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ADVOCACY FOR NEW AMERICANS: HELPING YOUTH COMING FROM REFUGEE BACKGROUNDS Presented by: Alexx Goeller Refugee Youth Services Coordinator Refugee Services Office SESSION OBJECTIVES • Basic understanding of refugees and the refugee process • Refugee landscape here in Utah • Potential solutions, best practices and resources for working with refugee youth and their families WHO IS A REFUGEE? A refugee is a person forced to flee his or her country due to persecution based on religion, race, nationality, political opinion or membership in a particular social group. Most refugees are women and children. IMMIGRANT OR REFUGEE? An immigrant voluntarily leaves his or her native country to seek a more prosperous life. Some immigrants come legally while others do not. • • • A refugee flees his or her country. They are then legally brought to the United States by the U.S. Department of State for the purposes of protection. Refugees may become permanent residents after one year. They may apply for citizenship after five years. All refugees may legally work in the U.S. upon arrival. HOW MANY REFUGEES ARE IN THE WORLD TODAY? There are approximately 21,300,000 refugees in the world today. Less than 1% will be resettled in a third country, like the United States. THREE DURABLE SOLUTIONS 1. Voluntary repatriation: refugees can return to their home country because situation has improved 2. Local integration: refugees resettle in a nearby host country with an ability to work legally 3. Resettlement in a third country: refugees resettle in a third country WHO IS RESPONSIBLE FOR RESETTLEMENT IN THE UNITED STATES? The Department of State determines which refugees resettle in the U.S. and oversees the refugee admissions process. The International Office of Migration purchases the initial plane ticket and coordinates travel. This is a loan that refugees are required to pay back The Department of Homeland Security coordinates security background checks with the FBI, CIA, Department of Defense and Department of State. The Office of Refugee Resettlement (ORR) is responsible for coordinating domestic resettlement in the United States after arrival. HOW MANY REFUGEES ARE IN UTAH? Of the 85,000 refugees being resettled in the United States, about 1,150 will resettle in Utah. It is estimated that there are 60,000 refugees, including U.S.- born children, currently living in Utah from more than 20 countries. UTAH REFUGEE SERVICES Governor Jon M. Huntsman established the Utah State Refugee Services Office (RSO) in 2008. • RSO resides within the Department of Workforce Services. • The mission of RSO is to improve the lives of Utah refugees by maximizing integration, coordinating refugee services, and managing federal funding. • RSO provides leadership in service coordination, connection with community leaders policy review, advocacy, resource development and management of all essential refugee services in Utah. The Department of Workforce Services offers various benefits for refugees: • Cash Assistance (for the first eight months in the United States through the Family Employment Program - FEP) • • • • • Food Stamps Medical Assistance (Medicaid and Medicare) Child Care Assistance Employment Services Case Management (for two years) There are two resettlement agencies (VolAgs) in Utah that bring in new refugees assigned by the Dept. of State: Each resettles approximately 550 refugees annually. Resettlement Core Services Within the first 90 days: • Reception and Placement Airport Pickup Housing Food $900 for housing needs Case Management • Cultural & Employment Orientations • Job Placement • Health Screenings • Application assistance for Benefits & Social Security Card • School Enrollment (i-94, FERPA, proof of housing, immunizations) • Selective Services Registration • And more! • WHERE ARE REFUGEES LIVING? Resettlement areas Granite District – Primary Salt Lake District – Secondary Canyons + Murray School Districts – Secondary Sandy and Provo areas – Foster and adoptive families Ogden District Areas of second migration Cache Valley area – Working meat packing plants Heber Valley area – Working in laundry plants BARRIERS FOR REFUGEE FAMILIES ● Filling out forms – difference of forms (i-94s for birth certificate) ● Interrupted or informal education ● Testing requirements ● School options ● Communication with schools ● Graduation requirements ● Acquisition of transcripts ● School rules and dress codes ● Mental/Emotional distress ASSETS OF REFUGEE FAMILES ● Increase diversity ● Bring new perspectives & experiences ● Cultural ambassadors (language, religion, food, clothing …) ● Eager to learn; educational appreciation ● Multi-Lingual and Bi-cultural social skills ● Perseverance and resilience through adversity WAYS TO HELP ● Determine which agency they’re affiliated with and utilize those resources! ● Assist with carpool/Set-Up carpool systems ● Engage with refugee families ● Educate yourself about refugees, their backgrounds and traumarelated behaviors ● Volunteer with refugee serving agencies ● Allow a refugee parent to shadow you ● Attend vibrant cultural community events ● Keep these families in mind for various school-related events ● Invite/Encourage refugee parents to be involved in local PTA and other after-school related events ● Ask questions, be welcoming BEST PRACTICES • • • • • • Clayton Middle School Tumaini Center Roosevelt Elementary Technology Inter-agency Collaboration uen.org/advocacy RESOURCES • • • • • • Refugee Services Office (RSO) refugee.Utah.gov Refugee Education Initiative – therefugeeeducationinitiative.org Refugee Backgrounders from BRYCS, IRC and Cultural Orientation Resource Center (COR) – brycs.org; culturalorientation.net Internationals Network – internationalsnps.org/resources/ School District Liaisons – Contact Alexx for their information Transitions for Refugee Youth (TRY) Evening Program – csme.Utah.edu/try-2 • International Rescue Committee (IRC) – rescue.org/us-program/ussalt-lake-city-ut • Catholic Community Services (CCS) – ccsutah.org • Asian Association of Utah (AAU) – aau-slc.org • UN Refugee Agency (UNHCR) – unhcr.org • English Skills Learning Center (ESLC) – eslcenter.org • Migration Policy Institute (MPI) – migrationpolicy.org • National Child Traumatic Stress Network – nctsn.org QUESTIONS? Refugee Services Office Alexx Goeller 801-347-3218 [email protected] refugee.utah.gov UTAH REFUGEE HEALTH PROGRAM Objectives: Explain overseas medical evaluation process. Review domestic health screening. Review common health conditions. OVERSEAS MEDICAL EVALUATION Evaluate the physical and mental health status prior to departure to United States. OVERSEAS MEDICAL EVALUATION Under the authority of the Secretary of Health and Human services and the Immigration and Nationality Act and the Public Health Service Act. CDC Division of Global Migration and Quarantine provide screening guidelines. Conducted by panel physicians selected by Department of State consular officials. OVERSEAS MEDICAL EVALUATION Purpose: Screens for conditions that may prevent admission to the United States. Assess health needs and related resettlement needs. Assess fitness to travel and medical requirements for travel. Improve the health of refugees experiencing resettlement. <#> OVERSEAS MEDICAL EVALUATION Timeline: Most medical documentation is only valid for 6 months. Medical Examination: initial exam; vaccinations Out-processing: TB/other investigations and treatment; vaccinations; management of complex medical cases Travel request Pre-departure medical screening (72 hours prior to departure): presumptive treatment Pre-Embarkation Check <#> DOMESTIC HEALTH SCREENING Domestic Health Screening The Federal Refugee Act of 1980 created a uniform system of services for refugees in the United States. The purpose of the domestic screening is to “reduce the spread of infectious disease, ensure ailments are identified and treated, promote preventive health practices, and to ensure good health practices facilitate successful integration and self-sufficiency. Each and every newly arriving refugee is entitled to a complete healthscreening exam in the first 30 days of arrival. Address immediate health needs Referral for follow up care Introduction to the American health care system DOMESTIC HEALTH SCREENING P H Y S I C A L E X A M - A D D R E S S E S H E A L T H C O N C E R N S A N D I S S U E S I N T H E F O L L O W I N G A R E A S : Cardiology Dermatology Endocrinology ENT Genitourinary GI Hematology Musculoskeletal Neurology Nutrition Obstetrics Ophthalmology Pulmonology Preventive (family planning, tobacco) Screenings: hearing, dental, and vision S F D D D C R E E N I N G A N D T E S T I N G - A S S E S S O R S E X U A L L Y - T R A N S M I T T E D I S E A S E S , P A R A S I T E S , E F I C I E N C I E S A N D C H R O N I C I S E A S E I N C L U D I N G : HIV Hepatitis B Hepatitis C Syphilis Schistosomiasis Strongyloides Giardia Anemia Diabetes Other intestinal parasites DOMESTIC HEALTH SCREENING Domestic Health Screening Immunizations- the U.S. Advisory Committee on Immunization Practices (ACIP) vaccination requirements do not apply to refugees at the time of their initial admission to the U.S; however, refugees must meet the vaccination requirements when applying for adjustment of status or permanent resident status in the U.S. (one year or more after arrival). Presumptive Treatment-for parasites known to be common to specific regions from which refugees are arriving specifically Schistosomiasis (Praziquantel) and Strongyloides (Ivermectin). DOMESTIC HEALTH SCREENING Domestic Health Screening TB Screening-targeted testing for latent TB infection (LTBI) primarily using QuantiFERONâ-TB Gold (QFT-G), which is an alternate testing method for the tuberculin skin test (TST) and offers increased specificity and sensitivity. TST may be used if QFT-G blood draw is unsuccessful or if the QFT-G is indeterminate. DOMESTIC HEALTH SCREENING Reportable Conditions in Refugee Arrivals, Utah January 1, 2010-December 31, 2015 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 8317 8134 5111 4595 2288 1831 2243 1281 27 *Includes-syphilis, gonorrhea, chlamydia **Includes-strongyloides, schistosomiasis, giardia, B hominis and other ***Test < 10 yrs; positive is > 10 UG/DL 197 33 26 173 15 Tested Positive DOMESTIC HEALTH SCREENING Identified Conditions in Refugee Child (<19) Arrivals, Utah October 1, 2015-August 31, 2016 130 85 35 34 23 Pulmonolo… 30 Ophthalm… Hematology GI Genitourin… ENT/Heari… Endocrinol… Dermatolo… Dental 4 21 Nutrition 35 22 Neurology 43 26 OB-GYN 74 Musculosk… 81 Mental… 68 Cardiovasc… 140 120 100 80 60 40 20 0 DOMESTIC HEALTH SCREENINGPSYCHOLOGICAL DISTRESS “Identifying mental illness in refugees poses multiple challenges to providers and organizations…These challenges range, from technical aspects of language barriers and accessibility, to phenomenological questions such as the definition of mental illness across cultures.” Nature of refugee experience contributes to psychological distress and poorer emotional wellness. Risk factors exist along the resettlement continuum: Pre-migration: age, gender, education, rural vs urban, region of origin, trauma/torture, death of a relative Migration: being detained, time spent in camp, adjudication process/length, incidence of torture Post-migration: communication barriers, housing, restricted economic opportunities, separated from family, physical health needs, social isolation DOMESTIC HEALTH SCREENINGPSYCHOLOGICAL DISTRESS Challenge to clearly understand level psychological distress among refugee population Prevalence studies tend to have selection bias due to the setting of the study Epidemiological studies attempt to address selection bias, but encounter communication difficulties, stigma and local beliefs about mental health Study found that 125 different screening and diagnostic tools existed in English CDC states that studies have shown high prevalence of depression, posttraumatic stress disorder (PTSD), panic attacks, somatization, and traumatic brain injuries in refugees DOMESTIC HEALTH SCREENINGPSYCHOLOGICAL DISTRESS Mental Screening & Referrals Refugee Arrivals <19 y/o , Utah October 1, 2015-August 31, 2016 140 127 120 100 80 60 50 47 40 20 0 Screened Referred Accepted CONTACT INFORMATION Amelia Self, MSW State Refugee Health Coordinator Manager, Prevention, Treatment and Care Program Utah Department of Health 801-538-6221 [email protected]