Primary Care for Immigrants and Refugees. Brianna Stein, MD Assistant Clinical Professor UCSF DFCM Annual Review in Family Medicine December 8, 2017

Transcription

1 Primary Care for Immigrants and Refugees Brianna Stein, MD Assistant Clinical Professor UCSF DFCM Annual Review in Family Medicine December 8, 2017

2 Disclosures I have no financial or commercial interests to disclose

3 Objectives Learn about demographics of the immigrant population in the US Define refugee Understand the process of becoming a refugee Discuss an approach to caring for refugees and immigrants in the primary care setting Appreciate the importance of partnering with community organizations

4 Who am I?

5 Immigrant population in the US 43.2 million foreign born in US in 2015 = 13.4% population

6 Immigrant population in the US

7 Immigrant population in the US

8 Immigrant population in the US

9 Immigrant population in the US 46% immigrants live in 3 states California 25% Texas 11% New York 10% 65% immigrants live in 20 major metropolitan areas New York, LA, Miami = largest immigrant populations Most undocumented immigrants live in these major metro areas

10 What is a refugee?

11 Definitions Immigrant Documented Special cases: unable to return to their home country because of persecution or well-founded fear of persecution due to race, religion, nationality, membership in a particular social group, or political opinion Refugee status granted abroad Asylee status granted in US VOT victim of modern day slavery SPIV Iraqi or Afghan interpreters/translators U visa victim of a crime Undocumented

12 Total population of immigrants in US Undocumented Documented Asylum seekers not yet granted Status granted as refugees, asylees, VOTs, etc.

13 How do immigrants get to the US? General immigration pathway Country of origin Destination country Refugee/Asylee pathway Country of origin Flight/displacement Resettlement country

14 How is a person granted refugee status? Country of origin Flight/displacement - Screening and evaluation by UNHCR month vetting process by US gov -Oversees medical exam -Matched with US-based resettlement agency (Volag) Resettlement country - Volag helps arrange housing and services -Domestic medical exam with in 30 days of arrival

15 How is a person granted asylum? Legal process that involves USCIS Forensic medical evaluation can be an important part of the case Undergo examination = more likely to be granted asylum Country of origin Flight/displacement (in USA) - Seek asylum within one year of last arrival in US Resettlement country (remain in USA) - Domestic medical examination

16 Services for refugees Within the first days of arrival, volags Arrange housing Apply for SSN Enroll children in school Initial domestic medical examination within 30 days of arrival English language training Seek employment services Government cash assistance and medical benefits last 8 months Adults find their own source of health insurance Children eligible for CHIP/Medicaid

17 Six settings in which refugees access care Domestic medical exam Episodic care Comprehensive primary care Refugee care in medical education N-648 evaluation evaluation for disability when undergoing process of naturalization Asylum evaluation Physicians for Human Rights and Health Right International provide training

18 What are topics unique to refugees, requiring special attention by a physician?

19 Approach to care for refugees Referenced from Mishori, et al. Am Fam Physician 2017; 96(2):

20 Domestic medical exam All refugees undergo oversees medical examination prior to resettlement Look for untreated conditions that may cause a public health threat Access documentation through state and local health departments Focus on All Communicable diseases Mental health problems Nutrition status Immunization gaps Children Lead levels Growth status CDC has detailed guidelines based on country of origin

21 Domestic medical exam Referenced from Mishori, et al. Am Fam Physician 2017; 96(2):

22 Comprehensive primary care Referenced from Mishori, et al. Am Fam Physician 2017; 96(2):

23 Brainstorm potential barriers to care for refugees

24 Barriers to care Referenced from Mishori, et al. Am Fam Physician 2017; 96(2):

25 Summary Immigrants make up > 13% of the US population and most live in major metropolitan cities of the US Refugees Type of documented immigrant Granted access to the US abroad Unable to return to their country because of persecution Immigration, flight, and resettlement are profound life events Take time to understand the health of your patients before, during and after immigration Initial evaluation of refugees/immigrants requires both routine screening and preventive care as well as screening for communicable diseases and mental health problems Refugees/Immigrants face many potential barriers to health and wellness Know organizations in your area that serve refugees/immigrants and partner with them Each deserves high-quality, comprehensive, longitudinal, and relationship-centered primary care

26 Family doctors = perfect group to care for refugee and immigrant populations!

27 Resources Referenced from Mishori, et al. Am Fam Physician 2017; 96(2):

28 Questions

29 References Mishori R, Aleinikoff S, and Davis D. Primary care for refugees: challenges and opportunities. Am Fam Physician. 2017; 96(2): Walden J and Valdman O, et al. Building capacity to care for refugees. Fam Pract Manag Jul-Aug;24(4): Pew Research Center. Lopez G and Bialik K. Key findings about U.S. immigrants. Published 2017, May 3. Retrieved 11/20/2017 from US Citizenship and Immigration Services. Refugees and Asylum. Retrieved 11/20/2017 from Lustig SL, Kureshi S, Delucchi KL, Iacopino V, Morse SC. Asylum grant rates following medical evaluations of maltreatment among political asylum applicants in the United States. J Immigr Minor Health. 2008;10(1):7 15. Mishori R, Hannaford A, Mujawar I, Ferdowsian H, Kureshi S. Their stories have changed my life: clinicians' reflections on their experience with and their motivation to conduct asylum evaluations. J Immigr Minor Health. 2016;18(1): Centers for Disease Control and Prevention. Immigrant and Refugee Health. Retrieved 11/201/2017 from Office of Refugee Resettlement. State of California programs and services by locality. Retrieved 11/20/2017 from Refugee Processing Center. Reports: admissions & arrivals. Retrieved 11/20/2017 from Steven Ruggles, Katie Genadek, Ronald Goeken, Josiah Grover, and Matthew Sobek. Integrated Public Use Microdata Series: Version 7.0 [dataset]. Minneapolis: University of Minnesota,