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Immigrant Health

By Kelly Kreisler, MD, FAAP

(continued from Kansas Pediatrician eNewsletter, August 2018)

I am fortunate that a large part of my pediatric practice involves caring for children in immigrant families. They come from all over the world, and their stories fill me with gratitude that I am a U.S. citizen. Native Americans make up only about 2% of the current U.S. population, meaning the majority of our own families once came to the U.S. as immigrants. A little over a quarter of U.S. children live in an immigrant family, as defined by having a parent who is foreign born. Nearly 18 million U.S. children have at least one immigrant parent with an estimated 5.1 million children in the U.S. living with at least one undocumented parent. In 2016, almost 90% of children in immigrant families were U.S. citizens. (https://www.migrationpolicy.org/programs/data-hub/charts/children-immigrant-families) Over 90% of these children have a working parent. Like my patients’ parents, they are working very hard, yet they are disproportionately affected by poverty. (http://www.nccp.org/topics/immigrantfamilies.html) Contrary to popular myths, immigrants add to our economy, lower the crime rate in our communities, and pay taxes. Immigrants do not come to the U.S. from only one place or for only one reason. Kansas was in the national news this year as a chemistry professor at the University of Kansas and father of three was arrested on his front lawn. He came to the U.S. to study science and engineering and was granted an H1-B visa for highly skilled workers. He had overstayed his visa and built a family while contributing to our economy and the education of our young adults. He was granted a stay of removal while he continues the long process of applying for citizenship through legal channels. Other immigrants have not been as fortunate.

It is challenging to keep up with all of the issues facing children in immigrant families today. Some important topics to follow include public charge, deferred action for childhood arrivals (DACA), and separation of asylum seeking parents from their children. Public charge is a complicated issue related to benefits received by immigrants who are entering the U.S. through legal channels and their future ability to become a U.S. citizen. U.S. Citizenship and Immigration Services currently defines “public charge” as an individual who is likely to become “primarily dependent on the government for subsistence, as demonstrated by either the receipt of public cash assistance for income maintenance, or institutionalization for long-term care at government expense.” (https://www.uscis.gov/news/fact-sheets/public-charge-fact-sheet) The current administration is looking at a broader definition of public charge, which would include receipt of SNAP benefits, WIC, and Medicaid. According to the AAP Department of Federal Affairs, there was recently some inaccurate national reporting about who may be affected by the new rules. It is important to pay attention to the news, but verify reporting through The National Immigration Law Center and The AAP Department of Federal Affairs.

In September of last year, the AAP issued a statement opposing the end of DACA in response to President Trump’s executive order ending DACA. Briefly, DACA is an administrative program that allows children brought here under the age of 16 with no criminal history to apply to work legally in the U.S. (https://www.uscis.gov/archive/consideration-deferred-action-childhood-arrivals-daca) On August 14, 2018 the USCIS website indicated they were resuming accepting DACA applications due to a court order. The “DREAMers” were brought here as children and often don’t identify with their country of birth. They are American in their language, culture, and identity. I have had many patients who always assumed they were American citizens until they were graduating high school and seeking employment or college opportunities.

In May of this year, the AAP issued a statement opposing the separation of children and parents at the southern border. Pediatricians across the country raised their voices to speak up for more than 2,000 children forced to endure the stress of being removed from their parents’ care. Here are just a few highlights:

https://www.kentucky.com/opinion/op-ed/article215278665.html
https://www.nytimes.com/2018/02/28/opinion/immigrant-children-deportation-parents.html
https://www.cnn.com/2018/06/14/health/immigrant-family-separation-doctors/index.html
https://www.kansascity.com/opinion/readers-opinion/guest-commentary/article213702764.html

Here are some ways you can help children in immigrant families:

1. Educate yourself:

Join the Special Interest Group on Immigrant Health of the AAP Council on Community Pediatrics. This group has an active listserv. The SIG will be hosting a webinar series offering CME and MOC credit over the course of the academic year. Save the dates for the webinars below and check the KAAP website immigrant health page soon for updated details.

September 12, 2018: Deportation: What Comes Next?
Daniel Neuspiel MD, MPH and Kelly Kreisler MD, MPH

January 8, 2018: Tools Pediatricians Can Use to Advocate for Children & Families Who Have Immigrated
Elizabeth Collins MD, MPH, DTM and Danielle Dooley MD, MPH and Mallory Curran JD

March 2019: Trauma-Informed Approach to Pediatric Refugees & Immigrants
Minal Giri, MD and colleagues

June 20, 2019: Pediatric Medical Forensic Evaluations for Immigrant & Refugee Children
Minal Giri, MD and Education Work Group member TBD

2. Provide resources in your clinic:

The National Immigration Law Center website (nilc.org) contains many reliable patient resources related to health care. This includes up to date, accurate information about topics like DACA, Affordable Care Act, and Public Charge.

Medical Legal Partnerships http://medical-legalpartnership.org/ are good resources to find an immigration attorney. The attorneys participating in the MLP may or may not have expertise in this area, but they can make a recommendation for a trustworthy attorney. There are many individuals preying on the high levels of fear among immigrant families. The American Immigration Lawyers Association aila.org is another reliable place to find information about immigration news and reputable attorneys.

Refer your families to the local embassy. Embassy-finder.com is a great tool to find a local embassy or consulate. They offer free consultations and other resources for immigrants living abroad.

3. Advocate:

Speak up for immigrant children in your community. Become a key contact for the AAP Department of Federal Affairs by sending an email to kids1st@aap.org. They send weekly emails with specific details about the AAP response to issues, breaking news, and advocacy messages.

Advocate for funding for community health workers (CHW). Neither Kansas nor Missouri insurance providers currently reimburse for CHWs despite evidence showing they help keep patients out of the emergency department.

4. Volunteer:

Volunteer with local organizations serving immigrants and refugees.

Sign up to provide medical review for immigrant children. MRI seeks to link clinicians with pro-bono attorneys and clinicians to get immigrants out of detention and into medical care. https://www.migrantclinician.org/

5. Care for yourself:

Caring for families affected by trauma can be exhausting and traumatic for providers. Watch for signs of secondary trauma in yourself and practice self-care.

https://www.aap.org/en-us/Documents/ttb_physician_wellness.pdf

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