Background: About four in ten refugees entering the US each year are young children and adolescents (Fig 1). These young refugees may have experienced disrupted early lives, high violence exposure and further adverse experiences in settlement countries. 80 to 90% of refugee children have been exposed to harsh conditions, including long-term hunger and violence. Such hardships initiate a trajectory that puts refugee children at increased risk of malnutrition and chronic health problems after resettlement. Moreover, immigrant children are more likely to live below the federal poverty level than non-immigrant children. They are also less likely to have access to medical care and quality early education programs. In 2018, over 1500 refugees and people with special immigrant visas (SIVs) resettled in our state. Of these, 11% of refugees and 21% of people with SIVs resettled in our city. Locally, providers at our patient centered medical home noted an increase in our immigrant and refugee patient population within the same time frame. Verification of this observation was difficult due to inconsistent documentation in medical records, probably due to fears of disclosing undocumented (visa) status, deportation and/ or family separation. In an effort to advocate for improved comprehensive health care of our growing immigrant and refugee population, specialized services and provider education were integrated in our patient centered medical home. Methods: An educational toolkit was designed to guide local primary care providers in the care of immigrant or refugee children. Key clinical domains that were prioritized were medical screening, developmental screening, and addressing mental health, trauma, and social determinants of health inequity. Educational sessions were scheduled, with a live educational event, and printed handouts provided. Knowledge assessment and improvement of providers were determined through interactive discussion and real-time audience response post-test. Welcoming, inclusive signs were designed for waiting areas, and interpreter services made available in the medical home(Figure 2). Support for school readiness and academic success were encouraged. To address social determinants of health inequity, relevant community resource referrals and warm hand-offs were encouraged. Finally, the last phase planned was community education via print and electronic media platforms. Results/Conclusion: We identified opportunities for positive practice change in our patient centered medical home by creating a safe, healthy environment for immigrant and refugee children. These included implementing screening protocols for newly arrived children, along with relevant integrated/co-located medical services. Strength and resilience were recognized as assets among immigrant children and families. The next step is to investigate what promotes good adjustment and social integration of refugees and immigrants into resettlement areas. Constant collaboration with community partners and health care providers are also expected to further optimize health care services of immigrant and refugee children.
Integrating the Care of Immigrant and Refugee Children in a Patient-Centered Medical Home: A Resident-Led Advocacy Project
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Aishwarya Palorath, Ana Mendez, Melissa Grageda; Integrating the Care of Immigrant and Refugee Children in a Patient-Centered Medical Home: A Resident-Led Advocacy Project. Pediatrics July 2020; 146 (1_MeetingAbstract): 573. 10.1542/peds.146.1MA6.573
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