispanics have made gains in the last 20 years, but despite these gains, gaps in academic performance between Hispanic and non-Hispanic White students remain" (p. 1). Accordingly, it is likely the median education level of Hispanic migrant farm workers remains largely unaltered in the last 20 years.

Approximately two-thirds of migrant workers are under the age of 35 and over one-fourth are 21 years of age or younger. Children as young as 10 or 11 may be found working in the fields (US Department of Labor, 1997). The typical migrant farm worker earns an annual income of $7,500 (Bechtel, Davidhizar, & Spurlock, 2000). Shorris (1992) addressed the working conditions of many Mexican Americans, overwhelmingly the largest group of Hispanic migrant workers nationwide, as follows:

   Because of the Mejicano's willingness to endure danger,
   intolerable working and living conditions, and so on, the
   Mejicanos became the safety valve for labor in the
   Southwest, low paid casuals, relegated to the worst jobs,
   and hired and fired almost capriciously (p. 106).

Few migrant workers have health benefits through their jobs, such as sick leave and medical insurance, and economic pressures make them reluctant to miss work unless the condition is so severe that work is prevented (North Carolina Farmworkers Agrability Project, 2002). Although Latinos make substantial contributions to the U.S. economy, they continue to have some of the worst health outcomes. For example, cardiovascular disease is the leading cause of death among Latinos nationwide, 1.2 million Mexicans in the U.S. have been diagnosed with diabetes, and only five percent have employer-sponsored health insurance coverage (Moreno, 2004). Lack of medical insurance results often in little or no medical treatment for injuries or medical conditions, and workers are rarely covered by workers compensation. According to Moreno, the life expectancy of migrant farmworkers is 49 years compared to the national average of more than 77 years.

In terms of access to community services, including medical care and vocational rehabilitation, migrant farm workers are one of the most underserved and impoverished populations in the United States (Migrant Clinicians Network, n.d.). A 1998 national study by Berkely Planning Associates (as cited in North Carolina Farmworkers Agrability Project, n.d.) revealed that very few migrant workers were aware of disability-related services such as special education and vocational rehabilitation. However, the migrant farm workers involved in the study were more aware of other social services such as migrant health services; Medicaid; Food Stamps; and Women, Infants, and Children support. The authors postulated that the lack of knowledge and utilization of disability-related services might largely be the result of a poor understanding of available services by social service professionals who routinely encounter the migrant population. Part of the reason for this problem may also relate to the reluctance of migrant workers, particularly Hispanics, to apply for services and seek out available community supports. Inherent fears of negative consequences, such as determination of employment ineligibility or deportation, are pervasive.

Culturally Sensitive Rehabilitation Plans and Services

When a migrant worker does seek vocational rehabilitation services, the rehabilitation counselor must be culturally sensitive throughout the rehabilitation process. Swensen (1994) outlined several factors that should be understood by the rehabilitation provider: Hispanic norms, cultural values and concepts, and attitudinal perceptions. Important ethnological considerations in the Hispanic culture relate to (a) the role of family; (b) respect for others; (c) personal dignity; (d) personal dialogue styles; (e) personal and professional commitments; and (f) alternative therapies (Rivera & Cespedes, 1983; Roessler & Rubin, 1998).

The Role of Family

In the Hispanic culture, family is generally an important concept. Therefore, counseling should include the extended family, where possible. The counselor must understand the roles of family members. The father, typically regarded as the family authority, is often the primary provider; and the mother, frequently viewed as the family nurturer, is often the primary caregiver or homemaker. Bean, Perry, and Bedell (2001) identified specific guidelines for marital and family therapists to use in interactions with Hispanic families. These guidelines, which can be equally as effective for rehabilitation professionals, include acting as an advocate for the family, evaluating the immigration experience, assessing acculturation, respecting the father, not forcing changes, providing concrete suggestions, and warmly engaging the entire family and significant others.

Respect for Others

Hispanic individuals characteristically emphasize respect for the personhood of others. This includes respect for elders, children, adults, and strangers alike, as well as for persons in authority (Rivera & Cespedes, 1983; Roessler & Rubin, 1998). Hispanics, known frequently as individuals who value diplomacy and tact, may tend to view direct confrontation and arguments as rude and disrespectful. Although the individual may seem initially agreeable, implied agreement may be a result of reluctance on the part of the individual to express disagreement, and does not necessarily mean that the person will follow through with the specified rehabilitation plan (Bechtel, Davidhizar, & Spurlock, 2000). Fully processing counseling recommendations for understanding and mutual agreement with the Hispanic consumer should be viewed as a necessary precursor to contracting for specific behaviors and actions involved in the rehabilitation plan.

Personal Dignity

Personal dignity refers to the individual's integrity, feelings of self-worth, and self-respect (Swensen, 1994). Rivera and Cespedes (1983) state, "A Hispanic person must maintain his/her dignity ... One cannot ask for, beg, or seek services at the expense of his/her dignity" (p. 67). If too many obstacles are encountered in the rehabilitation plan, the individual may not proceed with services. The Hispanic consumer may perceive difficulties and delays as an affront, which places him/her in a position of losing dignity (Rivera & Cespedes; Roessler & Rubin, 1998).

Personal Dialogue Styles

In the United States, as in many countries, the issue of personal space is an important consideration in personal dialogue styles. Personal space refers to the appropriate distance maintained between individuals during conversation or other interaction. In the Hispanic culture, personal space tends to be narrow, and communication at close range tends to be the rule of interaction. Swensen (1994) recommends narrowing the gap in space between counselor and client to promote a more trusting relationship. Similarly, Carkhuff and Anthony (1979) recommend facing clients shoulder to shoulder, leaning forward in the chair, maintaining eye contact, and eliminating distractions that may detract from counselor attending efforts, in all counseling settings. Hackney and Cormier (2001) suggest, "it is important to determine the client's cultural orientation toward verbal expressiveness and cultural values regarding emotional expression and disclosure" (p. 121). These rules of counseling interaction apply to the many Hispanic consumers who value forthright communication.

Personal and Professional Commitments

The majority of Hispanic individuals subscribe to the belief that a person's word (la palabra) is binding (Rivera & Cespedes, 1983; Roessler & Rubin, 1998). Verbal agreements, common in the negotiation process, are obligatory, and may be the preferred method of conducting personal business. Written application forms related to the need to verify information, as well as signed release of information forms and other documents may be viewed as indicative of a lack of trust. Rehabilitation counselors must be aware of potential reluctance to complete such forms, and must be able to explain the necessity of the forms and procedures in a culturally sensitive manner. Only necessary documents should be presented, and all forms used should be easily understood and provided in Spanish.

Alternative Therapies

The use of alternative therapies is very prevalent in the Hispanic culture (Bechtel, Davidhizar, & Spurlock, 2000). Keegan (1996) found that 44% of Mexican Americans had used alternative practitioners at least once in the previous year. Mental or physical illness is seen by many Hispanics to be a consequence of behavior, or simply the result of fate. A disability such as blindness, deafness, retardation, or clubfeet may be viewed as an "act of God," representing a burden the individual is required to bear (Eshleman & Davidhizar, 1997; Bechtel, Davidhizar, & Spurlock, 2000). The need for preventative or diagnostic medicine, such as a general physical examination, may be viewed as unnecessary. Medical care may be sought only when survival is at risk (Swensen, 1994). Thus, concrete suggestions for medical intervention based on traditionally effective therapies may be accepted, while recommendations for experimental interventions with limited documented success may reinforce the ideal of an insurmountable burden.

The Kentucky Migrant Vocational Rehabilitation Program

Drawing upon collaborative efforts with the Kentucky Office of Vocational Rehabilitation, the University of Kentucky's Graduate Program in Rehabilitation Counseling, and the federal Agribility project, the KMVRP began delivering services to migrant and seasonal farm workers with disabilities and their families on October 1, 2000. Initially, the KMVRP served a four county area in central Kentucky. Expansion efforts have enabled the program to extend farther into the eastern and western areas of the state, broadening its reach to an eight county service region.

The KMVRP has sought to design, implement, and evaluate a partnership model between the collaborating agencies. Harley (2002) noted that the program's primary goals are addressed through five core objectives:

1) Improve the cultural competency of project partners in order to better meet the vocational rehabilitation needs of migrant farm workers and their families;

2) Assist migrant farm workers with disabilities in achieving employment that reflects their interests, and enhances their independence;

3) Expand outreach efforts that increase case finding of migrant farm workers with disabilities;

4) Enhance collaborative efforts among agencies that serve migrant farm workers; and

5) Measure the effectiveness of the project through process and outcome evaluations.

The underlying philosophy that drives the KMVRP is expressed as "Trabaja y Triunfa," loosely translated as "Work and Move Ahead" (M. Hayden, personal communication, 2001). The program philosophy, conceptualized as "Rehabilitese Para Trabajar," or generally as "Rehabilitation For Work," has served as a focal point for the development of a rehabilitation intervention process that is affecting the regional Hispanic migrant farm worker community in many positive ways (M. Hayden, personal communication, 2003). The KMVRP has demonstrated success in identifying and serving members of the target population by emphasizing a service model based on four fundamental principles: (1) cultural sensitivity training for program and collaborative agency personnel; (2) comprehensive outreach strategies; (3) pre-intervention capacity-building for consumers and service personnel; and (4) the development of working relationships with individual rehabilitation consumers, the target community, and the professional community at large. These core principles will be discussed in detail.

Cultural Sensitivity Training

In a continuous effort to expand the competency of program and collaborative agency staff, the KMVRP has committed to provide recurrent educational activities for counseling personnel. In conjunction with KMVRP staff, collaborative OVR personnel spent five weeks in cultural immersion training in Morelia, Mexico to enhance cultural awareness and Spanish language skills. Upon return, Spanish language classes were initiated on a weekly basis to maintain and expand communicative ability. Each month, the KMVRP and OVR staffs hold a forum to review project goals and engage in cultural competency activities, such as listening as consumers describe their life and work experiences, attending lectures from medical and legal professionals associated with the consumer population, and hosting luncheons with consumers to celebrate Mexican holidays.

A process evaluation following the second full year of operations revealed substantial strides in accomplishing the program's core objective related to cultural sensitivity training (Harley, 2002). During the first year of operations the program engaged in clarifying core objectives, establishing and organizing program facilities, developing and expanding collaborative efforts with partnering agencies, and establishing the training mechanisms to be utilized in addressing the critical need for cultural responsiveness in program service offerings. By the end of year two, the KMVRP had succeeded in developing and providing continuous Spanish language training subsequent to the five-week cultural immersion project, recurrent educational seminars reflecting content in ethnic diversity and corresponding rehabilitation interventions, and periodic workshops related to employment development, as well as psychosocial and medical issues of the Hispanic migrant farm worker community. Additionally, a cultural diversity course, developed during year two of program operations and provided by the UK-GPRC, emphasizes Hispanic/Latino culture and views of disability. As evidenced by in-service and external training offerings, emphasis has been placed on the need for KMVRP and OVR staff involved with the program to develop bicultural and bilingual competencies.

KMVRP Outreach Strategy

Having qualified rehabilitation personnel alone does not necessarily ensure successful vocational rehabilitation of the migrant population. Swensen (1994) noted that, "clients will usually not refer themselves, but are a product of an effective outreach and advocacy organization" (p. 9). An aggressive outreach program, consistently implemented and followed, is a necessary precursor to the identification and recruitment of rehabilitation clients within the migrant community. Outreach services should not only include direct contact with migrant workers, but should also provide for the training of social service, health, and medical personnel to familiarize them with vocational rehabilitation services, eligibility requirements, and application procedures. Brochures written in Spanish and English should be developed and distributed. As members of the Hispanic migrant community frequently report religious affiliation with the Roman Catholic Church and other religious organizations, contact with church pastors, priests, and related personnel to familiarize them with vocational rehabilitation services may also prove effective as an outreach technique. After a potential consumer is acquainted with vocational rehabilitation services, a subsequent task of outreach is to foster his or her acceptance of such services. However, migrant workers with disabilities may avoid applying for rehabilitation services for several reasons, including transportation inaccessibility and language barriers. Additionally, workers may avoid applying due to fear of deportation if they do not possess verifiable citizenship or eligible worker status. Further, if the individual is receiving disability income, food stamps, rent subsidies, or similar services, he or she may be reluctant to jeopardize that source of income by returning to work (Smart & Smart, 1996). Finally, for some Hispanic migrant farm workers there may also be a cultural disincentive to applying for services. Cruz (1979) notes, "Hispanic families tend to overprotect and paternalize their disabled [sic]. Even if a disabled [sic] individual wants to learn to be independent and self-sufficient, he [or she] is seldom allowed to do so" (p. 33). The need for educational outreach efforts aimed at assisting this population with understanding the potential for employment and independent living for persons with disabilities is apparent. However, this does not imply that persons of Hispanic ethnicity are not willing or anxious to work. To the contrary, the primary purpose of migration for the majority of individuals is to secure productive employment. Data from 21 surveys compared the work attitudes of Mexican Americans with Euro-Americans. Survey results found Mexican American employees to be as, or in some cases more, productive and cooperative as their Euro-American equals while reporting satisfaction with job duties, and demonstrating a strong work ethic (Weaver, 2000). Migrant farm workers with disabilities often continue to work in pain, and discontinue working only when the impairment becomes severe. Taking time away from work to apply for services may not be possible, and without sources of income support, utilizing vocational rehabilitation services for retraining may be very difficult (North Carolina Farmworkers Agrability Project, n.d.).

Based on the KMVRP service delivery model, community outreach efforts begin with the program's outreach workers who aggressively pursue widespread exposure to the migrant community. In order to have an adequate understanding of the culture, the counselor must be willing to leave his or her office setting and interact with the client in his or her own community (Schmidt, 1982; Helms & Cook, 1999). Primary outreach efforts revolve around the identification of migrant farm workers with disabilities within the regional population, and the dissemination of information pertaining to the availability of program services. The KMVRP responds to the varied cultural interests and perceptions within the Hispanic community through a diverse outreach staff, which includes individuals from Columbia, Cuba, Mexico, Panama, the United States, and Venezuela. Through proactive efforts that seek to capitalize on both naturally occurring and created outreach opportunities, program personnel have successfully made resilient and expanding inroads into the target community (see Table 1 for examples of specific outreach activities). These outreach workers are project employees who are not rehabilitation counselors, but who make referrals to rehabilitation counseling personnel.

The KMVRP underpins its outreach efforts with a focus on the general advocacy needs of potential consumers within the Hispanic population at large. Through a comprehensive outreach strategy, the program is witnessing a significant increase in the number of individuals seeking program information and applying for services (Harley, 2002). Yearly and cumulative outreach results are presented in Table 2.

A unique aspect of the KMVRP is that services can be provided to family members of rehabilitation consumers. The practice of daily affiliation with the Hispanic community is of fundamental importance to program outreach efforts. Accordingly, outreach workers routinely attend informal social gatherings in the homes and neighborhoods of potential rehabilitation consumers. Outreach workers provide transportation and translation services for related needs, such as attending medical appointments, assisting with the purchase of household goods, and facilitating access to other community supports. Additionally, the KMVRP utilizes an outreach theme on a weekly basis: sample weekly themes include visits to every farm in the eight county catchments area, visits to regional migrant education centers, and meetings with select community medical care providers to discuss collaborative efforts. Each week a strategic location is selected for concentrated exposure to the target population. Most importantly, the outreach workers accompany program consumers through each phase of the rehabilitation process, providing the individual level of support needed for successful intervention (M. Hayden, personal communication, July 10, 2003).

The KMVRP employs a patient services coordinator to serve as liaison between the outreach worker and the rehabilitation counselor. The patient services coordinator provides the essential functions of arranging consumer appointments with OVR staff, conducting follow-up and follow-along services, and managing the program database, which tracks the progress of consumers through the rehabilitation counseling process. Additionally, the patient services coordinator assists outreach workers in making community contacts and facilitating the dissemination of program information to consumers at select community events.

A fundamental focus on personalized outreach efforts has contributed appreciably to the program's success (see Table 2 for specific outreach results). Outreach activities were implemented systematically across a three-year period, expanding program services from a four county catchments area in year one, to seven counties in year two, and eight counties in year three. In addition, these outreach activities were cumulative from year one to year three. A particularly effective outreach initiative centered on the identification of target population consumers who have tested positive for HIV, representing a rapidly growing subpopulation within this consumer group. Other specific outreach efforts include providing English language training classes for Hispanic consumers, utilizing Hispanic radio and newspaper media on a weekly basis to advertise program services, soliciting referrals from current consumers, canvassing Hispanic neighborhoods to locate new consumers, developing focus groups of Hispanic farm workers to identify service needs, and including consumers and representatives from the community as members of the KMVRP's advisory board.

Pre-Intervention Preparation

The KMVRP program has found it beneficial, and in many cases necessary, for consumers to engage in a process of-pre-intervention preparation prior to and during the eligibility determination process with the participating vocational rehabilitation agency. Pre-intervention preparation can serve to enhance the potential for consumer success in the rehabilitation counseling process. Upon referral for eligibility determination, preparation-building activities serve as a buffer to facilitate immersion into the vocational rehabilitation system. Additionally, during eligibility determination delays and intervention related wait periods, preparation-building activities play an important role in relationship development with individual consumers. Preparation-building strategies vary among consumers, but generally fall under the categories of relationship building, personal and family advocacy, assistance with community and ancillary service access, translation, transportation, and English language instruction.

The concept of pre-intervention preparation applies to rehabilitation personnel as well. While the KMVRP focuses on preparing consumers for rehabilitation services through consumer preparation activities, the program simultaneously seeks to enhance the professional preparation of vocational rehabilitation counselors and outreach workers through cultural sensitivity and competency training.

The Development of Working Relationships

The KMVRP capitalizes on opportunities to disseminate program information through key community events, such as regional conferences and coalition meetings, identified as forums of interest to the Hispanic community. As a direct result, working affiliations have been developed with a vast network of community business and social service agencies, including the Fayette County Health Department, AIDS Volunteers of Lexington, The Hope Center, University of Kentucky Medical Center, Bluegrass Care Clinic, Community Action Council, Catholic Action Center, Migrant Network Coalition, Bluegrass Farm Worker Health agency, Radio Vida 1440 am, La Voz (Spanish newspaper), The Salvation Army, Migrant Education Centers, and various religious organizations offering Latino ministry, among many others (M. Hayden, personal communication, July 18, 2003).

Through efforts with these partner agencies, the KMVRP is helping to provide important cooperative services to the Hispanic migrant and seasonal farm worker community. Current service offerings include: (1) access to information and assistance with referral processes that address important disability issues (e.g., sudden onset disability, rehabilitation processes, and urgent medical concerns), (2) access to primary intervention services (e.g., vocational rehabilitation, translation/interpreting services, and educational opportunities); and (3) access to ancillary intervention services (e.g., health care, personal and family systems counseling, and transportation assistance).

Program Evaluation

According to Harley (2002), during the first three years of operation, the KMVRP provided program information to 1700 individuals (see Table 2). One hundred and five individuals were referred to the collaborative vocational rehabilitation agency, OVR, for services. At the end of year two, 36 of 56 referrals were deemed eligible for rehabilitation services, and received vocational rehabilitation intervention in addition to varied pre-intervention and general advocacy support services. An additional 49 consumers were referred to DVR for service in year three. Year three eligibility decision information remains pending. At the time of year two program evaluations, expansion efforts had resulted in a marked increase in consumers served (as evidenced by the substantial increase in consumers receiving program information, OVR referrals and OVR eligibility for services), culminating in 88 case closures, with many positive employment outcomes (M. Hayden, personal communication, 2003). Referrals from the eight county service area continue to increase on a quarterly basis, and hundreds of target consumers and their family members are being served annually.

Discussion and Implications for Rehabilitation Counseling

In terms of access to community services, including medical care and vocational rehabilitation, Migrant and seasonal workers, primarily Mexican/Mexican-American in the United States, represent one of our most underserved and impoverished rehabilitation populations. Despite significant service needs, Hispanic migrant and seasonal workers and their families are often reluctant to seek out community services. Apprehensions associated with potentially negative consequences, such as the determination of employment ineligibility or deportation, are pervasive. In addition, prevalent cultural norms, which often stigmatize persons with disabilities as unproductive and dependent, provide little impetus for positive change.

Hispanic farm workers have substantial needs for information and support that foster adjustment to everyday life in a new country (Fisher, Marcoux, Miller, Sanchex, & Cunningham, 2004). The results of this research indicated that specific types of services (e.g., providing English language training classes, utilizing Hispanic radio and newspaper media to advertise program services, soliciting referrals from current consumers, canvassing Hispanic neighborhoods to locate new consumers, developing focus groups of Hispanic farm workers to identify service needs, including consumers and representatives from the community as members of the KMVRP's advisory board, etc.) provide effective means of disseminating pertinent information to the Hispanic/Latino (viz. Mexicans/Mexican American) rehabilitation populations. The proactive and strategic outreach efforts employed by the KMVRP have yielded a substantial increase in the number of individuals seeking information and services, as well as increased contact with family members and significant others. Given the important role that family plays in the lives of Mexicans/Mexican Americans, outreach efforts directed toward family members and significant others serve to enhance the consumer's potential for success. The literature, as well as KMVRP outreach results, supports the idea that counselor/outreach worker willingness to make home visits and community contacts with members of the Mexicans/Mexican American migrant population is desirable, resulting in a greater willingness on the part of consumers to participate in services and place trust in the counseling relationship (Ramirez, 1999; Flores & Carey, 2000).

A survey conducted by Ibarra (2000) of Latino families living in the Lexington, Kentucky area revealed several areas of concern for this population. Foremost was potential action of the Immigration and Naturalization Service (99%); followed by fear of the police (90%), property owners (85%), other minorities (46%), and Whites (12%). Only 15% of the sample participants had documented immigration status. Ninety-two percent of the sample had part-time jobs without benefits and 8% had full-time jobs with benefits. The vast majority of the jobs were in agriculture (90%). The types of services sought by Latinos included employment services (80%), English language classes (60%), translation/interpreter services (60%), health services (45%), clothing (35%), and food stamp assistance (15%). Ibarra noted, "the utilization rate of welfare services by the residents ... closely follows the national average, which states that Latinos have the lowest utilization rate of welfare services of all ethnic groups" (p. 8).

The significant human service needs of Hispanic migrant workers, including those with disabilities, are well established (Ibarra, 2000; Migrant Clinicians Network, n.d.; North Carolina Farmworkers Agrability Project, n.d.). Providing services through culturally sensitive programs is fundamental to facilitating consumer empowerment. According to Beck (1994), empowerment is "a major recent emphasis in disability rights and rehabilitation counseling." Hahn (1989) viewed the experience of disability as an event that results in a fundamental change in how life is viewed. Rather than a perspective that remains overtly concerned with body image and ability, disability fosters a life perception that focuses on the need to live independently and realize full use of personal assets. Therefore, consumer empowerment is central to the realization of rehabilitation goals, which depend largely on consumer initiation and corresponding personal action. Rehabilitation counselors can provide professional intervention with respect to evaluation, assessment, rehabilitation planning, adjustment counseling, identification of available resources, and training and placement services: ultimately, however, the consumer must take responsibility for achieving agreed upon rehabilitation goals. Thus, a fundamental responsibility of the rehabilitation counselor is to facilitate consumer empowerment, enabling meaningful consumer participation in the rehabilitation process.

According to Gutierrez (1995), "empowerment theory suggests that changes in beliefs and attitudes contribute to the participation of individuals in social change and assumes that individuals will work for the collective good if they develop a sense of critical consciousness" (p. 229). Empowerment relates to the power of individuals to initiate actions, based on personal choices, which will improve their personal, political, and social situations. Hispanic migrant farm workers with disabilities require a substantial degree of personal power to overcome the considerable obstacles present in order to succeed in the rehabilitation process. Obstacles existing concurrently with disability include language barriers, legality of citizenship and work status, educational status, and access to medical care, as well as the cultural perspectives of a new and challenging environment. Empowerment theory suggests that if Hispanics/Latinos as a group are to become politically empowered, they must develop a group identification that transcends specific national identity (Gutierrez). Association with the culture at large need not replace personal cultural identity, but can serve to supplement it in an empowering manner (Padilla, 1985).

The empowerment of Hispanic migrant farm workers with disabilities can be facilitated significantly through attention to the important cultural perspectives and unique rehabilitation needs of individual consumers involved in the counseling relationship (Rivera & Cespedes, 1983; Roessler & Rubin, 1998). Swensen (1994) outlined several counseling techniques and processes that are recommended when assisting Hispanic consumers: (1) initial contact with the consumer should include an orientation to the rehabilitation agency, an explanation of eligibility requirements, and a discussion of client's rights and responsibilities; (2) rapport should be established quickly; (3) evaluations, vocational and psychological, should be conducted by bilingual evaluators and testing material should be normed on Hispanic populations, where possible; (4) the formulation of the rehabilitation plan must involve the consumer; (5) training and placement should be tailored to the needs of the individual; and (6) all aspects of the Individual Plan for Employment (IPE) should be explained and followed.

Accordingly, when serving Hispanic consumers, counselors should be aware of expressed and implied commitments--on the part of the counselor, the agencies supplying services, and the consumer. Unfulfilled commitments may be devastating to the development of trust in the counseling relationship, and consumer commitment to the rehabilitation plan may diminish. Additionally, the counselor should reflect the communication style employed by the Hispanic consumer to aid the establishment and maintenance of rapport, as well as the development of a working alliance. Bilingual and culturally sensitive service providers are crucial to effective interventions, as is the involvement of family and significant others, where applicable, in the planning and implementation stages of counseling. Further, counselor efforts to facilitate understanding of the rehabilitation process, and to reflect the consumer's interests in training and placement recommendations, are integral components for rehabilitation counseling Success.

One of the most compelling pieces of legislation that has served to enhance rehabilitation services to Hispanics and other migrant populations is the 1978 amendments to the Rehabilitation Act. These and subsequent amendments have mandated public rehabilitation personnel communicate with non-English speaking individuals in their native language. A national workshop, conducted in 1983, sought to determine the impact of these amendments with regard to the needs of the Hispanic migrant population. The workshop participants made recommendations, which included the need to establish a national clearinghouse for information on Hispanics with disabilities and the need to provide financial support for research into the rehabilitation experiences of Hispanics with disabilities. Suggested areas of research included investigating (a) services designed to meet the needs of elderly Hispanic persons, (b) the innovative delivery of services to migratory workers, (c) the feasibility of providing services in "sanctuary" centers for undocumented Hispanic immigrants, and (d) rehabilitation services designed to meet the needs of Hispanic students attending secondary schools (National Institute of Handicapped Research, 1983).

In 1984 Johnson & Associates published the results of a study using Rehabilitation Services Administration (RSA) statistics, state agency reports, interviews with administrators and counselors, and questionnaires completed by consumers with closed rehabilitation cases. The study found discrepancies in the overall quality and patterns of rehabilitation outcomes of majority and minority consumers, including Hispanics and other minorities as compared with White majority consumers. The authors concluded that because of different cultural backgrounds and values, disabilities, and experiences, sensitive and specialized services are warranted often.

Effectively identifying and serving members of the Hispanic migrant worker population depends on an informed, collaborative approach among outreach workers, rehabilitation counselors, and community service providers. All rehabilitation professionals should have a grasp of multicultural aspects of rehabilitation including stereotyping, prejudice, and social roles, as well as the processes of acculturation and adaptation (Smart & Smart, 1996). With a mastery of these concepts, "the trainee is in a much better position to provide ongoing client support in the face of workplace challenges" (Smart & Smart, p. 177). Factors which must be understood by rehabilitation counselors, and reflected in the rehabilitation process, include Hispanic norms and cultural values, such as the role of family, respect for others, communication practices, commitment to keeping one's word, and the role of alternative therapies.

Conclusion

The Kentucky Migrant Vocational Rehabilitation Program is demonstrating the efficacy of a service orientation based on the principles of cultural sensitivity training; resourceful outreach efforts that seek to capture and create key community access opportunities; pre-intervention preparation; and the development and maintenance of personal relationships with consumers, their families and significant others, and key community agency personnel. Programs such as the KMVRP, which are immersed in the Hispanic community, offer the potential to reach deep into the consumer population, gain vital cultural understanding, and build the instrumental relationships necessary to address the population's rehabilitation needs.

Table 1--The Kentucky Migrant Vocational Rehabilitation Program:
Progression of Sample Outreach Activities

Year 1 (10/01/2000-09/30/20010)

1.     Needs assessment completed to determine personnel training
       needs.
2.     Outreach activities initiated in a four county catchments area.
3.     Translation of program documents into Spanish language.
4.     Articles published and advertisements placed in local Spanish
       newspaper/radio.
5.     Program participation in the annual Migrant Network Coalition
       Health Fair.
6.     Focus groups of Hispanic farm workers established to identify
       consumer service needs.
7.     Consumers/community representatives included as members of
       program Advisory Board.
8.     Community immersion activities initiated by outreach workers,
       including attending local/regional events of interest to the
       Hispanic/Latino community, canvassing representative consumer
       neighborhoods, and providing both formal/informal translation
       and transportation services to foster consumer access to various
       human service supports, as needed.

Year 2 (10/01/2001-09/30 2002)

1-6.   Ongoing outreach activities continued from year one (i.e.,
       numbers three through eight).
7.     Identification of a sub-population of H1V positive consumers
       among Hispanic/Latino populations through collaborative working
       relationships with community health care providers, leading to
       targeted outreach activities and increased program referrals.
8.     English as a Second Language (ESL) classes initiated for
       Hispanic Consumers.
9.     Outreach activities expanded from a four county to a seven
       county catchments area.

Year 3 (10/01/2002-09/30/2003)

1-8.   Ongoing outreach activities continued from year two (i.e.,
       numbers one through eight).
9.     Entire outreach staff initiated translation services at a local
       infectious disease clinic and co-host regional HIV testing.
10.    Outreach team collaborated with UK-GPRC and DVR personnel to
       develop and implement a Spanish language video to disseminate
       vocational rehabilitation service information.
11.    Project Director accepted vice-chairman position with the
       Community Action Policy Council for Migrant Headstart.
12.    Project Director and collaborative DVR personnel worked with
       the Cabinet for Workforce Development to deliver a presentation
       at the Kentucky State Fair.
13.    Outreach activities expanded from a seven county to an eight
       county catchments area.

Table 2--The Kentucky Migrant Vocational Rehabilitation Program:
Outreach Results

                                    Year 1    Year 2       Year 3

Consumers Receiving Program           334    216 (550)   1,150 (1700)
  Information (Cumulative):

Consumers Receiving OVR Referrals      16     40 (56)       49 (105)
  (Cumulative):

Consumers Receiving OVR                 9     27 (36)    Data Pending
  Eligibility (Cumulative):

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R. Richard Breeding

University of Kentucky

Debra A. Harley

University of Kentucky

Jackie B. Rogers

University of Kentucky

Ralph M. Crystal

University of Kentucky

R. Richard Breeding, M.S., University of Kentucky, Department of Special Education and Rehabilitation Counseling, 224 Taylor Education Building, Lexington; KY 40509. E-mail:[e-mail]