Removing barriers to care for immigrant kids

Barriers to health care exist for many children, but can be particularly arduous for the 18 million children who are members of an immigrant family. The session “Addressing Barriers to Care for Immigrant Families” at the virtual 2021 American Academy of Pediatrics National Conference & Exhibition presented by members of the Program for Immigrant and Refugee Child Health (PIRCH) at Baylor College of Medicine and Texas Children’s Hospital in Houston covered the major barriers that immigrants children face and the initiatives that PIRCH has created to tackle the challenges seen in their area.

Common barriers to care for immigrant children include:

• Language - Roughly half of all immigrant have children with limited English proficiency, which can impact preventive care access and can lead to reductions in being satisfied with care
• Health literacy - Limited health literacy is more common in people who are racial or ethnic minorities, of a lower socioeconomic status, or have limited proficiency with English. A lack of health literacy has been linked to less utilization of preventive care, more emergency department visits for nonemergencies, and overall worse health outcomes for children.
• Cultural factors - Immigrant families may be used to a different health care system or non-Western approaches to treatment. Furthermore, there may be a different understanding of what is causing a disease or disorder.
• Health coverage - Immigrant children are twice as unlikely to be uninsured as their nonimmigrant peers. Additionally, children without legal residency status can’t access public health insurance options in most states in the United States. Unaccompanied immigrant children do have coverage when they are in the custody of the Office of Refugee Resettlement, but they are no longer covered once released to their family.
• Immigration-related fears - Families may worry that use of public benefits will negatively impact their legal residency status and some may avoid using any health care because they worry about deportation.
• Health system - Providers and staff may be inadequately trained. Support staff may be insufficient.

The PIRCH program was founded in 2018 with the mission to improve the health of immigrant children by removing barriers to care and promoting clinical excellence. The program has developed a number of initiatives to tackle common barriers in the Houston, Texas area, including:

• Uninsured children not going to subspecialty appointments following referral - PIRCH met with the financial services of Texas Children’s Hospital to discuss the unique needs of the population and then worked together to improve the needs of the patients. Staff was also educated about the issue. One potential idea the program may use is making a patient’s insurance status more prominent in the electronic health record.
• Not all providers have training in immigrant care - The program offers a noon conference series on care in the population. A community health education program with refugee Congolese mothers offers a mutually beneficial forum for health care provider and the mothers to learn from one another. A refugee and asylum seeker elective is also available for residents who want to focus on immigrant care. For clinicians out of residency, a global health journal club and annual grand rounds offer an opportunity to listen.
• Lack of awareness of medical homes that will take children regardless of immigration and insurance status - With the help of an intern, a list of low-cost clinics in the Houston area was created. The list includes clinics that will see both children and the entire family along with specialties available at the sites.
• Utilization of laboratory screening for immigrant children is not standard practice - An algorithm to determine what screenings might be necessary for the patient was developed to improve screening protocols.

Creating a program that addresses immigrant care in the community requires leadership who believes in the mission of improving access to care for all children as well as faculty who are dedicated to it. Working in the field also requires navigating a political minefield, but that can be addressed by refraining from taking sides or citing specific political figures; using language that is inclusive; and starting from the presumption that health care is a human right.

Reference

1. Monterrey A, Fredericks K, Haq H, Russel E, Swamy P. Addressing barriers to care for immigrant families. American Academy of Pediatrics 2021 National Conference & Exhibition; virtual. Accessed October 8, 2021.