Victim Advocacy and Prevention Sin Fronteras in Texas

Victim Advocacy Sin Fronteras Conference

2004 Press release of national and bi-national recognition

Girl Empowerment Festival / Festival de arte para el empoderamiento de las jóvenes in Laredo

The Girl Empowerment Festival/Festival para Chicas Líderes is offered in El Paso

The Power of the Promotora

The Role of the Promotor(a) Community Health Worker (pdf)

Sample training agenda in Spanish

 

 

 

The Power of the Promotoras
By Laura Zárate, Arte Sana 2003

Community Outreach Partners

Lessons from the Planned Parenthood Promotora Experience

Lessons from the Domestic Violence Movement

Promotoras as Agents of Change in Victim Services

References

The U.S. Census Bureau report “Language Use and English-Speaking Ability: 2000”, asserts that nearly 1-in-5 people, or 47 million U.S. residents age 5 and older, spoke a language other than English at home in 2000. Among those who spoke a language other than English at home were almost 11 million additional Spanish speakers. According to the report, Spanish speakers increased from 17.3 million in 1990 to 28.1 million in 2000, a 62 percent rise.

Yet across the nation, sexual assault and domestic violence training programs are rarely offered in Spanish due to a lack of bilingual trainers. The ongoing lack of bilingual direct service staff leads to re-victimization, as the help seeking process is delayed or impeded all together during a critical time of outcry. As a result, rape crisis and domestic violence hotline callers cannot always have their immediate needs met and in some cases shelter residents, or worse yet, a survivor's child is asked to 'help' due to a chronic lack of bilingual staff and institutional racism. As recent as 2002, a dual center advocate from Texas shared with me that when a monolingual Spanish-speaking victim arrived at her center, a staff announced “we have an alien”, in an effort to 'alert' the only Spanish-speaking staff. Limited victim service budgets, a lack of cultural competency, and a lack of political will have led to ineffective outreach with Latin@s in most states, especially with sexual assault issues. Given the ongoing budget cuts and secondary status assigned to many sexual assault and domestic violence risk-reduction and community education programs, it is imperative that victim service programs form meaningful collaborations with various community service groups. For those states that have seen a radical increase in their Latin@ population, a valuable community health model exists that has not only been recognized and implemented across the nation, but has in some cases also incorporated domestic violence and sexual assault peer education training.

Community Outreach Partners

The terms promotora, animadora, para-professional, community health advisor, lay health advisor, community health worker (CHW), are all used to refer to workers who are indigenous to the community and who serve and train through a community-based organization as opposed to holding a college degree. Promotora programs can provide culturally appropriate, holistic and community centered services that are grounded in local needs as gauged through the input of local members. (Baker, et.al. 1997) 

Promotora / CHW programs are widely used now and are more common in the health than the education field. The largest system to formally use the skills of CHWs was established in 1968, when the Indian Health Service adopted the Community Health Representative Program from the Office of Economic Opportunity. The program was designed to bridge gaps between people and resources and to integrate basic medical knowledge about disease prevention and care with local knowledge. Currently about 1,500 community health representatives work with tribally managed or Indian Health Service programs in more than 560 federally recognized American Indian and Alaska Native Nations (Satterfield, Burd, Valdez, Hosey, & Eagle Shield 2001). The Centers for Disease Control and Prevention cataloged more than 200 CHW programs in 1994. At least 600 such programs using approximately 12,500 community health advisors were estimated by The National Community Health Advisor Study of 1998 (University of Arizona, 1998). The Centers for Disease Control and Prevention have a database of such programs throughout the US that is available on-line.

In Texas, as well as other states many different promotora groups exist, yet all do not necessarily work together nor collaborate with each other. While there is no definitive data on the number of programs utilizing promotoras in Texas, the Promotora Program Development Committee for the State of Texas has determined that there are an estimated 20 programs representing at least 400 Community Health Workers throughout the State (U.T School of Public Health 2000).

While some are truly grassroots with their own sense of direction and indigenous leadership, others have less autonomy and are rather extension agents of larger government health agencies or formal non-profits. It is essential that any outside group wishing to work with promotora groups clearly understands the history and purpose of the programs. This is especially the case of grassroots promotora programs, for which direction comes from the women who are the animadoras (facilitators). Outside attempts to direct the organization would not succeed and are contrary to the foundation of the organization. With the growing utilization of promotoras or Community Health Workers (CHWs) in the U.S. has appeared a growing interest on the part of selected access-to-health programs, state legislatures, and federal agencies to standardize their training and qualification by creating formal requirements for licensing, certification, or "credentialing". The Texas Legislature in 1999, passed HB 1864 mandating the formation of a committee charged with: (1) reviewing and assessing promotora programs currently in operation around the state; (2) studying the feasibility of establishing a standardized curriculum for promotoras; (3) studying the options for certification of promotoras and the settings in which certification may be appropriate (Southwest Rural Health Research Center, The School of Rural Public Health, Texas A&M University System Health Science Center). In 2003, Texas began to implement a promotora / CHW certification program, the first of its kind in the nation.

Lessons from the Planned Parenthood Promotora Experience

For sexual assault advocates interested in promoting outreach with underserved Latin@ communities, especially in the colonias*, valuable lessons can be learned from the efforts of Planned Parenthood in South Texas. While assessing their primary target population (medically indigent Hispanic women) Planned Parenthood studied how these women discovered resources. The implications of their findings are relevant for victim service agencies, especially given the taboo nature of sexuality topics within some Latin@ communities. They found that health fairs and presentations to other organizations and women's groups were not reaching this community and that door-to-door distribution of information was the best way to reach medically indigent populations. Yet gaining access is not as easy as knocking on doors so Planned Parenthood assessed cultural issues and concluded that the persons disseminating the information needed to be community members, persons that the women could identify with and trust. It also determined that the educators needed to know the culture first hand in order to offer the information in a culturally sensitive manner. For this purpose language is key. The Planned Parenthood Promotora Project has been in existence since 1998 (Source: Commitment Newsletter, Department of Health Breast and Cervical Cancer Control Program, May 2000, Volume 9, Number 5, Texas).

*Colonias are subdivisions in unincorporated areas with inadequate infrastructure, unpaved roads, and inhabited by residents with very low incomes. Colonia residents are among the most marginalized groups. Texas has the largest number of colonias and the largest colonia population. Over 400,000 people live in more than 1,400 colonias that are found within a 1,000 mile stretch of the border, primarily between Brownsville and El Paso. The Texas counties of Star, Maverick, and Zavala are three of the ten poorest in the country (Source: Colonias in Texas, General Characteristics of Texas Colonias www.hud.gov/texcol.cfm).    

Lessons from the Domestic Violence Movement

The following programs that offer proven strategies for addressing domestic violence issues are prime examples of models in which sexual assault training can easily be integrated.  

Since 1992, Lideres Campesinas, Inc. (Farmworker Women's Leadership Network) has worked to develop the capacity of and provide a unified voice for farm worker women in California. This statewide network of women activists train women organizers in the causes of domestic violence, its symptoms and available resources. The domestic violence training program addresses how cultural and poverty issues affect the way that farmworker women deal with the violence in their lives.  

Organizers who go through the training return to their communities share the information they have learned with other farmworkers.   Lideres Campesinas uses a variety of strategies to break the linguistic barriers and cultural reluctance that impede Hispanic farm worker women from being vocal about their abuse, including teatro popular (popular theatre). The leaders perform skits in Spanish at forums and other community education activities that include scenarios of domestic abuse. Women in the audience are able to recognize abusive conditions in their own lives and identify with the performers. The skits are often followed by presentations on the cycle of domestic violence and information about available community resources. Lideres Campesinas partners with social service organizations, law enforcement, and others in the community in their efforts to prevent violence among farm worker women.

  “Farm worker women have domestic violence problems and there is no support in their areas. We want to bring in services to their communities and train them so they can empower themselves and other women. The message that we are trying to spread among the thousands of women who need to hear it is: ”It is up to us to take control of our lives”.
—Mily Trevino-Sauceda, Founder and Director of Lideres Campesinas.

The Texas Migrant Clinicians Network  ‘Familias con Voz'  project began in 1998. In this project advocates lead community-based presentations at churches, schools, WIC clinics, and individual's homes on the dynamics of domestic violence. Topics addressed in the presentations include: the forms of domestic violence, power and control in intimate relationships, the continuum of violence, how violence affects children, safety planning, and resources available in the community. Advocates staff a table at the local flea market to provide informal presentations to men on family violence issues. Several Advocates have also received training on the Healthy Families/Familias Saludables curriculum, developed by Women's Crisis Support ~ Defensa de Mujeres. This is a six workshop series that focuses on primary prevention of domestic violence. Six advocates have led the series of workshops for families in their communities and labor camps (if they are migrant workers). All of the trainings are conducted in Spanish. In 2003, eleven promotoras worked with this project. Funding for this program comes from the Texas Department of Human Services, Department of Human Services, Office of Community Services, Family Violence Program.  

“Its very important to assure that the training you provide is comprehensive so that the promotoras feel comfortable with their role in the community. For safety and the comfort of the promotoras, we have found that presentations should be made in groups of two. Pairing less experienced promotoras wth more experienced promotoras can help new promotoras feel more comfortable with giving presentations to their peers. It is also extremely helpful to have a leader or coordinator in each local community if your program is not locally based. Promotoras know their communities best, so allow them to be creative in helping to design the program”.  
- Stephanie Freedman, Migrant Clinicians Network

The Texas Migrant Health Promotion ‘REACH 2010 Community Promotora Coalition' was implemented in 2000. While the program's main objectives include diabetes education and the organization of physical activity and healthy cooking techniques groups in the colonia homes, the promotoras are crossed trained in other health topic areas, such as domestic violence, to serve the needs in case that is the priority. The program includes 36 promotoras who participate 35 hours a week on a seasonal basis from December through April, and nine year round full-time promotoras. The Promotoras who work on a full-time basis are salaried employees, the seasonal promotoras receive an educational stipend. The funding comes from federal, state agencies and private foundations.  

In 2002, the REACH project initiated an annual Encuentro Binacional de Promotores de la Salud in Texas. The third encuentro was in Summer of 2004. Migrant Health Promotion has a Capacity Building Program out of their office in Michigan, whose main objective is to assist agencies in starting promotora programs. The person in charge is bilingual.

Promotoras as Agents of Change in Victim Services

Established promotoras or lay health advisors can develop meaningful links to victim service agencies because:

1) They are part of social networks through which community members offer and receive social support among one another.

2) They may already be concerned about the sexual and intimate partner violence issues that affect their community and know where both victims and perpetrators reside.

3) They can serve as a bridge between the victim service agency's formal service delivery system and the community's informal social support system by directly reaching, referring, and offering advocacy and support to victims. 

4) Their host agencies already have established training programs in which sexual and intimate partner violence issues can be easily integrated.

Promotoras can help address common disparities in both the knowledge base and individual perspectives related to sexual assault issues. Victim blaming is common among Latin@ communities in which sexual assault may be understood as an issue of provocation, rather than agresion and control. Shame, self-blame, isolation, and fear of the community's response make sexual assault issues especially difficult to address within the colonias. Promotoras have either already established or can make the time to build confianza (trust) to deal with these types of intimate issues 'que dan verguenza' (that are embarrassing or shameful). A direct referral from a trusted promotora who may be willing to accompany a victim, will be far more effective than a translated brochure. Likewise, a plática (small informal heart-to-heart talk) facilitated by a male promotor with other males can be effective in promoting male participation in violence prevention efforts, and countering the devastating effects of Latino male demonization, that is rampant among many government-funded victim service agencies with a strong criminal justice focus.

The potential benefit of collaborations between sexual assault programs and promotora groups is gaining attention, especially in border regions and rural communities that have seen an influx of Mexican immigrants. Additionally, some sexual assault programs have even begun to seek funding to formally validate the work being done by promotora groups in their communities, such as the Women Together / Mujeres Unidas Weslaco Un Nuevo Amanecer (UNA) Promotora Project which is designed to outreach families living in colonias and isolated rural areas of Hidalgo and Starr Counties, and the El Paso S.T.A.R.S. program.

The unique needs of border region victims, who live in areas with limited or no sexual assault services, will hopefully motivate more communities to help support the invaluable work of the promotora.

* The @ or arroba is used throughout Latin America by university students and women's right groups who want to make the Spanish language less gender exclusive, as the @ includes both the masculine 'o' and feminine 'a' endings.

References

Baker, E. Bouldin. N. Durham, M. Lowell, M. Gonzalez, M. Jodaitis,N. Cruz, L. Torres, I. Torres, M. and Adams, S. “The Latino Health Advocacy Program: A collaborative lay health advisor approach''Education & Behavior, Vol. 24:4, pp. 495-509, August. (1997)

Satterfield DW, Burd C, Valdez , Hosey G, Eagle Shield J. The "in-between" people: participation of community health representatives in diabetes prevention and care in American Indian and Alaskan Native communities. Health Promot Pract , 3 (2): 166-175. (2002).

Tuscon: University of Arizona. “Weaving the Future: A Summary of the National Community Health Advisor Study” (1998). (Available from the Annie E. Casey Foundation, 701 St. Paul Street, Baltimore, MD 21202)

University of Texas – School of Public Health. “A Qualitative Assessment of Promotoras Programs in the Texas LRGV” (2000) (2003).

Contreras, Ricardo, Hawes, Catherine, May, Marlynn, Southwest Rural Health Research Center, The School of Rural Public Health, Texas A&M University System Health Science Center. “Community Health Worker Certification Project”. Online summary.

Centers for Disease Control and Prevention, Community Health Workers/Promotores de Salud:   Critical Connections in Communities (2002). Online article.

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