The Philadelphia Refugee Health Collaborative: Creating a Sustainable Refugee Health Care System

The Problem: Providing and Sustaining Health Care to Refugees

Federal protocol mandates that each refugee must obtain a domestic health screening and orientation to the U.S. health care system within 30 days of arrival. Health screening includes immunizations, and examinations to identify any infectious diseases or potentially fatal toxins and emotional trauma (Centers for Disease Control and Prevention 2010). If refugees arrive with known health conditions, they must receive the mandated screening sooner. The screening process is typically facilitated by a state Department of Health or a State Refugee Health Coordinator.

Until recently, Pennsylvania had no state-sponsored governmental system in place to support refugees in receiving the mandated assessment. A system has been enacted in Lancaster County, but Philadelphia and the Delaware Valley remain without a defined system.

Philadelphia’s resettlement agencies—Hebrew Immigrant Aid Society Pennsylvania (HIAS PA), Lutheran Children and Family Service (LCFS) and the NSC—collectively resettle over 800 refugees each year. The number of refugees arriving each year has dramatically increased over the past five years. NSC’s annual resettlement number has increased tenfold, and HIAS PA’s has increased by 500 percent. Approximately 15-20% of refugees arrive with significant medical conditions that require specialist care and/or surgery/hospitalization soon after arrival. Resettlement agencies work with refugees to facilitate their transition into American society; navigation of the health care system is a major piece of this acclimation. Refugees receive eight months of government-funded Refugee Medical Assistance. After eight months, many refugee adults lose their insurance because they fail to qualify for government- or employer-sponsored coverage. (Children, disabled, elderly and refugees with significant medical conditions continue to receive benefits after the eight-month benefit period.)

In the past, resettlement agencies struggled to find culturally competent medical providers committed to providing limited English proficient refugees with screenings and long-term care. However, in 2007, NSC and Jefferson Family Medicine Associates (JFMA) piloted a new model involving a closely coordinated partnership between a resettlement agency and medical provider. The JFMA clinic sees five new and fifteen follow-up patients each week. The clinic provides an opportunity for family medicine residents to train in global health. By housing the clinic in a university health system, refugee patients have access to an extensive network of specialty practices. A Clinic Liaison from NSC escorts clients to their first appointment and provides on-site assistance at the clinic. Since 2007 through the dedicated work of each Collaborative member, Philadelphia’s network of refugee health clinics has grown significantly. HIAS PA, NSC and LCFS have partnered with medical providers to establish additional refugee health clinics at Fairmount Primary Care Center, Nemours Pediatrics, Drexel Women’s Care Center, Penn Center for Primary Care and Children’s Hospital of Philadelphia.

The Solution: The Philadelphia Refugee Health Collaborative

A defined health care system is vital to the refugee acculturation/integration process. The Philadelphia Refugee Health Collaborative aims to create a citywide system to address incoming refugees’ health needs and provide sustainable high-quality care. The Collaborative has identified two main goals, paired with specific objectives, to ensure that the system is successful. The first goal ensures that refugees resettled in Philadelphia have timely access to a network of primary and specialist care providers with the capacity to effectively address their complex physical and mental health needs. The second goal works to improve their health outcomes by implementing a community health education program. The Collaborative is one of the most innovative and comprehensive health care partnerships addressing refugee health needs in the nation.

Despite common challenges, until recently resettlement agencies in Philadelphia mostly worked independently to meet refugees' needs for screening, ongoing care and health education. Each agency utilized separate affiliated health care providers. This ad hoc approach fulfilled the immediate and most urgent refugee health needs, but failed to create a sustainable solution. The resettlement agencies and their refugee health clinics proposed a two-year joint citywide capacity building project to address refugee health needs.

The Philadelphia Refugee Health Collaborative’s core goal will be to create an equitable system of refugee health care in the Philadelphia region that ensures a consistently high standard of care for all newly arrived refugees. A collaborative project will enable partners to share best practices and information on a regular basis to improve overall quality of care; work closely with the State to develop systems to support the funding, coordination and reporting of refugee health screenings; and create standardized and coordinated systems for meeting screening and orientation requirements. The proposed Collaborative project includes developing additional specialized refugee health clinics; creating a shared on-line system for scheduling screening appointments; organizing regular training opportunities for resettlement agency and clinic staff; developing shared outcome measures for tracking refugee health screening and other health outcomes citywide; establishing a pilot community health outreach program staffed by refugee peer educators. The Collaborative has just received a two-year $195,000 grant from the Barra Foundation to support the capacity building project.

By working collaboratively and developing standardized and coordinated system for meeting refugee health needs, the agencies and clinics will create a more equitable system for all refugees that utilizes limited resources more effectively. The Collaborative aspires to develop Philadelphia's reputation as a Center of Medical Excellence for refugee health with nationally recognized best practices.

Conclusion

The Philadelphia Refugee Health Provider Collaborative has been formed to alleviate the navigation challenges faced by refugees resettled in the region and to create a more equitable system of health care. Through partnerships between refugee resettlement agencies and health care providers, the Collaborative is one of most innovative and promising approaches to refugee health care in the country.

Timely and effective provision of health care will not only make this region more attractive for refugee resettlement (and help stem population loss), but will ensure that refugees receive needed medical treatment as early as possible so that they can more quickly become contributing members of our community. By developing a citywide partnership, the Collaborative is developing an innovative model that can be replicated in other cities. The Collaborative is unique in connecting all regional resettlement agencies and most of the major medical institutions in a shared project of this scope and impact.

Katherine Bennett holds a master’s degree in Nonprofit Leadership from the University of Pennsylvania’s School of Social Policy and Practice and a Bachelor of Business Administration degree from Temple University’s Fox School of Business. She currently works for the Sustainable Business Network of Greater Philadelphia. She has previously worked both in the private sector, for a Fortune 500 financial services provider, and the public sector, for an economic development agency. Her interests lie in small business development and improving Philadelphia’s economic landscape for entrepreneurs.

References

Centers for Disease Control and Prevention. (2010). General Refugee Health Guidelines. Available at http://www.cdc.gov/immigrantrefugeehealth/guidelines/general-guidelines.html.

U.S. Citizenship and Immigration Services. (2011). Questions & Answers: Refugees. Available at http://www.uscis.gov/portal/site/uscis/menuitem.5af9bb95919f35e66f614176543f6d1a/?vgnextoid=e4eabcf527f93210VgnVCM100000b92ca60aRCRD&vgnextchannel=385d3e4d77d73210VgnVCM100000082ca60aRCRD.

U.S. Department of Health and Human Services, Office of Refugee Resettlement. (n.d.). Fiscal Year 2009 Refugee Arrivals. Available at http://www.acf.hhs.gov/programs/orr/data/fy2009RA.htm.