https://www.ajmc.com/focus-of-the-week/california-providers-describe-growing-crisis-for-immigrant-families
California Providers Describe Growing Crisis for Immigrant Families

Allison Inserro

This past summer, various service providers, local officials, and parents of immigrant families in the San Diego and San Francisco areas shared their experiences regarding health, legal, educational, and social services in the wake of changed immigration policies under the Trump administration. Discussed in a new issue brief released this week by the Kaiser Family Foundation, the conversations paint a picture of an increasing number of families disenrolling themselves and their children from California’s Medicaid program, and not renewing or not enrolling in other programs, even though they are eligible and not directly affected by the policy changes.

Moreover, healthcare providers, other service providers, and families report that fear is affecting daily life, health, and well-being, as well as increasing pressure on strapped local organizations and communities, which are attempting to find different ways to respond.

Besides increased immigration enforcement, the changes the administration has made over the past year include tightening the public charge policy; under the change, the United States will include the use of certain programs, which were previously excluded from being considered, such as the Supplemental Nutrition Assistance Program, nonemergency Medicaid use by nonpregnant adults, and use of housing assistance programs. Earlier this month, however, federal judges in New York, Washington state, and California temporarily blocked enforcement of the changes.

In addition, President Trump signed a proclamation barring legal immigrants who cannot prove they will have health insurance or a way to pay for it within 30 days of their arrival. Taken together, the moves are seen as a way to keep low-income immigrants from entering the country.
 
The brief said that families and children have increased mental health needs, such as anxiety and depression. Growing economic pressures are worsened by fear of using public programs and services. In addition, some people have lost jobs or are afraid to seek a job or go to work.
 
More specifically, fears include increased risk of deportation, potential negative impacts on the ability to adjust immigration status on themselves or their sponsor relatives, and being required to pay back benefits. Other common fears include children who worry about being separated from their parents, fears about driving or going out socially, and fears about interacting with the police, which may have an impact on crime reports.

“We have a lot of fear about deportation, not just from our undocumented population, but from our longtime immigrants,” a local official in San Francisco says in the report.

Families and providers also described increased discrimination and bullying in schools, saying that Muslim communities have been particularly affected.
 
Healthcare providers worry about the long-term negative consequences as a result of worsened health conditions, as well as the effect of unrealized potential among children. Children who previously did well in school are not, said one provider; another warned about effects that will be seen in 5 to 10 years stemming from disrupted attachment between infants and parents and to the community at large.

Families have increased problems sleeping or eating, healthcare providers said, as well as headaches and stomach aches, and worsened chronic conditions, such as asthma and diabetes. For many of these individuals, healthcare providers said these physical problems worsened existing mental health ones stemming from a history of violence and trauma. Even though families recognized that they and their children might benefit from mental health assistance, barriers to care include stigma, cost, and a lack of providers, especially ones who can offer culturally appropriate care.

Negative outcomes include the increased risk of food insecurity, delayed prenatal care, lack of access to specialty care, and less care continuity. One woman, told she had a mass in her breast, did not want to follow up with a specialist because of the change in the public charge rule, a provider said.
 
Local organizations and communities are shifting some resources in order to address the immediate, urgent needs of new refugees. Officials said they were operating in crisis response mode and have difficulty staying up to date with shifting legal and policy changes, which makes it difficult to advise families on some issues.

Providing legal support has become more challenging, including new cost barriers, as well as a lack of mental health resources to conduct the assessments that are often required to support immigration cases. Opportunities for immigrants who have been in the United States for a long time to adjust their status or to naturalize have become more limited because of declines in fee waivers and other policy changes, the report said.

Looking at a variety of future needs, providers listed a range of priorities including filling gaps in mental health care and legal support, and continuing to coordinate services such as by strengthening cross-sector partnerships and connecting people to existing services. Some cited examples such as linking healthcare to legal services, a legal services provider working with a social worker, a dental health clinic adding an on-site mental health counselor, and a legal services provider hiring a psychologist.

The brief also describes how providers are cross training—primary care providers and pediatricians providing mental health screenings and basic mental health treatment as part of their care after going through such a training. This allows behavioral health specialists to focus on more complex and severe cases.

In addition, a growing number of educational and other school staff are being trained in similar ways to provide mental health support.

Schools are also trying to cope by training staff on how to respond if immigration officials arrive or a family member is deported. Training includes recognizing stressors that may affect student behavior and knowing to link them to assistance rather than using punishment. Some schools are offering school-based clinics, but schools, as with nonprofit organizations, face their own financial burdens.

The supply of providers must be increased over the long term, and nonprofit organizations and local governments facing increased demands need additional resources, the report said. 

The brief was supported by the Blue Shield of California Foundation and was informed by health and behavioral health providers, educators, legal services providers, community-based organizations, faith-based organizations, funders, and local officials. Interviewers also spoke individually with some people and through roundtables and focus groups, including immigrant families.
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