RefugeeScreeningHarr isCounty

Slide1: 

Refugee Health Screening: A Local Perspective NACCHO Annual 2006 Conference July 28, 2006 San Antonio, Texas

Session Learning Objectives: 

Session Learning Objectives Review the standards for refugee health screening Examine local health department policy development around the provision of health services to local refugee populations Identify unique features and challenges with refugee health screening and compare/contrast with providing health services to immigrant populations

Session Learning Objectives: 

Session Learning Objectives Discuss a number of representative case scenarios that address the interplay between various agencies at the local community level Explore relevant topics such as human trafficking and specific refugee populations with which health departments have had experience

Overview: 

Overview The World of Refugee Health Refugee Health: Standards & Screenings Refugee Health: Challenges Refugee Health: Case Scenarios

The World of Refugee Health : 

The World of Refugee Health

Who is a Refugee?: 

Who is a Refugee? A Refugee is “any person who is outside his or her country of nationality who is unable or unwilling to return to that country because of persecution or a well-founded fear of persecution…based on…race, religion, nationality, membership in a particular social group, or political opinion.” Source: U.S. Citizenship and Immigration Services, A Bureau of US Department of Homeland Security (www.uscis.gov)

Slide7: 

Source: U.S. Committee for Refugee & Immigrants – at http://www.refugees.org

Refugee Resettlement – National Perspective: 

Refugee Resettlement – National Perspective Source: U. S. Department of State Website - http://www.state.gov/g/prm/asst/rl/rpts/36116.htm Number of Refugee Admissions

Refugee Resettlement – National Perspective: 

Refugee Resettlement – National Perspective Federal FY 04 arrivals totaled 52,868 Africa: 29,125 East Asia: 8,079 Europe & Central Asia: 9,254 Latin America & Caribbean: 3,556 Near East & South Asia: 2,854 Federal FY 05 ceiling set at 70,000

Refugee Resettlement – National Perspective: 

Refugee Resettlement – National Perspective During FFY 2004, 78% of newly arrived refugees resettled in 16 states: California (13%) Minnesota (11%) Texas (6%) New York (6%) Washington (5%) Florida (5%) Georgia (4%) Arizona (4%) Wisconsin (3%) Massachusetts, Pennsylvania, Ohio, Virginia, Illinois, Oregon, and North Carolina (just less than 3% each)

Refugee Health: Standards & Screenings: 

Refugee Health: Standards & Screenings

Components of Refugee Resettlement & Health Screening: 

Components of Refugee Resettlement & Health Screening

 Refugee Health Screening - Overseas : 

Refugee Health Screening - Overseas Required Screening Screen for communicable diseases of public health significance (serologic testing for HIV & syphilis, chest radiograph for TB) Documentation of immunizations Physical or mental disorders that may result in harm to self or others Drug addiction

Refugee Health Screening – Domestic : 

Refugee Health Screening – Domestic Recommended Screening History & Physical (including hearing, vision, dental, nutrition) Laboratory screening Mental health screening Documentation of immunizations Introduction to U.S. health care system (Follows protocol set forth by Office of Refugee Resettlement, 1995)

Goals of Refugee Health Screening - Domestic: 

Goals of Refugee Health Screening - Domestic Assist Refugee in Resettlement Process by Protecting Health & Well-Being of Individual Refugee and/or Refugee Family Protect Community & Public’s Health Against Introduction of Illness or Disease

Refugee Health Screening – Domestic: 

Refugee Health Screening – Domestic Based on public health approach Based on conditions with: Screening methods available that are cost-effective and accurate Interventions available to treat or prevent spread of disease Examples include: TB testing, Hepatitis B screening, parasite testing, immunization screening Source: Dr. Elizabeth Barnett; Travel Medicine; September 15, 2004: vol. 39, p. 834.

Refugee Resettlement – Texas Perspective: 

Refugee Resettlement – Texas Perspective Source: Texas Department of State Health Services website

Refugee Resettlement – Texas Perspective: 

Refugee Resettlement – Texas Perspective Arrivals to Texas (by county) - (FFY 04-05) Harris = 1642 Dallas = 1128 Tarrant = 483 Travis = 312 Potter = 218 Bexar = 185 Taylor = 130 Other = 185 TOTAL = 4283

Slide19: 

Harris County, Texas

The Harris County Community: 

The Harris County Community Harris County is the 3rd largest county in U.S. Population of over 3.5 million people: 1.9 million within City of Houston 1.2 million in unincorporated areas of Harris County 450,000 in 30 other municipalities within Harris County Geographically large & diverse Politically diverse Population diverse

Harris County Public Health & Environmental Services (HCPHES): 

Harris County Public Health & Environmental Services (HCPHES) Governmental agency, chartered in 1942 Currently with 700+ staff positions Population served: Ranging from 1.5 to over 3.5 million persons Unincorporated Harris County (all of our services) Unincorporated Harris County plus combinations of municipalities except Houston (many of our services) Entire county (e.g. mosquito control, refugee health screening)

HCPHES – Refugee Health Screening Process : 

HCPHES – Refugee Health Screening Process Initial Provider Visit Outreach Worker Intake Laboratory/Follow-up Visit Continuation of Resettlement Process 48-72 hours 3-6 weeks As necessary

HCPHES – Process of Refugee Health Screening: 

HCPHES – Process of Refugee Health Screening Outreach Worker Intake: Intake Interview Paperwork completion for processing Placement of Tuberculin Skin Test (PPD) If HIV(+), referral to local specialized partner for HIV Outreach Worker Follow-up: Reading/Interpretation of PPD (high-risk) Transportation to contractor for initial health screening visit

HCPHES – Process of Refugee Health Screening: 

HCPHES – Process of Refugee Health Screening Initial Health Screening Visit: History & Physical Completion of State-Required Screening Form Laboratory testing, including parasite testing (stool specimen) & HIV testing Evaluation and update for immunizations +/- PPD Referral to other health care entities, as needed

HCPHES – Refugee Health Screening: 

HCPHES – Refugee Health Screening Follow-up Health Screening Visit (3-6 weeks): Follow-up on problems/questions Follow-up on results of laboratory testing, including parasite & HIV testing Continue updating for immunizations Referral to other health care entities, as needed

Issues in Refugee Health Screening: 

Issues in Refugee Health Screening Infectious diseases Parasitic infections, TB, Hepatitis B exposure, & STDs (especially in victims of rape, torture) Immunizations Difficulty in obtaining documentation of previous immunizations Mental health illnesses Co-morbidities, especially in victims of torture, rape, forced abortions Chronic conditions Examples include malnutrition, diabetes, hypertension, & oral disease

Refugee Health: Challenges: 

Refugee Health: Challenges

Notable Challenges in Refugee Health Screening: 

Notable Challenges in Refugee Health Screening Cultural and language barriers Transportation Transiency of refugee(s) Other competing interests Cultural sensitivity training, interpreter services Travel vouchers, transport van Intensive outreach, flexible outreach worker schedule Multi-agency approach with partner agencies (e.g., VOLAGs) Challenge Potential Solution

Refugee Health: Case Scenarios: 

Refugee Health: Case Scenarios

Case Scenario #1: 

Case Scenario #1 12 year old Eastern European boy Stool exam returns positive for three parasites Family no longer at original address

Case Scenario #2: 

Case Scenario #2 37 year old East Asian female Active tuberculosis Self-treating via “cupping”

Case Scenario #3: 

Case Scenario #3 45 year old African male, medications confiscated during travel Noted to be “irritable” when PPD placed and had cut on wrist, possibly self-inflicted Wrist injury noted on screening exam but no action taken Jailed on charges of “family violence”

Closing Thought … “Everyone has the right to recognition everywhere as a person before the law.”: 

Closing Thought … “Everyone has the right to recognition everywhere as a person before the law.” Source: Article 6, Universal Declaration of Human Rights, 10 December 1948.

Slide34: 

For more information: visit HCPHES Website - www.harriscountyhealth.com