Pilot: Reducing Occupational Health and Safety Risks Among Young Workers in Agriculture through Clinician Engagement

Occupational hazards of adolescent farm workers is a topic many argue is critical, but for which there have been few directed activities in the research and healthcare community. This project tailored the RCAT survey instrument to develop a tool for clinicians to assess and reduce the risks of their adolescent agricultural patients. 
Agricultural workplace fatality rates among youth under age 18 are extremely high, accounting for approximately 42% of workers killed during 1992-2000, and 10% of workers killed from 1998-2007. Although ag work is one of the most dangerous jobs for adolescents, little research has characterized the work experience and health risks for Latino youth working in agriculture. This small project introduced a rapid clinical assessment (RCAT) tool developed by the Migrant Clinicians Network to migrant health care providers in the Yakima Valley Farm Workers Clinic.
The RCAT tool is a newly developed instrument that provides information on occupational hazards encountered by working youth in farmworker communities. To address the needs specific to the Yakima Valley, we adapted material created by MCN and integrated specific data and regulatory information from the Washington Department of Labor and Industries. There were challenges in conducting research within a busy clinical setting. However, the involvement of the clinic staff in shaping the tools for this project was successful, with 10 clinician participants (nurse, physicians, nurse practitioners, and physician assistants) testing RCAT in 10 patient visits during routine clinical practice. 
The RCAT was introduced in the Yakima Valley Farm Workers Clinic (YVFWC), a farmworker clinic system serving 139,369 patients in Central Washington State. A survey was successfully conducted through PNASH and YVFWC ’s community-based project, El Proyecto Bienestar, contributing to research and setting Yakima community research and education priorities. The survey yielded novel data on the work hazard experience of young workers in agriculture. This data was integrated into a survey of young Latino-American farmworkers, 14 to 18 years old, regarding their agricultural work experience. One hundred forty youth with farm-work experience completed the survey; 6% reported a previous work-related injury or illness and 53% reported receiving some workplace health and safety training. Correct identification of legally restricted duties for youth varied but were generally low, indicating the need for workplace health and safety guidance for youth employed in agriculture. Participants identified working alone past 8pm (57%), driving a forklift (56%), doing roofing work (39%), working in freezers (34%), and driving a delivery vehicle (30%). The Internet was identified as the most likely and reliable place youth would go to find information on workplace health and safety. Few participants (15%) reported clinician-initiated conversations on occupational health; however, a high proportion of participants responded positively to questions regarding the usefulness of the RCAT for this purpose.
Principal Investigator: Catherine Karr, MD, PhD
Professor, Pediatrics and Environmental and Occupational Health
University of Washington
PNASH Pilot Project 2011-2013
Partners and Advisories
Yakima Valley Farm Worker Clinic 
Migrant Clinicians Network  
WA State Department of Labor and Industries
Heritage University 
El Proyecto Bienestar
Perla ME, Iman E, Campos L, Perkins A, Liebman AK, Miller ME, Beaudet NJ, Karr CJ. Agricultural occupational health and safety perspectives among Latino-American youth. J Agromedicine. 2015;20(2):167-77. doi: 10.1080/1059924X.2015.1010064. Erratum in: J Agromedicine. 2015;20(3):393. PubMed PMID: 25906275; PubMed Central PMCID: PMC5798607.