children in immigrant families: how to be an...
TRANSCRIPT
Wake Forest Baptist Medical Center
Children in Immigrant Families:
How to Be an Advocate
Julie M. Linton, MD, FAAP
Assistant Professor of Pediatrics, Wake Forest School of Medicine
Co-Chair, AAP Immigrant Health Special Interest Group
Disclosure
In the past 12 months, I have had no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of
commercial services discussed in this CME activity.
I do not intend to discuss an unapproved/investigative use of a commercial product/device in my
presentation.
Objectives
The names and identifying details of the children and families whose stories I will share have been changed to protect their confidentiality and safety.
Describe the changing policy landscape for children in immigrant families
Illustrate the impact of evolving policy on children and families
Offer opportunities for pediatric health professionals to support and advocate for children in immigrant families
Background: The Changing Landscape
Imag
e re
pro
du
ced
fro
m: K
ids
Co
un
t D
ata
Cen
ter.
htt
p:/
/dat
acen
ter.
kid
sco
un
t.o
rg
One in four
US children
lives in an
immigrant
family.
Nine out of
ten of these
children are
US citizens.
Almost 6 million US-citizen children under the age of 18live in mixed-citizenship status families.
Background: Common Language
Children in Immigrant Families
Citizens Non-citizens
Lawfully present/ lawfully residing
immigrants
Immigrantswithout
legal status
Mixed citizenship
families
LawfulpermanentResidents
Refugees, asylees, people with T- and U
non-immigrant status, special immigrant
juvenile status
J-1 classificationand other
lawful status
Family members
are all citizens
DACAYouth
Image by Ricky Choi, MD, MPH and Julie M. Linton, MD
Background: Key Immigration Principles
• Immigration system draws on 3 key principles:
1) reunification of families;
2) admitting immigrants with skills that are valuable to US economy
3) protecting persons fleeing persecution and other humanitarian reasons
• Lawful Permanent Residence (“green card” or LPR status)
o Certain categories of immigrants may become eligible to apply for LPR status.
• U.S. Citizenship
o To become eligible to apply for naturalization, must have LPR status for at
least 5 years (or 3 years if obtained LPR status through US citizen spouse)
• Immigrants without legal status
o Individuals who lost permission to remain in the U.S., or who entered the U.S.
without permission
But it’s much more complicated…
Slide Credit: Tamar Magarik Haro, American Academy of Pediatrics
Federal Policy Update:Building a Foundation
for Advocacy
Changing Policy Landscape
• 2017 Executive Orders
• Restrict entry from selected Muslim-majority countries, North Korea
• Cut refugee entry from 110,000 to 45,000 in FY18
• Make all immigrants in US w/o authorization immigration enforcement priorities
• Punish “sanctuary cities”
• Call for construction of a border wall
• Increase border patrol and detention along the southern border
• Family separation at the border
• Deferred Action for Childhood Arrivals (DACA)
• Public Charge
Slide Credit: Tamar Magarik Haro, American Academy of Pediatrics
Refugee Resettlement
Image from: https://www.npr.org/2016/08/20/490682349/in-the-face-of-a-bloodied-boy-a-call-to-look-more-deeply-at-syria
Photo Credit: Veronica Cardenas
Children and Families in Flight
Separation of Children and Families
“Studies overwhelmingly demonstrate the irreparable harm
caused by breaking up families.”
Dr. Colleen CraftPresident, American
Academy of Pediatrics
http://www.latimes.com/opinion/op-ed/la-oe-kraft-border-separation-suit-20180503-
story.html
Detention of Immigrant Children
When first detained,
children are sent to CBP processing
centers, where
conditions threaten children’s
health and well-being.
Imag
e fr
om
: h
ttp
://w
ww
.was
hin
gto
nti
me
s.co
m/m
ult
imed
ia/i
mag
e/
6_
18
20
14
_im
mig
rati
on
-ove
rlo
ad-2
-11
82
01
jpg
/
Fear, Uncertainty, and Toxic Stress
Photo Credit: Veronica Cardenas
Sensitive Locations
• Current DHS policy says
immigration enforcement actions
are not to occur at:
• schools
• medical treatment and health
care facilities
• places of worship, religious or
civil ceremonies
• during public demonstrations
• Exceptions to the policy exist.
Slide Credit: Tamar Magarik Haro, American Academy of Pediatrics
Image from: https://www.washingtonpost.com/news/post-
nation/wp/2017/10/26/a-10-year-old-immigrant-was-rushed-to-the-hospital-in-an-ambulance-she-
was-detained-on-the-way/?utm_term=.d6cb85bcfd98
Deferred Action for Childhood Arrivals
• There are more
than 680,000
youth with DACA,
but there still is
NO deal
• Court ruling
forces DHS to
accept new
DACA renewals
• Permanent
solution resides
with Congress
Data on DACA: https://www.migrationpolicy.org/programs/data-hub/deferred-action-childhood-arrivals-daca-profiles
ww
w.fu
turesw
itho
utvio
lence.o
rg/stand
-dream
ers-will-figh
t/
Public Charge
• A person is a “public charge” if they are dependent on the
government for basic subsistence
• Longstanding policy and guidance provide that only two types of
benefits are considered in a public charge determination:
1. cash assistance
2. institutionalization for long-term care at government expense
• In early February, a leaked, draft proposal from DHS would
drastically expand the benefits considered to include WIC, SNAP,
Medicaid, CHIP, the ACA health insurance subsidies, Section 8
housing assistance, and Earned Income Tax Credit
• Not final, not public and not in effect
• Opportunity for public comment if/when published
Slide Credit: Tamar Magarik Haro, American Academy of Pediatrics
Wake Forest Baptist Medical Center
All Hands on Deck:
Supporting Children in Immigrant Families
Advocacy: Many Facets, Many Levels
High Quality Health Care
Medical Education
Research and Public
HealthAdvocacy
Community Engagement
Childrenand
Families
IndividualClinic
Community RegionalNational
“Public Sphere”
Cultural Humility and Cultural Safety
• Cultural humility: Openness and respect for differences1
• Cultural safety: Recognition of power differences and in[equities] in
health and the clinical encounter that result from social, historical,
economic, and political circumstances2
1. Tervalon & Murray-Garcia J, Journal of Health Care for the Poor and Underserved, 19982. Papps & Ramsden, International Journal of Quality in Health Care, 1996
Creating Safe(r) Spaces
Image from Bellevue Hospital, courtesy of Dr. Benard Dreyer
Key Resources:
• National Immigration Law Center (NILC) Toolkit: https://healthtoolkit.nilc.org/login/
• KIND (Kids in Need of Defense): https://supportkind.org/resources/know-rights-information-ice-raids-parentscommunityattorneys/
• AAP Council on Community Pediatrics Immigrant Health Toolkit: http://bit.ly/1y6HR1D
Key Resources:National Immigration Law Center (NILC) Toolkit: https://healthtoolkit.nilc.org/login/
KIND (Kids in Need of Defense): https://supportkind.org/resources/know-rights-information-ice-raids-parentscommunityattorneys/
Supporting Families
• Build resilience:
Engage children
and families in
efforts to read, talk,
sing, and play
together
• Encourage parental
self care (e.g.
physical activity,
community, faith)
Wake Forest Baptist Medical Center
Engaging in Communities
Pete Cooch & Heyman Oo
Holly Vo & John Luttrell
Slide Credit: Tamar Magarik Haro, Madeline Curtis
Protecting Immigrant Children
(January 2017)
Opposing President Trump’s Decision to End DACA
(September 2017)
Professional Organizations:
American Academy of Pediatrics Response
Opposing detention of pregnant women and
adolescents (March 2018)
Opposing Separation of Mothers and Children at
the Border (March 2017, 2018)
AAP Chapter Advocacy
Public Dissemination of Research
Full broadcast available at: https://www.kff.org/other/event/immigrant-families-in-america-today-how-fear-and-toxic-stress-is-affecting-daily-life-well-being-and-health/?utm_campaign=KFF-2017-December-Immigrant-Families-Lawfully-Undocumented&utm_source=hs_email&utm_medium=email&utm_content=2&_hsenc=p2ANqtz-8j4DvjLayipgspLg-6cbJ6Vg6enKQnHUDb7-DllDr6lQV5gwOicptXaR3kqVg0AwzFhB4VbLQIsLOHeYL8M5RQxybEzg
Wake Forest Baptist Medical Center
Earned Media
Social Media
The Public Sphere: #putkids1st
• Disseminate evidence regarding the impact of policy on health
• Speak up via earned media (e.g. Op Eds, interviews with reporters)
• Connect via social media (#tweetiatrician)
• Become a key contact via AAP Federal Advocacy:
email [email protected]
• Join the AAP Immigrant Health Special Interest Group via the
AAP Council on Community Pediatrics: email [email protected]
Conclusions
• Immigration policies increasingly threaten the health of immigrant families.
• Health care providers are uniquely poised to provide credible, caring messages to support immigrant families, from the bedside to the community to the broader public sphere.
• We must empower all children – including our own – to speak up against hate.
Photo Credit: Veronica Cardenas
Acknowledgements• Wake Forest School of Medicine Department of Pediatrics
• Wake Forest Clinical and Translational Science Institute
• Program in Community Engagement
• Maya Angelou Center for Health Equity
• American Academy of Pediatrics colleagues
• AAP Immigrant Health Special Interest Group (Marsha Griffin, MD; Alan Shapiro, MD; Raul Gutierrez, MD, MPH; Ricky Choi, MD, MPH; Lanre Falusi, MD; Yasuko Fakuda, MD; Janine Young, MD; Kate Yun, MD; Andrea Green, MD, et al.),
• AAP COCP & COCM Executive Committees (Jim Duffee, MD; Nusheen Ameenuddin, MD; David Hill, MD; et al.)
• AAP leadership and staff (Benard Dreyer, MD; Fernando Stein, MD; Karen Remley, MD, MPH, MBA; Mark Del Monte; Judy Dolins; Tamar Haro; Madeline Curtis; Camille Watson; Jamie Poslosky; Susan Martin; et al.)
• Community and advocacy partners locally and nationally
• Forsyth County Department of Public Health; Imprints Cares; HealthCare Access; Winston-Salem Forsyth County Schools
• The Young Center, NILC, KIND, Frameworks Institute
• Culture of Health Leaders, a Program of the Robert Wood Johnson Foundation
• Photographer: Verónica G. Cárdenas-Vento, http://veronicagabriela.com/
References 1. AAP Council on Community Pediatrics Immigrant Health Toolkit, http://bit.ly/1y6HR1D.
2. AAP Council on Community Pediatrics. Community pediatrics: navigating the intersection of medicine, public health, and social determinants of children’s health.
Pediatrics 2013; 131(3): 623-628.
3. AAP Council on Community Pediatrics. Providing Care for Immigrant, Migrant, and Border Children Pediatrics, 2013, 131(6): e2028-34.
4. AAP. Trauma toolbox for primary care. M. D. Dowd, Editor. www.aap.org/traumaguide
5. Artiga S & Ubri P. Living in an immigrant family in America: How fear and toxic stress are affecting daily life, well-being, & health. Henry J Kaiser Family Foundation.
Available at https://www.kff.org/disparities-policy/issue-brief/living-in-an-immigrant-family-in-america-how-fear-and-toxic-stress-are-affecting-daily-life-well-being-
health/.
6. Byrne O, Miller E. The flow of unaccompanied children through the immigration system: A resource for practitioners, policy makers, and researchers. Vera Institute
New York, 2012.https://www.vera.org/publications/the-flow-of-unaccompanied-children-through-the-immigration-system-a-resource-for-practitioners-policy-makers-
and-researchers
7. Capps R, Fix M, Zong J. The Education and Work Profiles of the DACA Population. Migration Policy Institute 2017; Available at:
http://www.migrationpolicy.org/research/education-and-work-profiles-daca-population. Accessed September 8, 2017.
8. Deferred Action for Childhood Arrivals (DACA) Data Tools. Migration Policy Institute. Available at: https://www.migrationpolicy.org/programs/data-hub/deferred-
action-childhood-arrivals-daca-profiles.
9. Dreby J. The burden of deportation on children in Mexican immigrant families. Journal of Family and Marriage 2012;74(4):828-45.
10. Fazel et al. Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet 2012; 379: 266–82.
11. Hainmueller J et al. Protecting unauthorized immigrant mothers improves their children’s mental health. Science 2017; doi 10.1126/science.aan5893.
12. Kids Count Data Center. http://datacenter.kidscount.org
13. KIND (Kids in Need of Defense). Know Your Rights Information on ICE Raids for Parents/Community/Attorneys. Available at:
https://supportkind.org/resources/know-rights-information-ice-raids-parentscommunityattorneys/. Accessed July 29, 2017.
14. Linton JM, Griffin M, Shapiro A. Detention of Immigrant Children. Pediatrics, Published online March 2017, DOI: 10.1542/peds.2017-0483.
15. Linton JM, Kennedy E, Shapiro A, Griffin M. Unaccompanied Children Seeking Safe Haven: Providing Care and Supporting Well-Being of a Vulnerable Population.
Children and Youth Services Review. Accepted for publication on March 22, 2018. In press.
16. Mathema S. Keeping Families Together: Why All Americans Should Care About What Happens to Unauthorized Immigrants. University of Southern California’s
Center for the Study of Immigrant Integration (CSII) and Center for American Progress, March 16, 2017. Available at:
https://www.americanprogress.org/issues/immigration/reports/2017/03/16/428335/keeping-families-together/. Accessed July 31, 2017.
17. National Immigration Law Center. www.nilc.org
18. National Child Traumatic Stress Network. Refugee Services Toolkit Core Stressors Overview. Available at: http://nctsn.org/trauma-types/refugee-trauma/learn-about-
refugee-core-stressors. Accessed July 12, 2017.
19. Papps & Ramsden, International Journal of Quality in Health Care, 1996
20. Rhodes SD, Mann L, Siman FM, Song E, Alonzo J, Downs M, Lawlor E, Martinez O, Sun CJ, O’Brien MC, Reboussin BA, & Hall MA. The impact of local
immigration enforcement policies on the health of immigrant Hispanics/Latinos in the United States. Am J Public Health, published online ahead of print Dec 18
2014, e1-e9.
21. Tervalon & Murray-Garcia J, Journal of Health Care for the Poor and Underserved, 1998
22. US Department of State. Refugee Resettlement in the United States. 10/21/15. Available at: https://2009-2017.state.gov/documents/organization/249289.pdf,
Accessed July 29, 2017.
23. UNHCR. Children on the Run. Washington, DC. May 2014.
24. Venkataramani et al., Lancet Public Health, 2017;2:e175-81.
25. Women’s Refugee Commission, Lutheran Immigration and Refugee Service, Kids in Need of Defense. Betraying Family Values: How Immigration Policy at the
United States Border is Separating Families. Available at: https://www.womensrefugeecommission.org/rights/gbv/resources/1450-betraying-family-values
Wake Forest Baptist Medical Center
Photo Credits: American Academy of Pediatrics