Impacts of COVID-19 shelter in place across key life domains among immigrant farmworker Latina mothers and young adults.

OBJECTIVE: Individuals and families from racial and ethnic groups experience social and economic disadvantage making them vulnerable to the disproportionate impact of the COVID-19 pandemic. This study sought to capture the impacts of Shelter in Place (SIP) across key life domains including family life, education, work, mental health, and coping strategies among a sample of Mexican-origin mothers who were currently engaged in agricultural work, or whose spouses were engaged in agricultural work, and young adults who had a parent working in agriculture. METHOD: During the summer of 2020, while California was under SIP orders, we conducted three virtual focus groups using Zoom(r). We recruited focus group participants from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS), an ongoing, 20-year, longitudinal cohort study of Mexican-origin families in a predominantly agricultural area of California. Three focus groups were conducted with mothers (n = 9), mean age = 48 years, young adult women (n = 8) and young adult men (n = 5), mean age = 18 years, respectively. RESULTS: Mothers reported high levels of stress stemming from fear of Covid-19 infection, work instability and financial concerns, children's schooling, anxiety about an uncertain future, and the demands of caretaking for dependents. Adverse mental health impacts were particularly pronounced among participants experiencing multiple adversities pre-dating the pandemic, including unemployment, single motherhood, and having undocumented family members. For young adults, work instability and varying work hours were also a source of stress because they made it difficult to make decisions about the future, such as whether to attend college or how many classes to take. Families used coping strategies including expressing gratitude, focusing on what's under one's control, familismo, and community engagement to manage mental health challenges during SIP. CONCLUSION: In the event of future pandemics or disasters, particular attention is needed to those who experience unemployment, are undocumented and/or have undocumented family members, and/or are single parents facing economic adversity. During public health emergencies, action at the local, state, and national level is needed to support farmworkers and other vulnerable groups' secondary major stressors stemming from inequities in access to affordable housing, childcare, living wages, healthcare, and other benefits.

Don't change who we are but give us a chance: confronting the potential of community health worker certification for workforce recognition and exclusion.

BACKGROUND: For community health workers (CHWs) and promotores de salud (CHWs who primarily serve Latinx communities and are grounded in a social, rather than a clinical model of care), the process of certification highlights the tension between developing a certified workforce with formal requirements (i.e., certified CHWs) and valuing CHWs, without formal requirements, based on their roles, knowledge, and being part of the communities where they live and work (i.e., non-certified CHWs). California serves as an ideal case study to examine how these two paths can coexist. California's CHW workforce represents distinct ideologies of care (e.g., clinical CHWs, community-based CHWs, and promotores de salud) and California stakeholders have debated certification for nearly twenty years but have not implemented such processes. METHODS: We employed purposive sampling to interview 108 stakeholders (i.e., 66 CHWs, 11 program managers, and 31 system-level participants) to understand their perspectives on the opportunities and risks that certification may raise for CHWs and the communities they serve. We conducted focus groups with CHWs, interviews with program managers and system-level participants, and observations of public forums that discussed CHW workforce issues. We used a thematic analysis approach to identify, analyze, and report themes. RESULTS: Some CHW participants supported inclusive certification training opportunities while others feared that certification might erode their identity and undermine their work in communities. Some program managers and system-level participants acknowledged the opportunities of certification but also expressed concerns that certification may distance CHWs from their communities. Program managers and system-level participants also highlighted that certification may not address all challenges related to integrating CHWs into health care systems. CHWs, program managers, and system-level participants agreed that CHWs should be involved in certification discussions and decision making. CONCLUSIONS: To address participant concerns, our findings recommend California stakeholders build a voluntary certification process structured with multiple pathways to overcome entry barriers of traditional certification processes, maintain CHW identity, and protect diversity within the workforce. Positioning CHWs as decision makers will be critical when designing state certification processes.