Refugee Health: Overview of California Screening Program + Key Findings of 2017 Health Data 14 th Summer Institute on Migration and Global Health Oakland, June 18-20, 2018 Nuny Cabanting, MPH Office of Refugee Health Center for Infectious Disease California Department of Public Health
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Refugee Health: Overview of California Screening Program + Key Findings of
2017 Health Data14th Summer Institute on Migration and Global Health
Oakland, June 18-20, 2018
Nuny Cabanting, MPHOffice of Refugee Health
Center for Infectious DiseaseCalifornia Department of Public Health
Outline• Introduction• Resettlement Process • Program Overview• RHEIS Overview• Demographic Characteristics Data• Health Screening Data
• A refugee is a person who is outside of his or her country and is unable or unwilling to return because of persecution or a well-founded fear of persecution
§ Communicable diseases of public health significance
§ Lack of required vaccinations§ Physical and mental disorders with associated
harmful behaviors§ Psychoactive substance abuse and
dependence
U.S. Points of Entry for Refugees
California Refugee Resettlement Process
California Department of Social Services,
Refugee Programs Bureau• provides financial and social
services assistance
California Department of Public Health,
Office of Refugee Health
Center for Disease Control and Prevention Provides technical instructions and
guidance to physicians conducting the domestic
medical exam
Federal, Office of Refugee Resettlement
Administers the refugee program nationally to provide financial,
medical, and social services assistance to Refugees
Resettlement Agencies
Overview of CA Office of Refugee Health (ORH)
Office of Refugee Health
In California, the Office Refugee Health (ORH) coordinates the following programs:
§ Refugee Medical Assistance Program (RMA) – ORH contracts with Medi-Cal to provide RMA-based
Medi-Cal benefits for 8 months from the date of arrival to those individuals who do not qualify for regular Medi-Cal
§ Refugee Health Assessment Program (RHAP)
Other “Refugee” Classifications Served by ORH
• Cuban/Haitian Entrant• Asylee (1.travels to U.S. on their own and applies
for political asylum 2. family requests)• Special Immigrant Visa (Iraqi & Afghani)• Victims of severe forms of trafficking• Unaccompanied Refugee Minor
Refugee Health Assessment Program
Objectives:• To prevent & control health problems of public
significance• To improve the general health status of refugees
through:– Early identification and referral for treatment of
both acute and chronic health conditions– Achieved by County Refugee Health Programs – Linkage to Medi-Cal Primary Care
Contra Costa
San Francisco
Alameda
Santa Clara
San Diego
Sacramento
Stanislaus
Los Angeles
Local Health Jurisdictions
About 98% of statewide
arrivals are seen in our
county clinics
San Bernardino
Riverside
Kern
Long Beach
Imperial
Health Assessment Process
• Refugees are scheduled individually or as a family • Health assessment typically take 2 visits
sample)• 2nd Visit–Visit with medical provider to perform physical exam,
review labs– Referral to primary provider
• CDC medical guidelines• Culturally and linguistically
appropriate• Main Sections:
- Arrival Data- Medical Exam/History- Tuberculosis- Immunizations- Laboratory Tests- Diagnosis- Mental Health
Refugee Health Assessment Program Form
Health Assessment Objectives
• Screen communicable diseases• Identify chronic diseases• Assess immunization status for children and adults• Provide mental health screening• Refer clients to health providers for further
evaluation, treatment, and follow-up
Refugee Health Information System (RHEIS)
• Web-based database• Transmit refugee health screening data • Tool to improve and standardize the collection of quality, comprehensive data • Platform to provide data reports to local, state and federal agencies
Refugee Health Data Report
• Demographic Characteristics • FFY 2002-2017
• Health Screening Data• FFY 2017
• Data Collection from 12 LHJs• Annual reporting• Available on website
*A total o f 11,563 cases were screened for FFY 2016-2017† Case responses with missing values or "not applicable" were excluded
Table 2. Screening Tests* by Results : California FFY 2016-2017
Screening Tests
Availability of valid data* for screening test
Cases w ith positive/elevated† results
Selected Parasite Results, FFY 2016-2017
Table 3. Intestinal Parasites Detected by Stool Examination: California FFY 2016-2017Parasites No. %
Blastocystis hominis† 1932 40.1%
Entamoeba coli‡ 706 14.7%
Endolimax nana‡ 633 13.1%
Giardia Intestinalis* 596 12.4%
Dientamoeba fragilis† 446 9.3%
Entamoeba histolytica* 115 2.4%
Entamoeba hartmanni‡ 97 2.0%
Chilomastix mesnili‡ 96 2.0%
Ascaris lumbricoides* 71 1.5%
Iodamoeba buetschlii‡ 70 1.5%
Hymenolepiasis* 35 0.7%
Entamoeba dispar‡ 14 0.3%
* Pathogenic† Controversial (pathogenic/nonpathogenic)‡ NonpathogenicNote: Data presented refer to cases not individuals.
Based on CDC Intestinal Parasite Guidelines for Domestic M edical Examination for Newly Arrived Refugees (2013)
Tuberculosis Disposition, FFY 2016-2017
TB Disposition No. %
TB Class 0 (No TB exposure, not infected) 9225 90.7%
TB Class II (TB infection, no disease) 896 8.8%
TB Class IV (TB, not clinically active) 22 0.2%
TB Class I (TB exposure, no infection) 26 0.3%
* Health assessments completed by County Refugee Health Program for Federal Fiscal Year (FFY): Oct 1-Sept 30
Table 4. Tuberculosis Disposition Among Arrivals*: California FFY 2016-2017
Data Usage
• Assess Health Disparities• Policy Development• Improve Clinical Practice• Promote Healthy Lifestyles• Monitor and evaluate health status of refugees• Health Profiles• Program Evaluation• Pilot Studies