RapidResponseSurvey:HealthImpactsofFederalImmigrationPolicy

InitialFindings,May2017

Meileen Acosta,Epidemiologist.SolanoCountyPublicHealth.Mdacosta@solanocounty.comWillDominie,PolicyManager.BARHIIandthePublicHealthAllianceofSouthernCalifornia.WDominie@PHASoCal.org

• RapidlyChangingNationalConversation• IncreasedUncertainty• SteppedupICEEnforcement• ReportsofICEatHealth/SocialServiceLocations

• ProposalsforBorderWall• ThreatstoSanctuaryCityFunding• Muslim/RefugeeBan• Xenophobic/RacistViolence

PolicyContext

• ProgramParticipationDataAnalysis(WIC,etc.)

• InterviewswithImmigrantServingOrganizations

• RapidResponseSurvey

BARHII/AllianceActions

• Rapid,Policy-DrivenDataCollection• BuildonStaffKnowledgeandExperiencewiththeCommunity

• ShareBARHII/AllianceEfforts• ResultsInform:• InternalPractice• PolicyAdvocacy

SurveyGoals

• Meantasainitial,rapid,qualitativeassessment

• Notascientificrepresentativesample• Conveniencesurveywithself-selectedparticipation

• Willbeaccompanied/followedbyquantitativeanalysis

Limitations

ProgramTypesClinical

• Clinics/FQHCs• Pediatrics• Medi-Cal

PublicHealth• MentalHealth• Lead• DrugandAlcohol• Epidemiology• FamilyHealth/Maternal

Health• Immunizations• NeedleExchange• STD/HIV• RapeCrises

SocialServices• WIC• CALWorks and

Employment• CALFresh• CPS• Homelessness

CommunityPartners

N=50

Responses

N=50

N=157

Results:Combined“Have you witnessed or heard from clients that they have been impacted by the new immigration and refugee policy, enforcement and public discussion since November 2016 in the following ways:”

58%

55%

43%

33%

31%

30%

26%

19%

14%

12%

0% 10% 20% 30% 40% 50% 60% 70%

Afraidtocontinueorsignupforpublicprograms,services,and/or…

Increasedfear,stress,orothermentalandemotionalhealthimpacts

Familymembersatriskofdetentionanddeportation

Afraidtoleavethehouseorneighborhood

Afraidtotravel(bycar,transit,orplane)

Dropsinprogramutilizationorparticipation

Atriskoflosinghealthcare

Atriskoflosingjobs/wages

Atriskoflosinghousing

Atriskoflosingothernecessities

ResultsbyRegion“Have you witnessed or heard from clients that they have been impacted by the new immigration and refugee policy, enforcement and public discussion since November 2016 in the following ways:”

56%

52%

41%

26%

26%

25%

26%

18%

12%

11%

66%

62%

46%

56%

48%

44%

24%

24%

20%

12%

0% 10% 20% 30% 40% 50% 60% 70%

Afraidtocontinueorsignupforpublicprograms,services,and/or…

Increasedfear,stress,orothermentalandemotionalhealthimpacts

Familymembersatriskofdetentionanddeportation

Afraidtoleavethehouseorneighborhood

Afraidtotravel(bycar,transit,orplane)

Dropsinprogramutilizationorparticipation

Atriskoflosinghealthcare

Atriskoflosingjobs/wages

Atriskoflosinghousing

Atriskoflosingothernecessities

SouthernCalifornia NorthernCalifornia

WhatAreWeHearing- AccessingServices

“Apatienttoldmeshewasafraidofgoingbacktocountyclinic.Shefeelsfearfulthatbecauseweareagovernmententitywewillturninherinformationandillegalstatustoimmigrationauthorities.Notonlyhasshestoppedseeingourclinic,herspecialist,butalsosheisreluctanttotakeherdaughtertothePediatricsdepartmentforthesamereason.Herdaughterwhoisonly3hashadahistoryofabnormalbloodwork,wassetuptoseeaspecialistforpossibleleukemiaandisrecentlyfainting.”

“Ireceivedacallfromaclientwhomisasinglemotherwith2children.TheclientcalledtorequestcancellationofCalFreshbenefitsforherchildren,statingshefearedreceivingbenefitswouldcreatelegalissuesforherinthefuturewhichcouldresultinherdeportation.Iinformedtheclientherinformationisnotshared,howeverclientinsistedwecancelherCalFreshbenefits.”

WhatAreWeHearing- PreparingforICE“Isawapatientrecentlyataneveningclinicatalocalschoolwhowassufferingfromheadaches.Aninterviewandexamledmetobelievethesewererelatedtostress.Asweexploredsourcesofstressforher,sherevealedthatneithershenorherhusbandaredocumentedbuttheironlychildwasborninthiscountryandis,therefore,acitizen.Shouldtheybedeported,shehasnoideahowshewilldealwithfindingcareforherchildwhois8yearsold.”.

“ThechildrenatourschoolsarrivecryingbecausetheyareafraidthattheirparentsmaybepickedupbyICEagentsandtheywillnotbereturningtoschooltopickthemup.Parentswhoaredroppingorpickinguptheirkidsfromourschoolshavereportedthattheywon'twalktowardstheschooliftheyseeapatrolcarinthevicinityoftheschool.”

WhatAreWeHearing- MentalHealth

“OneoutreachclientthatwasactivelyinterestedinengaginginMentalHeathServicespriortotheelection,whoisnowsoafraidtoleavetheirhousethattheyhavecutoffallcontactwithgovernmentagenciesforfearofbeingthoughtofasillegal(sic)becausetheyare"brown,"andaremarriedtosomeonewhoisinfactillegal. Theyareworriedaboutdrawingattentiontotheirspouseasillegal,sotheywon'tengageinanythingthatcouldrequirepersonalinformationtobeshared/registered.”

“We'vebeenseeingmorechildrenaffectedemotionallybythefearthattheirparentsorthemselveswillgetdeported.We'veseeninincreaseinpsychosomaticsymptoms(i.e.sleepdisturbances,headaches,stomachaches,tiredness,nausea)andanxiety/fearsincrease.”

WhatAreWeHearing- IsolationandFear“I’vehadseveralclientswhodonotwanttocomeoutoftheirhomestodosimplelivingroutines.Ithasbecomedifficulttogoshoppingforfoodsthattheyneedduetobeingscaredthattheywillbesubjectedtoracialprofilingthatmayleadthemtobeingheldup.”

“Ihaveanundocumentedpatientwhohasadiagnosisthat'shighrisktopublichealth.He'sadaylaborerand,sometimes,duetofearhe'llbecaughtanddeported,he'llforgogoingtowork.Lostwagesrenderhimunabletosupporthimselfandhisspouse.”

DataIntoAction:NextSteps

Suggestions?

• PublicHealthAwakenedhaspreparedthisguideforpublichealthdepartmentswishingtosupportimmigrantcommunities:http://publichealthawakened.com/guide-for-public-health-to-protect-immigrant-rights/

• TheNationalImmigrationLawCenterjustputtogetheranexcellentguideforhealthcareproviderswhichwasaccompaniedbyarecordedwebinarandslides.

• Guide:https://www.nilc.org/wp-content/uploads/2017/04/Protecting-Access-to-Health-Care-2017-04-17.pdf

• Recording:https://attendee.gotowebinar.com/recording/viewRecording/516256275702666498/4325227337731450370/sara@humanimpact.org

• Slides:https://www.nilc.org/wp-content/uploads/2017/04/NILC-Health-KYR-Webinar-20170424.pdf

• CaliforniaHealthAdvocateshasputtogetherthesefrequentlyaskedquestions:https://d3n8a8pro7vhmx.cloudfront.net/capca/pages/62/attachments/original/1494018311/2017_05_04_CPCA_Immigrant_Patient_FAQs.pdf?1494018311

• SanFranciscoandSanMateohavemadepublictheir detailedinstructionstostaffininteractionswithICE:• https://www.sfdph.org/dph/files/PoliciesProcedures/COM10-

ImmigrationStatusInteractionsWithICE_Agents_Policy.pdf• http://barhii.org/wp-content/uploads/2017/03/SanMateoMessagetoStaff.pdf

Resources

• Meileen Acosta,Epidemiologist.SolanoCountyPublicHealth.Mdacosta@solanocounty.com

• WillDominie,PolicyManager.BARHIIandthePublicHealthAllianceofSouthernCalifornia.WDominie@PHASoCal.org

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