Alumni Profile

Vickie Ybarra is director of planning and development for the Yakima Valley Farm Workers Clinic in Yakima, Washington. She has been with the clinic for more than 20 years and has seen many changes. From its beginning as three small sites, the clinic has grown to more than 17 sites in two states. It is now the largest migrant health center and the second or third largest health center in the country. Because of this expansion, according to Ybarra, the clinic has become more complex. Sites now serve diverse populations with different needs and programs require complicated planning and evaluation.

She has also seen changes in the migrant population that the clinic serves in that they are more "settled out." When asked what "settled out" means, she explains that twenty years ago, farm workers in the Yakima Valley were part of a Western migrant stream that came up from California and Texas and after harvesting fruit and other crops in Washington State, would then return to their homes in California, Texas, or Mexico. Now, farm workers might move north to Chelan, Washington, to pick fruit but their homes are in Yakima Valley. "Technically they meet the definition of 'seasonal farm workers' because they move to Chelan to pick fruit but their home base is here," she says.

She considers "settled out" good for kids and families. The clinic is able to provide better continuity of care, but this creates its own challenges. "The clinic now needs to be more responsible for providing continuous primary care, such as home visits for the new baby, a home assessment if a patient has asthma, and patient education and self-management classes," she says. The clinic also finds itself dealing with an explosion of new cases of diabetes: over 7,000 of its patients have the disease. "It's overwhelming in some ways. Pediatricians are starting to routinely diagnose type-2 diabetes in adolescent patients," she says. "We've put some effective programs in place but we serve a high-risk Hispanic population who are overweight, and lack physical activity."

As director of planning and development, Ybarra is responsible for the planning and evaluation of many of these programs. Her department also conducts needs assessments for potential new clinic sites and develops organization-wide strategic plans and policies. She finds it rewarding to evaluate a program and provide information to the director on what's working and what needs to improve so that a program actually gets, for example, reductions in HbA1c in people with diabetes.

In addition to her responsibilities at the clinic, Ybarra has served on the local school board for seven years and in 2008, ran for the state legislature. "I don't see the work I do in community health as isolated from the other work that I do," she says. "To some extent, that's what public health teaches us: the well-being of a community is connected to a lot of things. Public health training helps us make those connections."