Project Summary
The project team (Salud) proposes to examine how integrating clinical and legal support through a Medical-Legal Partnership model at Salud Para La Gente, a Federally Qualified Health Center serving agricultural communities, affects access to State Disability Insurance (SDI) among pregnant Latin@ and Indigenous agricultural workers, and how this access positively influences maternal stress, financial stability, and engagement in prenatal care.
Research Questions/Aims
- Access: What proportion of eligible patients successfully access SDI?
- Barriers: What were the primary reasons for not pursuing SDI? Perceived
- Value: How do patients who received SDI describe its impact on stress, financial stability, and engagement with prenatal care?
- Health Outcomes: How does access to SDI influence maternal and infant health outcomes?
- Implementation: What adaptations are required to embed legal navigation into existing Community Health Worker (CHW) and Comprehensive Perinatal Services Program (CPSP) workflows to facilitate SDI access and improve outcomes?
Actionability
- Inform clinic-level practice changes, county birth equity strategies, and state-level improvements to the Comprehensive Perinatal Services Program (CPSP) and State Disability Insurance (SDI) processes, which are advancing racial and Indigenous health justice by reframing wage replacement as an earned, health-protective intervention rather than discretionary support.
Meeting the Moment
Recent cuts to Medicaid funding and tightened eligibility requirements disproportionately harm pregnant individuals and low-income families, especially in rural and agricultural areas. To address these federal legislation impositions, the project team is examining how inequitable access to State Disability Insurance (SDI) reinforces exposure to hazardous work during pregnancy and perpetuates avoidable maternal and infant health disparities.
Outcomes
Health Outcomes: Maternal and infant health indicators, including prenatal care engagement measured by gestational age at entry to care and number of prenatal visits, and gestational age at birth and birthweight, with preterm birth examined as a derived outcome, respectively; Perinatal mental health indicators such as breastfeeding initiation status at delivery or early postpartum, explored and interpreted cautiously given variability in documentation and timing
Methodology
Using a mixed-methods approach with implementation-focused research, the study will pair quantitative analyses of SDI access and health outcomes with qualitative interviews to assess workflow variation and implementation feasibility. Grounded in Community-Based Participatory Research principles, the team will center the lived experiences of farmworkers and frontline care teams to identify context-specific, actionable systems-level adaptations.
Salud Para La Gente Watsonville Law Center Watsonville Community Hospital