1 / 51

Refugee Health In Minnesota

Refugee Health In Minnesota. Carol Berg, RN, MPH Public Health Manager, UCare cberg@ucare.org. Presentation Objectives. Describe refugee and immigrant populations in Minnesota. Explain the MDH Refugee Health Program. Cite the health needs assessed among new arrivals.

salma
Download Presentation

Refugee Health In Minnesota

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Refugee Health In Minnesota Carol Berg, RN, MPH Public Health Manager, UCare cberg@ucare.org

  2. Presentation Objectives • Describe refugee and immigrant populations in Minnesota. • Explain the MDH Refugee Health Program. • Cite the health needs assessed among new arrivals. • Identify strategies to enhance culturally-specific health care services for new arrival populations.

  3. USCIS Definitions U.S.A. U.S. Citizen Non-Citizen Non-Immigrant Immigrant authorized employment LPR LTR undocumented individual student visitor on business tourist Persons fleeing from persecution refugee asylee parolee 8/03

  4. What does it mean to be a refugee? • Foreign-born resident who: • is not a United States citizen • cannot return to his or her country of origin because of a well-founded fear of persecution due to race, religion, nationality, political opinion, or membership in a particular social group • Refugee status is generally given: • prior to entering the United States • by the Bureau of Citizenship & Immigrant Services (USCIS) • Eligible for up to 8 months of public assistance.

  5. What does it mean to be an immigrant? • Foreign-born resident who: • is not a United States citizen • is defined by U.S. immigration law as a person lawfully admitted for permanent residence in the United States • either arrives in the U.S. with an immigrant visa issued abroad, or adjusts their status in the U.S. from temporary to permanent resident • may be subjected to a numerical cap

  6. What does it mean to be an asylee? • Foreign-born resident who: • is not a United States citizen • cannot return to his or her country of origin because of a well-founded fear of persecution • due to race, religion, nationality, political opinion, or membership in a particular social group • Asylee status is generally given: • after entering the United States • by the State Department or USCIS

  7. What does it mean to be a parolee? • Foreign-born resident who: • is not a United States citizen • has been given special permission to enter the United States: - under emergency conditions or - when that person's entry into the U.S. is considered to be in the public's interest

  8. Migrants to Minnesota • Primary Migrants to Minnesota • Foreign-born persons whose primary state of resettlement in the U.S. was Minnesota • Arrival notification from CDC • Secondary Migrants to Minnesota • Significant movement of refugees/ immigrants from state of primary arrival • Health information requested from primary arrival state • If no information is available, baseline health assessment should be done

  9. Refugee Health Program Goal • To control communicable disease among, and resulting from, the arrival of new refugees through: • health assessment • treatment • referral

  10. Coordinate initial health assessments, Educate providers regarding screening protocols, Administer contacts with local health departments for refugee screening, Collect and disseminate health screening data, Collaborate with Volags, MAAs, and other community based organizations, Provide health resources for foreign-born populations and their health care providers. Functions of MDH Refugee Health Program

  11. Refugee Health AssessmentInformation Flow Quarantine Station/CDC MDH Local Health Dept. Forwards to primary provider Screens Primary provider screens Screening form completed & returned

  12. Volags (Volunteer Agencies): Local Organizations or Affiliates • Catholic Charities (CC) • Lutheran Social Services (LSS) • Jewish Family Services or Minneapolis Jewish Family and Children's Services (JFS) • MN Council of Churches (MCC) • International Institute of Minnesota (IIM) • World Relief Minnesota (WRM)

  13. Amigos de las Americas Association for the Advancement of Hmong Women in MN Center for Asians and Pacific Islanders CLUES Confederation of Somali in MN Ethiopian Community in MN Hmong American Mutual Assistance Assoc. Hmong American Partnership Intercultural Mutual Assistance Association Islamic Center of MN Lao Assistance Center of MN Lao Family Community Oromo Community of MN SEA Community Council Slavic Community Center Somali Family Services United Cambodian Association of MN Vietnamese Social Services West African Mutual Aide Association *List not comprehensive Mutual Assistance Associations (MAAs)*

  14. Refugee Arrivals to MN by Region of World 1979-2010 Refugee Health Program, Minnesota Department of Health

  15. 2010 Primary Refugee Arrival To Minnesota (N=2,320) Lakeof theWoods Kittson Roseau Koochiching Marshall St. Louis Beltrami Pennington Polk Cook ClearWater Red Lake Lake Itasca Mahnomen Norman Hubbard Cass Becker Clay Aitkin Number of Refugees Arrival By Initial County Of Resettlement Wadena Crow Wing Carlton Ottertail Wilkin Pine Todd MilleLacs Kanabec 0 Grant Douglas Morrison 1- 20 Benton Stevens Pope Stearns Traverse Isanti Big Stone 21 - 50 Sherburne Chisago Swift Kandiyohi Anoka 51 - 100 71 Wash-ing-ton Meeker Wright Hennepin Ram- sey Chippewa Hennepin 101 - 300 Lac Qui Parle McLeod Carver Renville 301 – 1,000 Scott Yellow Medicine Dakota Sibley Lincoln Lyon Redwood 1,001 – 2,000 Rice Le Sueur Goodhue Nicollet Wabasha Brown Pipestone Murray Watonwan Blue Earth Waseca Steele Dodge Olmsted Winona Cottonwood Rock Nobles Jackson Martin Faribault Freeborn Mower Fillmore Houston

  16. Primary Refugee Arrivals, Minnesota2010 N=2,320 “Other” includes Afghanistan, Cambodia, Cameroon, China (incl. Tibet), Colombia, Cuba, Guinea, Kenya, Liberia, Mali, Mexico, Nigeria, Rwanda, Saudi Arabia, Sierra Leone, Sudan and Togo *“FSU” includes Armenia, Belarus, Kyrgyzstan, Moldova, Ukraine and Uzbekistan Refugee Health Program, Minnesota Department of Health

  17. African Refugee Family Reunification Suspended The State Department announced that the U.S. family-reunification program for African refugees has been suspended after DNA testing of applicants revealed widespread fraud. The suspension affects family members seeking to join East Africans, and some Liberians, already in the United States. Minnesota only accepted through the family reunification program (P-3) until June 2008. Source: Voice of America, August 20, 2008

  18. “Free Cases” or “Families without U.S. Ties” Def.-: Refugees who do not have family ties or anchors residing in the U.S. or the resettlement state With the change in resettlement policy, Minnesota started accepting “Free Cases” in July 2008: From July 2008 – Present: 849 (27%) of 3,166 arrivals came as “Free Cases” 2008: 44 (4%) 2009: 178 (14%) 2010: 959 (41%) Top Countries: Somalia, Burma and Iraq

  19. Primary Refugees without U.S. Ties (Free Cases)Minnesota, 2010 N=959 ‘Other’ includes Cuba and Sudan Refugee Health Program, Minnesota Department of Health

  20. “New” Refugee Populations 2008 to Present

  21. Burma (Myanmar) 1948 - 1974 1974 - 2010 2010 -

  22. Background • Over 140, 000 refugees along Thai-Burmese border since 1984 (Temporary Protection) • Students with claims of political persecution versus Ethnic Minorities • U.S.A:Expected to resettle in the US during 10 yrs starting FY2006 • Minnesota:Burmese started arriving in 2003; the KaRen/Burmese starting 2006 To date: 3,372 arrivals Source: Human rights watch and US State Department

  23. Bhutan

  24. Background • Over 106, 000 Nepali speaking Bhutanese (Lothsampas) refugees expelled from Southern Bhutan in the early 1990s; currently refugees are living in 7 camps in Nepal • Cultural, linguistic expressions denied; Bhutan has denied their right to return to their country • U.S.A:At least 60,00 are expected to resettle in the US - special humanitarian concern • Minnesota:Bhutanese refugees started arriving in May 2008 To date: 456 arrivals Source: Human Rights Watch and US State Department

  25. IRAQ 1963-1991 1991-2004 2004-2008 2008

  26. Background • Iraqi refugees (2.2 Million) Syria (~500,000) Jordan (~1.4 million) Other (~360,000) • U.S.A: 30,000 referred • Minnesota: Iraqi refugees started arriving in April 2008 To date: 445 arrivals Source: Human Rights First and US State Department

  27. Refugee Admissions Ceilings for FY2011 N=80,000 Source: US Department of State

  28. Types of Medical Exams • Overseas Visa Medical Examination • U.S. Public Health Service • Domestic Refugee Health Assessment • Minnesota Department of Health • Adjustment of Status Medical Examination • From temporary to permanent resident • Needed to obtain a green card • US Citizenship and Immigration Service

  29. Adjustment of Status Exam(Green Card Exam) • Immigrants: exam done by Civil Surgeon required • Refugees: immunizations only (unless arrived with Class A condition); local Public Health can act as Civil Surgeon • Forms are found at www.uscis.gov • Call MDH for more guidance

  30. Health Status of New Refugees, Minnesota, 2010‡ Health status upon arrival No of refugees No(%) with infection screened among screened TB infection* 2,086 (95%) 570 (27%) Hepatitis B infection** 2,160 (98%) 112 (5%) Parasitic Infection*** 2,106 (96%) 471 (22%) Sexually Transmitted 1,765 (80%) 28 (2%) Infections (STIs)**** Malaria Infection 234 (11%) 0 (0%) Lead***** 833 (87%) 16 (2%) Hemoglobin 2,151 (98%) 437 (20%) ‡ 2010 Preliminary results for arrivals between 01/01/2010 and 12/31/2010 Total screened:N=2,193(98% of 2,242 eligible refugees) * Persons with LTBI (>= 10mm induration or IGRA+, normal CXR) or suspect/active TB disease ** Positive for Hepatitis B surface antigen (HBsAG) *** Positive for at least one intestinal parasite infection **** Positive for at least one STI *****Children <17 years old (N=954 RHAs) Refugee Health Program, Minnesota Department of Health

  31. Health Status of New Refugees, MinnesotaImmunization Status, 2002-2010 Refugee Health Program, Minnesota Department of Health

  32. Health Status of New Refugees Upon Arrival to MN, 2010* Screening rate 98%(2,193/2,242) Immunizations 91% (2,003/2,193) started or continued age-appropriate vaccinations after health screening Tuberculosis27%(570/2,086) Latent TB infection or suspect/active TB case Hepatitis B5%(112/2,160) HBsAg positive *Preliminary Results

  33. Health Status of New Refugees Upon Arrival to MN, 2010*, cont’d Parasitic infection22% (471/2,106) Tested positive for at least one intestinal parasite (common: Strongyloides, Giardia, Schistosoma, Trichuris, E. histolytica) Lead level (<17 y.o.) 2% (16/833) Hemoglobin20% (437/2,151) less than 12gm/dL Referrals Primary Care (51%),Pediatrics (43% of <18 yrs),Dental (37%), Public Health Nurse (13%), Vision (8%) *Preliminary results

  34. Tuberculosis Infection* Among Refugees By Region Of Origin, Minnesota, 2010 N=2,086 screened 570/2,086 320/803 201/1,004 4/25 32/221 13/33 *Preliminary results *Diagnosis of Latent TB infection (N=568) or Suspect/Active TB disease (N=2) Refugee Health Program, Minnesota Department of Health

  35. Hepatitis B infection Among Refugees by Region of Origin, Minnesota, 2010 N=2,160 screened 112/2,160 37/834 74/1,039 1/28 0/227 0/32 *Preliminary results Refugee Health Program, Minnesota Department of Health

  36. Intestinal Parasitic Infection* Among Refugees by Region of Origin, Minnesota, 2010 N=2,106 screened 471/2,106 149/812 271/1,025 15/32 33/204 3/33 *At least one type of pathogenic intestinal parasite *Preliminary results * At least one stool parasite found (including nonpathogenic) Refugee Health Program, Minnesota Department of Health

  37. Health Concerns: Immediate • Infectious Disease – TB, parasites, hep B • NutritionalDeficits – poverty, disease • Immunizations – required for school • Mental Health – loss, fear, adjustment • Access to care – how, why, when, where • Interpreters – language/cultural • Costs –insured, under-insured, no insurance Source: MDH Refugee Health Program

  38. Health Concerns: Long Term • Chronic Disease – diabetes, hypertension, obesity, work hazards, TB in frail and elderly • Mental Health – family role and self definitionadjustment, isolation, lack of support • Access to care – misunderstanding and mistrust of system • Interpreters – language/cultural • Costs –insured, under-insured, no insurance

  39. Limitations of Domestic Screening Elective on parts of both state and refugee Wide variation in quality and comprehensiveness across states Funding sources may be limited Clinics’ and clinicians’ experience/ expertise in working with newly arrived refugees &/or tropical medicine varies state to state

  40. Areas of Need in Resettlement • Applying for Social Security number, public assistance, photo ID • Education; English language classes • Employment services • Housing, food, furniture, clothing (www.211unitedway.org) • Health care services: physical, mental, spiritual • Ethnic-specific support services (MAAs or other community agencies); www.iimn.org (ethnic resource directory) • Legal Assistance

  41. Strategies to Enhance Culturally Competent Care • Cultural Assessment (incorporate tool, results in medical record) • Other considerations: • interpreter services (Interpreting Stakeholder Group) • bilingual/bicultural staff • appropriate education resources (www.health-exchange.net) • Appoint staff as cultural resources (www.culturecareconnection.org) • PHN and community-based follow-up

  42. Interpreting Stakeholder Group ISG works to improve the quality and delivery of spoken language and interpreter services in Minnesota, and to promote the professionalization of the interpreting industry as a whole. http://www.isgmidwest.org

  43. Strategies to Enhance Culturally Competent Care • Cultural Assessment (incorporate tool, results in medical record) • Other considerations: • interpreter services (Interpreting Stakeholder Group) • bilingual/bicultural staff • appropriate education resources (www.health-exchange.net) • Appoint staff as cultural resources • PHN and community-based follow-up

  44. Stratis Health – Culture Care Connection www.culturecareconnection.org An online learning and resource center aimed at supporting health care providers, staff, and administrators in their ongoing efforts to provide culturally competent care.

  45. Diversity In Minnesota – Information Sheets http://www.culturecareconnection.org/matters/diversity/somali.html Somalis in Minnesota Hmong in Minnesota

  46. Know Your Community: County ProfilesCounty profiles detail pertinent demographic, socioeconomic, and health status data, with information about vulnerable populations. County Profiles offer providers and administrators an in-depth view of the communities they serve. This information can be used in strategic planning to ensure the provision of culturally and linguistically appropriate health services. http://www.culturecareconnection.org/navigating/mncountyprofiles.html

  47. Minnesota Health Literacy Partnership MHLP, a program of the Minnesota Health Literacy Council, was formed to help coordinate health literacy efforts across the state. The partnership is comprised of health care organizations, consumers, and literacy groups, as well as the state’s health and social service agencies, and has worked with a number of local organizations to develop health literacy training, patient education materials, and toolkits. www.healthliteracymn.org

  48. Community Health Education • Radio shows • ESL • Ethnic press • ECHO TV • Global Brown bags (for staff) • Metro Refugee Health Task Force • Community health forums • Etc!

  49. LEARN LListen with empathy to the client’s perception of the problem EExplain your perceptions of the problem AAcknowledge and discuss the differences and similarities RRecommend treatment NNegotiate agreement Berlin, E. A. and Fowkes, W.C., 1983

  50. Immigrant Health Task Force • Improve access to care • Data collection and analysis • Equitable payment for immigrant health services • Develop clinical guidelines • Diversify workforce • Use trained interpreters • Use CHWs • Train providers and educate new immigrants. • MN Immigrant Health Task Force, MDH, 2004

More Related