NARHC 2021 Program

Sept 9-11, 2021
Digital Conference
North American
Refugee Health Conference
Health means the world to us
northamericanrefugeehealth.com
Program/Abstract Booklet
2021 North American Refugee Health Conference: Health means the world to us | 1
Table of Contents
Welcome Letter from Conference Chair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Planning Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Keynote Speakers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Accreditation, Faculty Disclosure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Program Thursday, September 9, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Program Friday, September 10, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Program Saturday, September 11, 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Orals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Workshops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Posters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Sponsors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Conference Chair Peter Cronkright MD FACP
Professor of Medicine
Hassan Vatanparast MD PhD Professor
College of Pharmacy & Nutrition, School of
Clinical Associate Professor of Family Public Health
Anna Banerji O.Ont. MD MPH FRCPC Medicine University of Saskatchewan
DTM&H CTropMed Update University Hospital Board of Directors Member- Society of
CPD Conference Chair North American Refugee Healthcare
Indigenous and Refugee Health Andrea E. Green MDCM, FAAP Providers
Associate Professor She/her/hers) Scientific Advisory Panel Member-
Department of Paediatrics Professor of Pediatrics Osteoporosis Canada
and Dalla Lana School of Public Health Director Pediatric Global Health
Temerty Faculty of Medicine Larner College of Medicine at University of Patricia F. Walker MD DTM&H
University of Toronto Vermont FASTMH
Director Pediatric New American Program Professor of Medicine and Associate Program
Pediatric Primary Care Director, Global Medicine
University of Vermont Children’s Hospital University of Minnesota
Planning Committe Aisha Khatib MD, CCFP(EM),
Medical Director, HealthPartners Travel and
Tropical Medicine Center
CTravMed, DTM&H, CTropMed Past President, American Society of Tropical
Marc Altshuler MD Assistant Professor, Dept. of Family & Medicine and Hygiene
Professor, Department of Family and Com- Community Medicine, University of
munity Medicine Toronto Janine Young MD, FAAP
Thomas Jefferson University, Philadelphia Clinical Associate, St. Michael’s Hospital, Medical Director, Denver Health Refugee
Pennsylvania Unity Health Toronto Clinic
Clinical Director of Travel Medicine, Medical Co-Director, Denver Health
Aniyizhai Annamalai MD Medcan, Canada Human Rights Clinic
Associate Professor Co-Chair, ASTMH Course in Clinical Medical Advisor, Colorado Refugee Services
Departments of Psychiatry and Internal Tropical Medicine & Travelers’ Health Program
Medicine Councilor, ASTMH Clinical Group Associate Professor, Dept of General
Yale School of Medicine Pediatrics, University of Colorado School of
Medical Director, Yale Adult Refugee Clinic Patricia Li MD, MSc, FRCPC Medicine
Assistant Professor, Paediatrics Denver Health and Hospitals, Lowry Family
Neil Arya BASc MD CCFP FCFP DLitt McGill University Pediatrician, Montreal Health Centre
Fellow- Balsillie School for International Children’s Hospital
Affairs Scientist, Research Institute of the McGill
Fellow- International Migration Research University Health Centre
Centre
Adjunct Professor- Health Sciences, Wilfrid Sheikh Muhammad Zeeshan Qadar
Laurier University B. Pharmacy MSc.
Assistant Clinical Professor- Family Medi- Project Manager
cine, McMaster University (part-time) National Collaborating Centre for Infectious
Adjunct Professor- Environment and Re- Diseases
source Studies, University of Waterloo Rady Faculty of Health Science, University
of Manitoba
Carolyn Beukeboom NP-PHC MSc Winnipeg, MB, Canada
Adjunct Lecturer, Arthur Labatt Family External Affiliate to Centre for Refugee
School of Nursing, Western University Health, York University
Refugee Health Clinic, Centre for Family
William Stauffer MD
Medicine, Kitchener
Professor Department of Medicine
Division of Infectious Diseases and
Mahli Brindamour MD, FRCPC International Medicine
General Pediatrician
Pediatrics, Infectious Diseases & in the
Assistant Clinical Professor
School of Public Health
University of Saskatchewan
University of Minnesota
Director of Human Migration and Health
Jennifer Cochran MPH at the Center for Global Health and Social
Director, Division of Global Populations
Responsibility
and Infectious Disease Prevention
Bureau of Infectious Disease James Sutton PA-C
Massachusetts Department of Public Health Executive Director
Society of Refugee Healthcare Providers
Keynote Speaker Concurrent Keynote Speakers
Aniyizhai Annamalai MD Jose Debes, MD

Associate Professor Associate Professor, Department of Medicine
Departments of Psychiatry and Internal Medicine Divisions of Infectious Diseases and of Gastroenterology
Yale School of Medicine University of Minnesota
Medical Director, Yale Adult Refugee Clinic Associate Professor
Division of Epidemiology
School of Public Health at UMN
Sahar Bahadi Department of Gastroenterology & Hepatology
Advocate and Pediatrician Erasmus University, The Netherlands
Martin S. Cetron MD FIDSA FASTMH
Director, Global Migration and Quarantine
CDC James Johnston
Clinical Associate Professor
Head of Respiratory Medicine Division at Vancouver General Hospi-
Pablo S. Bose, Ph.D. tal
Associate Professor Department of Geography Evaluation Lead at Provincial TB Services at BCCDC
Director Global and Regional Studies Program Associate Member of the UBC School of Population & Public Health
Provost’s Faculty Fellow for General Education Department of Medicine, Faculty of Medicine, University of Toronto
University of Vermont
Nina Marano DVM MPH Dipl ACVPM

Stephen M. Cornish Chief
Master’s Degree, Global Risk and Crisis Management Immigrant Refugee and Migrant Health Branch
Director General of Médecins Sans Frontières Operational Center Division of Global Migration and Quarantine
Geneva, Switzerland Centers for Disease Control and Prevention
Université Panthéon Sorbonne in Paris
Post-Graduate Diploma in Conflict Resolution
University of Bradford
James Cullingham
Director/producer
The Cost of Freedom - Refugee Journalists in Canada
Tamarack Productions
Nogojiwanong - Peterborough ON
Marsha Griffin MD
Director, Division of Child and Family Health, University of Texas
Rio Grande Valley School of Medicine
Professor of Pediatrics, University of Texas Rio Grande Valley School
of Medicine
Co-Founder, Community for Children
Paul Spiegel MD MPH

Professor Health Systems Department of International Health
Johns Hopkins Bloomberg School of Public Health
Director Johns Hopkins Center for Humanitarian Health
Mike Woodman MD MPH DTM&H

Senior Public Health Officer
UNHCR Geneva
Accreditation Faculty Disclosure
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Continuing Professional Development to ensure balance, independence,
This one-credit-per-hour Group Learning program meets the
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Royal College of Physicians and Surgeons of Canada – Section 1
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Letters of Accreditation/Attendance
An email with instructions about your accreditation letter will be sent 2 to
3 weeks post-conference.
Program Thursday, September 9, 2021
Plenary Session 1 Presenters Moderator
0900 Opening remarks Anna Banerji Anna Banerji
0910 Keynote address: Impact of COVID-19 on Migrants and Refugees Stephen Cornish Anna Banerji
0955 Keynote address: CDC Update on Refugee Health Nina Marano Anna Banerji
1040 Health Break
1055 Concurrent Workshops - Session 1 Presenters Stream Submission# Moderator
W1 Improving opportunities for Health Gayathri Kumar

Jennifer
Outreach among Individuals Granted & Ben Levey Advocacy 1026678
Cochran
Asylum in the United States
W2 Clinician Advocacy to Support Refugees, Katherine

Advocacy 1044749 Marc Altshuler
Immigrants, and Asylum Seekers McKenzie
W3 Gender Based Violence During Rahel

Gender 1048385 Andrea Green
Displacement and Resettlement Hailemichael
W4 Talking about Stress: Mental Health Kate Yun Mental

Conversations in Languages Other Than Health & 1036608 James Sutton
English PTSD
W5 Canada’s Refugee Health Clinics Amidst Gabriel

COVID-19: structure, care models, Fabreau Migration and
1043831 Neil Arya
Resettlement
strengths and challenges
W6 Addressing the impact of family loss and Huda El-Zein

Paediatric Aniyzhaal
separation on refugee youth: Implications 1044028
Health Annamalai
for programming and policy development
W7 Splenomegaly in refugees: Etiology, William Infectious Hassan

MW2105
diagnosis and management Stauffer Disease Vatanparast
W8 COVID-19 Response Perspectives of Elizabeth

public health jurisdictions, health systems Dawson-Hahn
Sheikh
and community based organizations MW2102
Muhammad
with Refugee, Immigrant and Migrant
Communities
W9 Advancing the centers of excellence in Emily Jentes

Refugee
newcomer health: Moving the needle in the 1041701 Patricia Walker
Screening
next 5 years
W10 Strategies for Publishing Your Work in Paul Geltman Paul

Education
Refugee Health & Sana Loue Geltman
1155 Lunch visit the poster & exhibit halls
0125 Oral Abstracts - Session 1 Presenters Submission# Moderator
O1 Integrated Care Management to Improve Diabetes Outcomes in Waseem Sous 1052282 Hassan
Chronic Diseases &
Refugee and Immigrant Patients (I-Care) Vatanparast

Nutrition
O2 Dietary Intake and Nutritional Status among Refugees in Host Jacob Khuri 1048156
Countries: a Systematic Review
O3 Food security of Syrian refugee households who arrived in Samer Al- 1048075
Canada after 2015 Bazz
O4 Planetary Health concerns for Migrants in Mexico and Northern Marcos 1038747 Neil Arya
Central America Tamariz
O5 Navigating the Legal System: Ambiguity and Uncertainty for Lamis Jomaa 1043404
Global Health
Syrian Refugees in Lebanon
O6 Coordinating IOM Resettlement Activities in the Context of Alexander 1043238

COVID-19 Pandemic Klosovsky
O7 SARS-CoV-2 Pandemic Information and Healthcare Disparities Steven Repas 1043344

amongst Global Refugees: A Comparative Analysis
O8 Silent crisis: Community insights on suicide among displaced Ariel Zarate 1044819 Janine Young
Rohingya in Bangladesh
O9 Suicide Prevention Subgroup of Cox’s Bazar: A coordinated Ariel Zarate 1048562

Mental Health
response approach to community-centered suicide prevention in

humanitarian crises
O10 Explaining Variation in Refugees’ Post-Traumatic Stress and Shannon 1046867

Depression Outcomes in Ethiopia, Jordan, Kenya, and Uganda Golden
O11 Survivors of Daesh: Characterization of Health Conditions Nour Hassan 1048297

Among Yazidi Refugees Resettled to Canada
O12 Involuntary Sterilization Among Women from North and Central Elizabeth Yim 1042310 Carolyn
America Seeking Asylum in the U.S. Beukeboom
Women’s Health
O13 Reproductive Health of US-Resident Women from Countries Lillian 1043754

that Practice Female Genital Mutilation/Cutting (FGM/C): Whiting-
Women’s Health Needs Study Pilot Findings Collins
O14 Cervical cancer screening among resettled refugee women Serena 1044264
accessing care in an integrated safety-net setting Rodriguez
O15 Mental health services for refugee mother-daughter dyads Erum Agha 1043047
O16 Mental Health and Unmet Social Needs of Sexual and Gender Stephanie 1043733 Aisha Khatib
Gender and
Minority Asylum Seekers Loo

LGBTQI
O17 Health, gender, and war trauma: 5 year post-resettlement Sarah 1042867
health in a cohort of Karen war-affected adults Hoffman
O18 Refugee Immunization Information Systems Exchange (RIISE) Megan 1044926 Andrea Green
Project 2021 Updates Keaveney
O19 The SHIFA Project: Developing a Culturally and Linguistically Samantha 1042898
Immunization
Sensitive VR Educational Platform to Improve Vaccine Streuli

Acceptance Within a Refugee Population
O20 Perceived Barriers and Facilitators of COVID-19 Vaccination of Elizabeth 1041845

Refugee, Immigrant, and Migrant Communities Dawson-Hahn
O21 The COVID-19 Response of Health Systems Caring for Refugee, Elizabeth 1042886
Immigrant and Migrant Communities: A Qualitative Study Dawson-Hahn
O22 Community-based Collaboration: Meeting Refugees’ Needs Mary Helen 1046420 Patricia Li
During COVID-19 O'Connor
O23 COVID-19 restrictions and their impacts on migrant health in Sandra Smi- 1048530
humanitarian contexts ley & Carol
Covid
Devine
O24 Exploring and Addressing the Healthcare Challenges of Patricia Li 1048481

Refugees and Immigrant Families During the Covid-19
Pandemic
0225 Health Break
0245 Concurrent Workshops - Session 2 Presenters Stream Submission# Moderator
W11 Facilitating the Path to Citizenship through Anne Ryan, Advocacy 1041823 Sheikh
Medical, Legal and Community Partnership Suzanne Muhammad
Teeple, Jessie
Pettit and
Reem Aussy.
W12 We can do (no) harm: Building cultural Sandra Mattar Advocacy 1045287 Neil Arya
responsiveness in refugee mental health
training
W13 HIV and Sexually Transmitted Infections: Amir Mohareb Infectious 1048512 Mahli
Updates for Refugee Health Providers Disease Brindamour
W14 Lessons learned in setting up a unique Adrienne Carter Mental 1042937 Andrea Green
mental health treatment centre for Health &
refugees and Immigrants PTSD
W15 Collaborative complex case management in Astrid Migration and 1048598 Jennifer
a pandemic Velasquez Resettlement Cochran
W16 Centers for excellence in newcomer health: Jenna Beeler Refugee 1040732 Janine Young
Updates to the CDC domestic medical Screening
screening guidance
W17 Lead exposure and prevention in refugee Lois Wessel Refugee 1051633 Anna Banerji
communities: A guide to resources Screening
W18 Publishing Workshop Paul Geltman Education Paul Geltman

& Sana Loue
W19 How telemedicine can support access to Tim Foggin & Global Health MW2108 Aisha Khatib
refugee health and underserved populations Sharon Allen
0345 Health Break
Plenary Session 2 Presenters Moderators
Keynote address: Overcoming trauma, the perspectives of a Syrian pediatrician Sahar Anna Banerji
0400
Bahadi
0445 Closing remarks day 1 Anna Banerji
0450 End of Day
0450 Society’s Research Committe Meeting
0700 A new Twin Cities PBS documentary: Trusted Messenger
Program Friday, September 10, 2021

Plenary Session 3 Presenters Moderator
0900 Opening remarks Anna Banerji Anna Banerji
Keynote Address: The impact of COVID-19 on refugees: a Global Mike

0910 Anna Banerji
Overview Woodman
Keynote Address: Pregnant Mothers and Powerless Children: Outdated Marsha

0955 Janine Young
Systems at the US/Mexico Border Griffin
1040 Health Break
1055 Concurrent Workshops - Session 3 Presenters Streams Submission # Moderators
W20 Creating organizers out of advocates: What Eleanor Advocacy 1041537 Marc
community organizing can teach us about Emery Altshuler
advancing health equity for our refugee
patients
W21 How to Write an OpEd: Supporting Migrants Katherine Advocacy 1046545 Janine
Through Opinion Essay Advocacy McKenzie Young
W22 Integrating Ethics into Treatment for Refugee Rachel Singer Mental 1040024 Aniyzhai
Clients: Mental Health Implications Health & Annamalai
PTSD
W23 The National Newcomer Navigation Network: Mariah Migration and 1052823 Patricia Li
A tool to support collaboration across Maddock Resettlement
sectors to improve health outcomes among
Newcomers to Canada
W24 Trauma Informed Approaches for Working Nadia Paediatric/ 1033488 Mahli
with Youth Survivors of War and Torture Umadat Mental health Brindamour
W25 Recommended Travel Vaccinations in Aisha Khatab Travel MW2107 Patricia

migrants and Refugees Vaccination Walker
W26 Best practices in advancing maternal health Crista Women's MW2104 Carolyn
equity during the COVID-19 pandemic (TBC) Johnson- Health Beukeboom
Agbakwu,
Jeanne
Nizigiyimana
& Roseanne
Schuster
1155 Lunch visit the poster & exhibit halls
0100 Concurrent Keynotes Presenters Moderator
1. Understanding Hepatitis B and C with emphasis in refugee health Jose Debes Marc Altshuler
2. COVID-19, Humanitarian Emergencies & Forcibly Displaced Paul Spiegel Neil Arya
Persons
3. Tuberculosis James Mahli Brindamour

Johnston
0200 Oral Abstracts - Session 2 Presenters Submission # Moderators
O25 Promoting interfaith collaborations among refugee service Erum Agha 1023778 Jennifer
providers Cochran
O26 Health Equity Through Access to Comprehensive Quality Sara Guevara 1041926
Advocacy
Primary Care: The NYC Care Outreach Model
O27 Reconciliation: An Indigenous framework for Refugee Wellbeing Asta Rowe 1047956
O28 Borders and Policies: A critical discourse analysis of the Latoya Reid 1052426
dehumanization of Migrant Caravans by North American media
O29 Barriers to Healthcare Access for Refugees Resettled in Rebecca Leff 1043218 Aisha Khatib
Connecticut During the Coronavirus 2019 (COVID-19)
pandemic: Qualitative Perspectives from Frontline Providers
O30 Promoting Refugee Health in Resettlement during COVID-19: Julie Tippens 1043588
Global & Covid
Experiences and Perspectives of Community Health Workers
O31 COVID-19 Infection and Contact Tracing among Refugees in the Mengxi 1048273
United States Zhang
O32 A Collaboration to Harmonize COVID-19 Health Messaging Megan 1041428

and Fill Communication Gaps during initial U.S. Refugee Keaveney
Resettlement
O33 Caring for Refugee Patients: An Interprofessional Crash Course Alana 1024882 Peter
in Resettlement, Medical Intake, and Culture Petrassi Cronkright
Education
O34 Model for a Medical Student-Run Asylum Clinic Elizabeth Toll 1036310
O35 Navigating Barriers to Access Higher Education: Academic Zachary 1044139

Credential Evaluation for Displaced & Refugee Students Holochwost
Infectious Diseases and Research O36 Engaging Refugee Youth living with HIV into Care - A Neerav Desai 1048354 Sheikh
community-based approach Muhammad
O37 Syphilis Among US-Bound Refugees, 2015 –2018 Shannon Fox 1048415
O38 Fewer losses in the cascade of care for latent tuberculosis with Rachel 1042390
solo interferon-gamma release assay screening compared to Talavlikar
sequential screening
O39 Development of a Story Map as a Clinical Decision-Making Laura Smock 1037796

Support Tool for Treatment of Intestinal Parasites among
Refugees
O40 Assessing barriers, attitudes, confidence, and knowledge of Ariel Zarate 1048552 Aniyzhai
humanitarian staff responding to suicide risk in Bangladesh Annamalai
Mental Health & PTSD
O41 Changing Upstream Social Determinants of Health for Refugees Jan Jenkins 1052683
and Immigrants
O42 Addressing survivors of torture mental health through Mbalu Lumor 1043024
Indigenous land-based healing practice
O43 Missed torture histories in asylum applicants: assessing the Andrew 1043559
frequency of omissions in forensic medical exams Milewski
O44 Growth indicators of Yazidi pediatric refugees resettled in Roopa 1039651 Mahli
Calgary, AB, Canada Suppiah Brindamour
O45 For the Parent, By the Parent: Creating a Program to Empower Pardeep Kaur 1043796
Parents of Refugee Background Using Novel Participatory & Bernice Ho
Paediatrics
Approaches
O46 Implementing the Strengths and Difficulties Questionnaire for Emily 1044178
Refugee Pediatric Mental Health: Maryland Pilot Program Fitzpatrick
O47 Evaluation of a Newcomer Navigator Program for Newly-arrived Patricia Li 1048550

Immigrant and Refugee Children
O48 Patient and Provider Perspectives on Migrants’ Access to Valentina 1048637 Hassan
Research & Innovations
Prescription Drugs in Ontario Antonipillai Vatanparast
O49 Social Risk Screening and Impacts on the Im/migrant Stephanie 1032868
Community: A Retrospective Analysis Loo
O50 Virtual Mental Health Trainings for Refugee Communities and Parangkush 1049661
Service Providers in the United States WITHDRAWN Subedi
0300 Health Break
0315 Concurrent Workshops - Session 4 Presenters Streams Submission # Moderators
W27 A Resilient model of care and advocacy for Ana Pavon Advocacy 1042088 Patricia Li
refugees and immigrants in Canada Marin
W28 Resources for newly arrived refugees during Megan Chronic 1042165 Peter
the COVID-19 pandemic Keaveney & Disease Cronkright
Emily Jentes COVID-19
W29 Cultural considerations in mental health Erum Agha Mental 1045556 Aniyzhai
therapy with resettled refugees Health & Annamalai
PTSD
W30 Oral health of humanitarian migrants: Mary Ellen Oral health 1048331 Anna Banerji
Canada as a case study Macdonald
W31 Refugees are safe in Canada; but how about Hassan Refugee MW2101 Jennifer
their nutritional health status Vatanparast Nutrition Cochran
W32 Fever in new refugees Andrea Refugee MW2106 Paul

Boggild Health Geltman
W33 Gender as the sixth ground for asylum: Eleanor Gender 1042846 Sheikh
Historical, legal and medical perspectives Emery Muhammad
and a call to action
0415 Health Break
0430 Plenary Session 4 Presenters Moderators
Keynote Address: “The Cost of Freedom” - working with refugee journalists on a docu- James Anna Banerji
mentary film Cullingham &
Arzu Yildiz
Closing remarks day 2 Chair: Anna Anna Banerji

0515
Banerji
0520 End of Day
Program Saturday, September 11, 2021
0900 Plenary Session 5 Presenters Moderators
0910 Opening remarks Anna Banerji
Keynote Address: Refugee Mental Health and Effects of COVID-19 Aniyizhai Anna Banerji
0955
Annamalai
Keynote Address: Challenges of displacement: Climate, conflict, resettlement and barriers Pablo Bose Anna Banerji
to health
1040 Health Break
Concurrent Workshops - Session 5 Presenters Streams Submission Moderators

1100
#
W34 Harnessing quality Improvement Cara Harasaki Advocacy 1043550 Janine Young
methodology to advocate for equity
inimmigrant and refugee healthcare
W35 COVID-19 expert declarations: The Jeremy Chang Chronic Disease 1043573 Hassan
clinician’s role in securing temporary COVID-19 Vatanparast
release of ICE detainees
W36 Culturally responsive assessment of Joelle Taknint Mental Health 1042996 Jennifer
cognitive impairment & PTSD Cochran
W37 Somatic and Movement Practices to Kirsten Mental Health 1043647 Aniyzhai
Enhance Resilience for Refugees: How Wilkinson & PTSD Annamalai
they work and why they matter
W38 Pediatric refugee health during the COVID Patricia Li Paediatric 1042433 Carolyn
pandemic: case discussions Health Beukeboom
W39 Strategic planning for refugee health Colleen Payton Research 1033057 Sheikh
research: Prioritizing activities for a Muhammad
research, evaluation, and ethics committee
W40 Developing Community-Led Vaccine Ridhi Arun Vaccination 1042689 Andrea Green
Campaigns for Refugee, Immigrant, and
Migrant Communities, Using Human-
Centered Design
W41 Lesssons learned from the Clinique Piere-Paul LGBTQI MW2109 James Sutton
Mauve working with racialized, migrant Tellier
and asylum seeking sexually and gender
diverse individuals in Montreal
1200 Health Break
1205 Plenary Session 6 Presenters
Considerations for Afghani Refugees Anna Banerji
Closing remarks Anna Banerji
1230 Conclusion of conference
Session: O1, Submission Number: 1035515 96.22 to 86.60 (p=0.01). The frequency of
normal blood pressures was 9 (18%) at
Integrated Care Management to Improve enrollment and 16 (32%) at one year. Rates of
Diabetes Outcomes in Refugee and Immigrant emergency room visits decreased from 66% to
Patients (I-Care) 36% and hospitalizations from 22% to 8%.
Rates of comprehensive care monitoring,
Waseem Sous, Christina Lupone, Megan Harris, Ayan Mohamed, including monofilament testing and
Liban Mohamed, Mary Jo Lakomski, Simone Seward, Andrea
Shaw ophthalmology screening, increased from 60%
to 82% and 44% to 48%, respectively. The rate
Learning Objectives of interdisciplinary support engagement with
1. Upon completion, participants will be pharmacy and nutrition visits increased from
able to explore I-Care's multipronged 58% to 78% and from 26% to 38%,
approach. respectively.
2. Upon completion, participants will be
able to discuss the implications of such Conclusions/Discussion
an intervention on refugee and immigrant This program highlights the importance of a
care. multidisciplinary community-engaged care
3. Upon completion, participants will be model that has demonstrated improvement in
able to describe the importance of a quality metrics and healthcare costs for refugees
multidisciplinary care model in chronic and immigrants.
disease management.
Background and Purpose/Rationale

Refugees and immigrants face significant
barriers to healthcare and are more likely to
have poorly controlled chronic disease than the
general United States population. I-Care aims to
improve health equity for refugees and
immigrants who face a disproportionate burden
of chronic disease.
Methodology
Refugees and immigrants with uncontrolled
diabetes and associated cardiovascular (CVD)
risk factors were enrolled in a care management
program within an academic adult medicine
clinic. The program utilized a care manager to
coordinate care and services between designated
primary care providers, affiliated clinical teams,
and community partners. Health literacy,
chronic disease parameters, and care utilization
were assessed at enrollment and 8-12 months
later.
Results/Impacts/Outcomes
A total of 50 refugees and immigrants were
followed for 8 to 12 months. Clinical parameters
found a reduced mean HbA1c from 9.32 to
8.60 (p=0.05) and reduced LDL mean from
Session: O2, Submission Number: 1048156
Methodology
Dietary Intake and Nutritional Status Among We searched PubMed and Web of Science
Refugees in Host Countries: A Systematic databases to review relevant studies published
Review between 2009 and 2020 using the PRISMA
guidelines.
Jacob Khuri, Mengxi Zhang, Kendall Holden, Teresia Mbogori,
Youfa Wang
A total of 14 articles from 10 countries were
Learning Objectives
included and assessed for study quality. Poor
1. Describe and summarize the dietary
dietary diversity and insufficient intakes of
intake (i.e., food intake, dietary diversity,
specific food groups and nutrients were
etc.) and nutritional status (i.e.,
reported. A double burden of malnutrition was
undernutrition, overnutrition, and
observed as high prevalence of stunting,
micronutrient-related malnutrition) of
underweight, anemia, overweight, and obesity
refugees who have resettled in non-camp
were reported, with refugees having worse
settings within host countries worldwide,
nutritional outcomes than immigrants and local
with a specific focus on the current
citizens. The highest reported overweight and
double burden of malnutrition.
obesity prevalence among refugees was found in
2. Specify and highlight the associated
the U.S. Vitamin D and iron deficiencies were
factors influencing refugee dietary
common, and hemoglobin levels among children
patterns and nutritional health outcomes,
were alarmingly low.
and to further visualize and explore these
factors by utilizing our cause-and-effect
Conclusions/Discussion
conceptual model categorized into
We captured various complex, nuanced factors
different major themes representing these
that influence refugee dietary intake and
connected factors.
nutritional status in a conceptual model using
3. Identify insights that inform future
the cause-and-effect analysis method. Five
interventions and research related to
major themes were identified: food security,
refugee dietary intake and nutritional
acculturation, pre-migration experiences and
status in order to potentially carry out
food intake, socioeconomic status, and post-
diet and health screening assessments;
migration resources. There is a need for
plan and implement nutrition education
comprehensive dietary and health screening as
resources and programs; recommend and
well as culturally appropriate nutrition education
develop refugee health policies and
resources and interventions for refugees. Future
initiatives; and conduct further relevant
longitudinal, qualitative studies are needed to
research studies.
further investigate associations between refugee
dietary intake, nutritional health outcomes, and
related risk factors.
Refugees remain vulnerable to acute food
insecurity, malnutrition, and critically
inadequate food and nutrient intake after
migration, regardless of host country
development level. There is currently no
systematic review summarizing the evidence on
both dietary intake and nutritional status among
refugees resettled in non-camp settings
worldwide. We conducted such systematic
review to describe the current evidence and
identify pertinent influencing factors.
Session: O3, Submission Number: 1048075 Results/Impacts/Outcomes
overall, refugee adult, child, and household food
Food Security of Syrian Refugee Households insecurity was high (68.3%, 60.9%, and
Who Arrived in Canada After 2015 76.9%, respectively). Of food insecure
households, 45.6% were moderately food
Samer Al-Bazz, Hassan Vatanparast, Lina Al-Kharabsheh, insecure and 17% were severely food insecure.
Mustafa Koc, Ginny Lane, Rachel Engler-Stringer, Judy White
There were more food insecure households
among the GAR (79.4%) and BVOR (80.8%)
Learning Objectives
compared to PSR (62.2%). Severe food
1. Describe the household, adult, and child
insecurity was more prevalent among the GAR
food security status of Syrian refugees
households (20.6%) compared to the PSR
who arrived and resettled in Ontario,
households (6.7%) and BVOR households
Quebec, and Saskatchewan after
(7.7%).
December 2015, and compare it with
that of the general Canadian population
and other at-risk sub-populations
Results indicate that recently arrived Syrian
2. Compare the similarities and differences
refugee families have a higher rate of household,
in household food security status of
adult and child food insecurity compared to
Syrian refugees across the three major
Canadian population and other at-risk groups.
Canadian refugee resettlement programs
Overall, PSRs have a better food security status
(government-assisted refugees (GAR),
compared to other refugee categories. Further
privately sponsored refugees (PSR), and
research is needed to understand the role of
blended visa office referred (BVOR));
refugee resettlement policy, programs, and
3. List the various levels/severity of food
practices in shaping the food security of recently
household food insecurity
arriving refugee cohorts.
The unique nature of Canada’s 2015 initiative
to resettle 25,000 Syrian refugees in a short
period of time raised concerns about their food
security. Syrian refugees are particularly
vulnerable to food insecurity. Objectives: (1)
determine household food security (HFS) status
of Syrian refugees in three Canadian provinces
(Ontario, Quebec, and Saskatchewan); (2)
compare the similarities and differences in HFS
status of Syrian refugees across the three major
Canadian refugee resettlement programs
(government-assisted refugees (GAR), privately
sponsored refugees (PSR), and blended visa
office referred (BVOR)).
Methodology
A cross-sectional study design was used on a
sample of 282 Syrian refugee households who
arrived and resettled in Ontario and
Saskatchewan, in Canada since November
2015.
In the first 30 days of the hurricane response in
Planetary Health Concerns for Migrants in northern Honduras, MSF carried out more than
Mexico and Northern Central America 2,000 medical consultations, and identified
skin diseases, physical and psychological
Marcos Tamariz, Diogo Galvao, Carol Devine, Sandra Smiley, trauma and respiratory infections as the main
Juan Carlos Arteaga
health issues. Medical care, psychological
support and health promotion services were also
Learning Objectives
provided in more than 200 shelters for
displaced people for patients. Treatment was
able to describe how extreme weather
provided for many patients of chronic diseases
events, through the particular case of
who were unable to access care. A rapid needs
Honduras, are an additional driver of
assessment of participants in the January 2021
migration and exacerbate people's health
caravan to the United States found that many
needs
respondents were migrating for reasons related
to the storms.
able to define how it is essential to
incorporate a planetary lens to
understand needs and inform health and
These findings provide insight into the needs
humanitarian responses, planning and
generated by this unprecedented series of
advocacy for migrants impacted by
storms, situating them in the broader context of
multiple threats such as extreme-weather
a pandemic, a climate crisis, and a change of
events and a concurrent pandemic.
government in the US. In climate “hotspot”
regions, a Planetary Health lens helps to better
able to describe the methods to do a
understand interconnected and emergent health
rapid needs assessment to understand
risks and design humanitarian responses and
displaced people's needs and examples
advocacy.
of the interpretation of the results and
how it helped with the humanitarian
response implementation

In late 2020, the destruction of unprecedented
back-to-back category 4 hurricanes Eta and Iota
displaced thousands and left 250,000 without
access to health care. Médecins Sans
Frontières, an international medical-
humanitarian organization, is responding and
bearing witness to the health impacts of the
storms.
Methodology
MSF expanded its activities in the country to
respond to the humanitarian needs created by
Eta and Iota. Routine health service data was
collected. A rapid needs assessment was carried
out among participants in the January 15, 2021
caravan to the US to understand health needs
and motivations for migration.
Session: O5, Submission Number: 1043404 According to participants, registration with
UNHCR was essential to receive subsidized
Navigating the Legal System: Ambiguity and healthcare and education, which alleviates but
Uncertainty for Syrian Refugees in Lebanon does not eliminate their harsh living conditions.
Most participants were engaged in informal work
Lamis Jomaa, Dana Nabulsi, Gladys Honein-AbouHaidar, regardless of their legal or registration status.
Hussein Ismail, Mahmoud Hashoush, Jasmin Lilian Diab
Nevertheless, lack of legal status remains a
major protection concern with SR exposed to
Learning Objectives
checkpoints, detention and raids, the fear of
1. Identify protection and legal barriers
which was reported as a major psychological
affecting the livelihoods of Syrian
stressor.
refugees in Lebanon
2. Explore the perspectives and experiences
of refugees and humanitarian workers
Findings reinforce the importance of refugee
towards UNHCR registration mechanisms
registration schemes and the need for clear
and its impact on their health and
pathways for legal residency to ameliorate the
wellbeing
negative effects of informal status on livelihood,
3. Identify the mental health implications of
wellbeing, mobility and access to services.
the protracted crisis and the complexity
of legal system on refugees

Lebanon remains the country with the highest
per capita number of refugees, however, the
government has not ratified the 1951 Geneva
Convention on the Status of Refugees raising
legal concerns for refugees’ status. This paper
further explores the vulnerability and protection
issues facing Syrian refugees (SR) and its
impact on their health and wellbeing.
Methodology
Qualitative data from a previous mixed method
study were analyzed. A total of 19 focus group
discussions (FGDs) with SR residing in informal
settlements in the Beqaa region and 12 key
informant interviews (KII) with representatives
from different humanitarian organizations were
conducted. Thematic analysis was conducted
with triangulation of results.
Initial findings shed light on the economic and
health disparities among SR, particularly those
lacking registration and formal assistance
(Nabulsi et al., 2020). Further analyses
pinpointed the complexity with which SR can
obtain legal residency in Lebanon, either
through UNHCR registration, suspended since
2015, or through ‘kafele’ or sponsorship.
Session: O6, Submission Number: 1043238 Methodology
These additional protocols for resettlement of
Coordinating IOM Resettlement Activities in the US-bound refugees were created in coordination
Context of COVID-19 Pandemic between IOM, Bureau of Population, Refugees
and Migration (PRM) and Centers for Disease
Amira Hamadeh, International Oorganization for Migration; Control and Prevention (CDC), aiming to cover
Patricia Mburu, International Organization for Migration; Tetiana
Seleznenko, International Organization for Migration; Judith refugee predeparture, travel and post-arrival
Quintanilla, International Organization for Migration; Myat arrangements. The protocols, disseminated
Thandar Aung, International Organization for Migration; across all USRAP sending missions, are
Alexander Klosovsky, International Organization for Migration;
Mayali Harith, International Organization for Migration; Lauren implemented by IOM migration health and
Rogers-Bell Susan Dicker, International Organization for operations staff to promote standardized
Migration; enhanced processes, even for locations with
limited IOM presence.
Learning Objectives
1. Upon completion, participant will be able Results/Impacts/Outcomes
to describe the complex environment The major COVID-19 enhancements in IOM
operating environment within the activities address specific needs of medical
resettlement landscape under COVID-19. cases during the pandemic, preventing COVID-
2. Upon completion, participant will be able 19 spread and meeting relevant national and
to list three (3) major areas targeted for international travel regulations.
COVID-19 enhancements during IOM
resettlement activities. Conclusions/Discussion
3. Upon completion, participant will be able These enhancements and expanded
to list at least one specific activity predeparture health checks promote safe and
included in each of the broader targeted uninterrupted resettlement through COVID-19
IOM area. testing, vaccination referrals, targeted COVID-19
health education messaging with additional
Background and Purpose/Rationale counseling to refugees at risk for serious illness
The International Organization for Migration from COVID-19, airport (departure, transit, and
(IOM) is responsible for providing predeparture receiving) assistance, distributing thermometers
assistance, travel arrangements, and at POEs for daily temperature monitoring post
coordinating post arrival medical needs for all arrival, as well as timely coordination of
US-bound refugees. The current environment immediate post-arrival health care.
shaped by the coronavirus (COVID-19) global
pandemic presents unique challenges for the US
Refugee Admissions Program (USRAP),
affecting both the IOM overseas operations and
the receiving entities in the US, including
resettlement agencies and health providers. To
ensure safe and uninterrupted resettlement in
the current settings, while meeting international
and local regulations, special protocols and
enhancements have been put in place in over
80 countries, including the US Ports of Entry
(POE).
Preliminary analysis of 141 surveys, 29 of which
SARS-CoV-2 Pandemic Information and were global refugees, showed 57.3% of all
Healthcare Disparities Amongst Global patients received the influenza vaccine and
Refugees: A Comparative Analysis 61.1% agreed that the influenza vaccine works.
92.7% of all patients agreed that COVID19 was
Steven Repas, Wright State University Boonshoft School of a serious disease and 63.9% would receive the
Medicine; Kate Conway, Wright State University Boonshoft
School of Medicine; Jacob Dickman, Wright State University COVID19 vaccine. The most common source of
Boonshoft School of Medicine; Christopher Evola, Wright State information included TV or radio (70.8%) and
University Boonshoft School of Medicine; Monica George, Wright the preferred method of translated information
State University Boonshoft School of Medicine; Paul
Hershberger, Wright State University Boonshoft School of was mailed handouts (28.8%).
Medicine; Estelle Viaud-Murat, Wright State University
Boonshoft School of Medicine Conclusions/Discussion
While preliminary analysis shows a large
Learning Objectives variance, additional analysis and data collection
1. Describe language-based disparities is underway. This study will aid in identifying
amongst global refugees. and informing health communication
2. Identify ways of communicating medical interventions needed to address health
information to global refugees. disparities within and among patients seeking
3. Demonstrate effective ways of educating care at an urban community health center.
global refugees on COVID19 mitigation
strategies.

In 2019, a new variant of coronavirus, SARS-
CoV-2 (COVID19) created a global pandemic
that has highlighted and exacerbated health
disparities Educating the general public about
COVID19 is one of the primary mitigation
strategies amongst health professionals. An
estimated 22% of the US population primarily
speaks a non-English language making mass
communication efforts difficult to achieve. This
study seeks to understand and compare several
topics surrounding COVID19 health
communication and identify potential healthcare
disparities between global refugees and native
English-speaking patients.
Methodology
A survey available in seven languages asking
opinions on COVID19, vaccines, sources of
information and other questions, was
administered Jan-March 2021 to patients at an
urban community health center which also
serves global refugees. Descriptive statistics and
comparative analysis were performed between
global refugees and native English-speakers.
Session: O8, Submission Number: 1044819 sources of support for help seekers with few
participants expressing willingness to engage
Silent Crisis: Community Insights on Suicide with humanitarian services.
Among Displaced Rohingya in Bangladesh
Ariel Zarate, Tahmina Parvin, Farhana Mahbub, Lauren Fischer Suicide presents a serious, prevalent issue
among the Rohingya community in Cox’s Bazar.
Learning Objectives Many attributed triggers of suicidal ideation to
1. Identify key drivers of suicidal behavior living conditions in the camp context, alongside
among the Rohingya refugee community mental health concerns exacerbated by the
as expressed by refugees directly. same. Addressing suicidality in the Rohingya
2. Identify the connection between basic community cannot neglect these factors, which
needs, human rights and suicidal become increasingly urgent amidst further
behaviors among the Rohingya refugee relocations and restrictions on activities and
community In Cox Bazar, Bangladesh. movement. For greater acceptance and
3. Describe suggested community directed appropriateness, humanitarian suicide
approaches to suicide prevention among prevention and mental health strategies should
the Rohingya refugee community in Cox integrate refugees’ expressed preference for
Bazar, Bangladesh. interpersonal support networks during personal
crises. Humanitarian support should redefine its
Background and Purpose/Rationale role, taking greater direction from affected
Suicide is a significant global health priority that communities as knowledge holders and creators,
remains relatively unexamined in humanitarian in suicide prevention and other areas.
emergencies. The Suicide Prevention Sub-Group
in Cox’s Bazar explored dynamics of suicidal
behaviors among Rohingya refugees, aiming to
inform appropriate population-level prevention
strategies.
Methodology
Employing a qualitative approach, we facilitated
a series of discussions with the Rohingya
community in Bangladesh from October-
November 2020. In 13 camps, 26 semi-
structured discussion groups were held with 181
participants. They explored cultural and
linguistic features of suicide, including current
and pre-displacement perceptions and
experiences.
Suicidal behaviors, particularly ideation, are
reportedly widespread, in spite of religious and
cultural injunctions against suicide and more
frequently observed since their arrival to the
camps in Bangladesh. Participants cited
securing basic needs, restricted opportunities,
and limited realization of basic rights as key
reasons for pervasive suicidal ideation.
Community care networks were preferred
To date the Subgroup has: collected input from
Suicide Prevention Subgroup of Cox’s Bazar: A 152 Rohingya community members about
Coordinated Response Approach to Community- suicide; adapted, contextualized, and translated
centered Suicide Prevention in Humanitarian a guide on telehealth response to suicide risk;
Crises created and facilitated a training on suicide
reporting and prevention for media professionals
Lauren Fischer, Ariel Zarate during COVID-19; created a frontline provider
survey (H-BACK-Suicide) to assess staff
Learning Objectives competence; and drafted the first
1. Describe the current context of suicide comprehensive suicide surveillance system for
prevention initiatives in the Rohingya humanitarian crises.
refugee response in Cox Bazar,
Bangladesh. Conclusions/Discussion
2. Identify successful activities for The Suicide Prevention Subgroup’s multi-
collaborative suicide prevention sectoral collaboration and focus on sustainable,
strategies. community-driven interventions may serve as an
3. Adopt recommended activities for a adaptable model for related contexts. Other
collaborative, community driven suicide global humanitarian response efforts should
prevention strategy. systematically address the issue of suicide in
meaningful partnership with affected
Background and Purpose/Rationale communities.
More than 2 years after the displacement of over
700,000 Rohingya from Myanmar into Cox’s
Bazar, Bangladesh, the first formalized efforts
on suicide prevention in this context began.
Rohingya community feedback and existing
studies suggest the issue is prevalent and
serious in this setting. The Suicide Prevention
Subgroup was formed to define and implement a
comprehensive strategy for suicide prevention
among multi-sectoral humanitarian actors who
work directly with the Rohingya community.
Methodology
In January-February 2020, we analyzed the
results of a previous suicide prevention
workshop to determine initial focus areas for the
Subgroup’s efforts. Subgroup members were
invited from multiple sectors of the refugee
response efforts, and meetings were held
biweekly, primarily via Zoom calls due to COVID-
19 lockdowns. Over 50 members representing
more than 20 national and international NGOs
and UN agencies participated through meeting
attendance and other communication to provide
feedback, refine materials, and coordinate
projects related to community-centered suicide
prevention.
Session: O10, Submission Number: 1046867 stressors, physical pain, social support, and
trauma history.
Explaining Variation in Refugees’ Post-
Traumatic Stress and Depression Outcomes in Results/Impacts/Outcomes
Ethiopia, Jordan, Kenya, and Uganda This study complements RCTs, which establish
causality and compare overall intervention
Shannon Golden, Center for Victims of Torture; Sarah Peters, efficacy. Our clinical assessment data and large
Center for Victims of Torture
sample sizes allow explanation of individual
outcome variance. Results establish significance
Learning Objectives
and magnitude of effects of explanatory factors.
Our comparative design tests which factors
able to describe how key demographic
consistently predict variation in outcomes across
characteristics, daily stressors, physical
locations, and which effects differ by context
pain, social support, and trauma history
(e.g. urban versus camp-based).
are associated with post-traumatic stress
and depression treatment outcomes for
refugees in humanitarian settings.
There is significant research evaluating efficacy
of trauma-focused psychotherapy interventions
able to identify implications for service
for refugees. Within this robust field, relatively
providers from understanding how
few studies disaggregate outcomes by client
treatment outcomes vary by key client
characteristics to assess which explanatory
characteristics.
factors are associated with greater or lesser
improvement. We advance this effort, and the
able to understand overall efficacy of a
growing literature on treatment outcomes in
trauma-focused counseling intervention
humanitarian contexts. These findings can help
with refugee populations living in Jordan,
service providers adapt programming to better
Ethiopia, Kenya, and Uganda.
serve needs of clients who are less likely to show
improvements after treatment.
This study advances understanding of trauma-
focused psychotherapy treatment efficacy with
refugee populations. First, our analysis includes
refugees in humanitarian contexts in Africa and
the Middle East, contributing to a small number
of studies conducted outside third-country
resettlement sites. Second, our analysis draws
upon large samples, which allows variance in
treatment outcomes to be disaggregated by
explanatory factors.
Methodology
This study analyzes data (N>5,000) collected in
clinical settings at intake and three months
following trauma rehabilitation counseling
services from the Center for Victims of Torture.
The dataset includes refugees in Ethiopia,
Jordan, Kenya, and Uganda. We use regression
models to predict changes in post-traumatic
stress and depression symptoms after treatment.
Explanatory variables are gender, age, daily
Session: O11, Submission Number: 1048297 conditions that may be linked to Daesh
exposure.
Survivors of Daesh: Characterization of Health
Conditions Among Yazidi Refugees Resettled to Results/Impacts/Outcomes
Canada We included 242 Yazidi refugees with a median
age of 19.5 [IQR 10-30] years and 58.3% were
Nour Hassan, University of Calgary; Annalee Coakley, University female. Approximately half (51.2%) of the
of Calgary; Ibrahim AlMasri, University of Calgary; Rachel
Talavlikar, University of Calgary; Michael Aucoin, University of sample had direct exposure to Daesh. The most
Calgary; Rabina Grewal, University of Calgary; Kerry McBrien, prevalent diagnoses were symptoms and signs
University of Calgary; Paul Ronksley, University of Calgary; (ICD10 chapter 18, 49.6%), nutritional
Gabriel Fabreau, University of Calgary
diseases (37.8%), mental and behavioral
disorders (33.5%), infectious diseases (30.9%),
Learning Objectives
and musculoskeletal diseases (28.7%). Through
1. Describe the sociodemographic
clinician consensus, mental health conditions
characteristics and prevalence of mental
(32.2%), suspected somatoform disorders
and physical health conditions among
(48.3%) and conditions of sexual and physical
resettled Yazidi refugees to Calgary.
violence (11.3%) were identified as likely
2. Describe the prevalence of mental and
attributable to Daesh exposure.
physical health conditions among
resettled Yazidi refugees stratified by age
groups and by sex among adults.
Yazidi refugees resettled to Calgary are mentally,
3. Identify specific health conditions among
socially and clinically complex. Given the high
Yazidi refugees that are most likely
prevalence of both physical and mental health
associated with exposure to Daesh,
conditions, healthcare delivery for this
according to clinical experts.
traumatized population requires a holistic
multidisciplinary approach.
Yazidi refugees, an ethno-religious minority from
Iraq and Syria, were resettled to Canada
between 2017 and 2018 after experiencing
mass displacement, genocide, and enslavement
by the Islamic State (Daesh). The health status
of resettled Yazidi refugees is unknown. We
characterize the mental and physical health
conditions of Yazidi refugees in Calgary.
Methodology
We performed a cross-sectional study of
resettled Yazidi refugees seen between 2017
and 2018 at the Mosaic Refugee Health Clinic
in Calgary, Canada. Sociodemographic and
medical diagnosis data were extracted through
chart review of electronic medical records. We
investigated the sociodemographic
characteristics and prevalence of physical and
mental health conditions stratified by age
groups and by sex among adults. We then
conducted an exploratory analysis consulting
five expert clinicians to identify specific health
Of the 14 women, 50% were HIV-positive, 64%
Involuntary Sterilization Among Women from had grown up in poverty, 64% were of Garifuna
North and Central America Seeking Asylum in ethnicity, and 93% had experienced SGBV.
the U.S 79% underwent their sterilization at the time of
childbirth. All underwent tubal ligation, 69%
Elizabeth Yim, Zoha Huda, Deborah Ottenheimer, Holly G. during cesarean-section. In 61.5% of cases,
Atkinson
consent was forced or coerced; the remainder
was unaware of being sterilized. 100% of
Learning Objectives
hysterosalpingogram results were consistent with
1. Upon completion, participant will be able
sterilization. All cases were defensive; of the 6
to distinguish between voluntary and
cases (43%) with known outcomes, 100% were
involuntary sterilization.
granted asylum.
to explain the role of forensic medical
evaluations in aiding an asylee's claim in
These results suggest that asylum-seeking
the U.S, especially those involving
women who have undergone involuntary
involuntary sterilization.
sterilization have also experienced multiple
forms of SGBV and discrimination due to
to describe the approach to evaluating a
ethnicity, health status, and/or income level.
woman who is suspected of having
Sterilization was performed by physicians under
undergone involuntary sterilization.
circumstances of coercion or disinformation in
the consent process, consistent with a violation
of medical ethics.
While voluntary sterilization is a safe, effective,
and widely-used form of contraception by
women worldwide, involuntary sterilization is a
violation of human rights and grounds for
asylum in the United States. Forensic medical
evaluation can be useful in documenting this
form of persecution and supporting asylees’
claims for immigration relief.
Methodology
We analyzed a case series of 14 asylum-seeking
women from North and Central America, who
had all experienced involuntary sterilization. A
retrospective review was conducted on the
personal and medical affidavits of the women. A
data entry form was developed to record
numerous independent variables, including
aspects of the asylee’s history (e.g.,
sexual/gender-based violence (SGBV) and
interactions with the medical profession);
forensic medical evaluation findings; and
hysterosalpingogram results.
Session: O13, Submission Number: 1043754 reported methods ever used. Of women with
FGM/C (51% of all participants), 28% had ever
Reproductive Health of US-Resident Women used a method compared with 40% without
from Countries That Practice Female Genital FGM/C. Seventy-one percent had a pelvic
Mutilation/Cutting (FGM/C): Women’s Health examination or Pap smear in the past three
years (75% with FGM/C and 68% without).
Lillian Whiting-Colins, Ghenet Besera, Ekwutosi Okoroh, Lillian Among live births in the past 5 years to study
Whiting-Collins, Roy Ahn, Petry Ubri, Doris Mukangu, Margaret
Snead participants, 73% received first trimester
prenatal care with no difference between births
Learning Objectives to women with and without FGM/C.
1. Describe selected reproductive health
characteristics of women with FGM/C Conclusions/Discussion
compared with those without FGM/C. The WHNS pilot study findings help understand
2. Describe how participants' demographic the reproductive health characteristics of women
characteristics (age, marital status, time affected by FGM/C. Findings can inform public
since immigration to the US, country of health and social services to better meet their
origin) are associated with FGM/C and needs. Full WHNS study implementation is
reproductive health factors. underway in four U.S. metropolitan areas in
3. Describe contraceptive prevalence and 2020-21.
methods used by WHNS Study
participants.

Information about U.S.-resident women from
countries where female genital
mutilation/cutting (FGM/C) is practiced is
limited. The Women’s Health Needs Study
(WHNS) was designed to collect information on
women’s health characteristics, experiences and
needs in selected U.S. communities with high
concentrations of residents from countries where
FGM/C is prevalent.
Methodology
In 2019, the WHNS piloted a hybrid venue-
based/respondent-driven sampling approach to
recruit, consent, and conduct structured face-to-
face interviews with 101 women aged 18 to 49
residing in a Southeastern U.S. metropolitan
area. Participants were born, or their mothers
were born, in an African country where national
FGM/C prevalence is ≥65%. We engaged the
community before and during the pilot to inform
the study procedures.
Thirty-four percent ever used a contraceptive
method, 14% in the past 30 days. Pills (14%)
and injectables (13%) were the most frequently
Session: O14, Submission Number: 1044264 groups (smokers, non-pregnant, BMI status,
ages 21-24); women aged 50-65 years were less
Cervical Cancer Screening Among Resettled likely. Among women screened, 5 of the 10 with
Refugee Women Accessing Care in an Integrated abnormal results completed follow-up; 3
Safety-net Setting completed follow-ups within the recommended
3-month timeframe. Median time to follow-up
Serena Rodriguez, Lei Wang, Cynthia Ortiz, Lance Rasbridge, was 87 days (IQR=50-98). During the study, the
Sentayehu Kassa, Simon Lee, Jasmin Tiro
adjusted hazard/chance of screening among
refugee women was 45% lower than that of
Learning Objectives
matched non-refugee women (95% CI: 47-65%;
1. List correlates of cervical cancer
p<0.01).
screening among resettled refugee
women accessing care in a safety-net
setting
Multiple demographic factors are associated
2. Describe the difference in cervical cancer
with cervical cancer screening among newly-
screening between resettled refugee
arrived refugee women who have significantly
women and matched non-refugee women
lower chances of completing screening
3. Describe the need for multi-level
compared to non-refugee women in a safety-net
interventions to increase cervical cancer
setting. Research is needed to identify
screening among resettled refugee
modifiable multi-level predictors of screening to
women
develop interventions for this under-screened
population.
Refugee women experience significantly higher
cervical cancer morbidity and mortality
compared to US-born women. This study aimed
to: 1) describe screening among newly-arrived
(estimated arrival within 90 days) refugee
women within a safety-net healthcare setting; 2)
identify correlates of screening; 3) describe
follow-up to abnormal screens; and 4) compare
screening differences between refugee and
matched non-refugee women.
Methodology
We identified a cohort of N&#3f754 newly-
arrived refugee women accessing care from
2010-2017 and matched women 1:3 with non-
refugee women (N&#3f2,262) on cohort entry
year, age, race, smoking status, Charlson index
score, and pregnancy status. We used Cox
Proportion Hazard Models to assess screening
correlates and differences between groups.
Among refugee women, the screening rate ≤3
years of enrollment was 22% (95% CI: 19-
25%). Women never smoking, pregnant, with
unknown BMI, and ages 25-39 years were more
likely to screen compared to their reference
Women lacked English language and work
Mental Health Services for Refugee Mother- experience upon arrival. Mothers had no or low
daughter Dyads education and daughters had varied education.
There was varied desire to socialize among
Erum Agha, UNC Chapel Hill - School of Medicine; Yusra daughters and low to none among mothers. All
Baloch, Emilia Bianco
dyads practiced Islam. Mothers’ vulnerability
made it challenging for daughters to pursue
Learning Objectives
thier goals; yet, the daughters supported their
1. Upon completion participants will be able
mothers’ dependence. Social and clinical
to describe mother-daughter dyads and
interventions improved outlook in all dyads.
thier unique mental health needs
to list suitable approaches to addressing
There is an urgent need for culturally
mental health needs for mother-daughter
appropriate programming and services. Services
dyads
must address the mother-daughter dyads as one
unit initially until clients are ready to seek
to conduct therapeutic and social support
independent services.
services for mother-daughter dyads with
knowledge and skills.

Patriarchy has historically been a traditional
social system in many Eastern countries and is
reinforced by internalization of norms through
socialization. When Eastern refugee mothers and
daughters resettle in the West, their roles shift
and daughters begin to take the parental role in
caregiving. Exposure to traumatic events
throughout the migration journey makes the
dyad more vulnerable and in many ways
inseparable. Limited research is available on
providing therapeutic services to mother-
daughter dyads. This presentation provides
insight into the emotional bonds between
mothers and adult daughters and their mental
health needs for optimum outcomes in the
context of social and inter-personal functioning.
Methodology
Case studies of mother-daughter dyads from
Pakistan, Afghanistan, and Syria are presented.
Women’s perspectives on their social, emotional
and mental health needs were sought using
semi-structured interviews. Data is a sub-set of
a primary qualitative study conducted to
examine the mental health needs of resettled
refugee women. Data was analyzed using
thematic analysis.
Session: O16, Submission Number: 1043733 or unmet social needs, such as food insecurity,
unstable housing, or employment needs. For
Mental Health and Unmet Social Needs of SGM individuals (n=70) with an intake 24-item
Sexual and Gender Minority Asylum Seekers Behavior and Symptom Identification Scale
(BASIS), the average total score was 1.71 (p-
Stephanie Loo, Boston University School of Public Health; value: 0.253; range: 0.60-3.14; standard
Houda Chergui, Immigrant and Refugee Health Center,
Department of Psychiatry, Boston Medical Center; Sarah deviation: 0.68). After approximately 12-months
Kimball, Immigrant and Refugee Health Center, Boston Medical of participation, 70% (49/70) individuals had a
Center; Section of General Internal Medicine, Boston University follow-up average BASIS total score of 1.28 (p-
School of Medicine and Boston Medical Center; Linda
Piwowarczyk MD MPH, Boston Center for Refugee Health & value: 0.250; range: 0-3.01; standard deviation:
Human Rights, Department of Psychiatry, Boston Medical Center 0.70).
Learning Objectives Conclusions/Discussion

1. Describe characteristics of a SGM asylum SGM-identified im/migrants face significant post
seekers within an urban trauma and migration psychosocial stressors that contribute
torture treatment center. to mental health morbidity. Considering the
2. Describe types and levels of unmet social intersection of unmet social needs and mental
needs impacting SGM im/migrants. health is of utmost importance, particularly for
3. Consider the intersection of unmet social this at-risk population.
needs and mental health screening scores
in a SGM im/migrant cohort.

Im/migrants, including refugee and asylum
seekers, face numerous social and political
barriers that can contribute to significant health
disparities. Within these groups are sexual and
gender minority (SGM) individuals who face
further compounding of stressors, such as
discrimination, isolation, and stigma that may
contribute to worsened mental health. Our
objectives were to identify and describe
demographic and mental health characteristics
of SGM individuals served by a torture treatment
and immigrant health program in Boston, MA.
Methodology
We used intake notes, clinical, and screening
data of a trauma and torture survivor program to
identify and analyze our cohort.
98 SGM individuals (50 males and 48 females)
were identified, with an average age of 34.9
years and 96.9% (95/98) majority English-
speaking. 83.7% (82/98) of the sample
identified as Black/African, and 82.7% (81/98)
reported their marital status as single. For those
responding to a social risk screening (n=50),
40% of respondents reported having at least 2
Health, Gender, and War Trauma: 5 Year Post- Results identified patterns of retention in
resettlement Health in a Cohort of Karen War- primary care, biometric trends, condition
affected Adults prevalence, and survival probabilities. There
were statistically significant and positive
Sarah Hoffman, Patricia Shannon, Tonya Horn, James Letts, associations between mental and physical
Michelle Mathiason
health, acts of violence in war, and gender.
Learning Objectives
To our knowledge this is the first analysis
able to identify patterns of health over
describing relationships between the long-term
time in a cohort of resettled Karen adults
health of war-affected Karen adults and specific
with refugee status.
acts of violence in war. The analysis addresses
key gaps in understanding of the sequela of
able to identify associations between
trauma from war over time and ongoing stressors
experiences in war, health outcomes, and
in displacement and migration. Findings also
other key variables.
provide important clinical insights into the
health trajectories of war-affected populations.
able to identify resettlement and ongoing
stressors and other potential contributors
to multidetermined physical and mental
health outcomes.

Approximately 140,000 refugees from Burma
have resettled to the United States over the last
decade, many of whom were exposed to
significant war traumas, including torture. Our
purpose was to examine 5-year patterns of
health in a cohort of Karen adults and to identify
associations between health outcomes, gender,
and specific acts of violence in war.
Methodology
The study was a five-year retrospective analysis
of a cohort of 143 Karen patients receiving
primary care at a mid-size urban clinic, who
were resettled to the United States between
2011 and 2013. Data were extracted from
electronic health records for all clinic
encounters (2011-2018). Qualitative
descriptions of war experiences were
transformed via deductive coding and integrated
with electronic health record data. Relationships
between acts of violence in war, gender, and
health status, and other key variables were
evaluated. Survival statistics visually displayed
the variability in health outcomes over the five-
year study period.
At present, ten states are working on Pilot 2 of
Refugee Immunization Information Systems the RIISE Project and an additional seven states
Exchange (RIISE) Project 2021 Updates are being recruited. Additionally, updates on
new collaborations with the Immunization
Megan Keaveney, Brandy Holloman, Amanda Dam, Mary Gateway as well as an evaluation of the RIISE
Hamilton, Yoni Haber, Deborah Lee, Emily Jentes
Project will be provided. Finally, a brief
discussion on the implications of COVID-19
Learning Objectives
vaccination planning will also be addressed.
1. Describe the RIISE Project goals and
objectives and better understand how
vaccination data is integrated between
Our oral presentation will provide updates from
different systems.
CDC on the RIISE Project, with project team
2. Define RIISE projects core
members discussing project activities. The
accomplishments and project activities
instructional methods include a Q&A session
over the past year.
and other opportunities for the audience to
3. Learn the steps about how to engage with
engage the presenters.
RIISE project if interested.

Since 2012, hundreds of thousands of refugees
have been vaccinated through the US-bound
refugee vaccination program. Maximizing states'
usage of overseas vaccination data enables
clinicians and ancillary staff to provide more
comprehensive preventive care for incoming
refugees and avoid over-vaccinating or missing
critical vaccinations. Since 2015, the CDC
collaborated with 15 partner states on the
Refugee Immunization Information Systems
Exchange (RIISE) Project to transfer overseas
refugee vaccination information from the CDC
Electronic Disease Notification system (EDN) to
state immunization information systems (IIS).
Methodology
The presentation will describe the envisioned
benefits of full implementation of RIISE
including ensuring refugee vaccination records
are made available electronically to the IIS. It
also helps better assess the impact of vaccine
recommendations and improves vaccination
access in hard-to-reach populations, especially
among newcomer populations. This presentation
will include RIISE Project updates from the past
year and introduce new states that have enrolled
or are currently implementing with the RIISE
Project
The SHIFA Project: Developing a Culturally and We find that a CBPR approach can be
Linguistically Sensitive VR Educational Platform effectively used for the co-design of a VR
to Improve Vaccine Acceptance Within a educational program. Additionally, cultural and
Refugee Population linguistic sensitivities can be incorporated
within a VR educational program and are
Samantha Streuli, University of California San Diego; Najla essential factors for effective community
Ibrahim, Somali Family Service of San Diego; Markie Esmailian,
IllumeSense; Manupriya Sharma, Palomar College; Ahmed engagement. Finally, effective VR utilization
Sahid, Somali Family Service of San Diego; Sanjeev Bhavnani, requires flexibility so that it can be used among
Scripps Clinic, Healthcare Innovation & Practice Transformation community members with varying levels of
Laboratory.
health and technology literacy.
Learning Objectives
1. Understand the importance of
We describe using community co-design to
community-based participatory research
create a culturally and linguistically sensitive VR
in the creation and customization of
experience promoting vaccination within a
necessary health interventions for under-
refugee community. Our approach to VR
resourced populations
development incorporated community members
2. Build upon community engagement
at each step of the process. Our methodology is
strategies used in refugee education to
potentially applicable to other populations where
design more effective health interventions
cultural sensitivities and language are common
3. Envision the ways that virtual reality and
health education barriers.
other innovative approaches can be
useful in the development of refugee
health interventions

To combat misinformation, engender trust, and
increase health literacy, we developed a
culturally and linguistically appropriate virtual
reality (VR) vaccination education platform using
community-engaged approaches within a Somali
refugee community. Vaccination rates for the
measles, mumps, and rubella vaccination
(MMR) have been low in this community due to
misinformation linking the MMR to autism.
Methodology
Community based participatory research (CBPR)
methods including focus group discussions,
interviews, and surveys were conducted with
Somali community members and expert advisors
to design the educational content. Co-design
approaches with community input were
employed in a phased approach to develop the
VR storyline. We included 60 adult Somali
refugees and 7 expert advisors who specialize in
healthcare, autism research, technology
development, and community engagement
Session: O20, Submission Number: 1041845 The following themes emerged as barriers to
vaccination: 1) lack of trusting relationships
Perceived Barriers and Facilitators of COVID-19 between RIM communities and government and
Vaccination of Refugee, Immigrant, and Migrant healthcare entities, 2) concerns about vaccine
Communities efficacy and safety, including misinformation,
and 3) limited information about country of birth
Christine Thomas, Windy Fredkove, Seja Abudiab, Yesenia or primary language in data collection. The
Garcia, Sarah Hoffman, Sayyeda Karim, Erin Mann, Kumi
Smith, Kim Yu, Katherine Yun, Elizabeth Dawson-Hahn following themes emerged as potential
facilitators of vaccination: 1) reliable and
Learning Objectives culturally concordant information from trusted
1. To identify barriers to COVID vaccination messengers, 2) vaccine provision directly and
in refugee, immigrant and migrant conveniently to communities, and 3) community
communities. partnership and engagement in vaccine efforts.
2. To identify facilitators to COVID
vaccination in refugee, immigrant and Conclusions/Discussion
migrant communities. Efforts to provide COVID-19 vaccines to RIM
3. To explore approaches to improving communities should focus on partnership and
COVID vaccination access in refugee, community engagement that foster trusting
immigrant and migrant communities. relationships, provide reliable and culturally
concordant information that addresses vaccine
Background and Purpose/Rationale concerns, and maximize convenience of
Refugee, immigrant, and migrant (RIM) vaccination opportunities.
communities have experienced a
disproportionate impact from COVID-19.
Vaccination may mitigate this impact if
equitably provided to RIM communities.
Objective: To identify barriers and facilitators of
COVID-19 vaccination among RIM communities
residing in the United States.
Methodology
We conducted qualitative interviews from
September 2020 through April 2021 among
public health professionals, healthcare
providers, and community members with
experience responding to the COVID-19
pandemic among RIM communities across the
US. Interviews were conducted using a semi-
structured interview guide, audio-recorded,
transcribed, and coded. We conducted a latent
thematic analysis facilitated by Dedoose
qualitative software.
A total of 60 interviews (53 single respondent
and 7 multi-respondent) were conducted. The
86 total informants averaged 10 years of
experience in their field and more than 5 years
of experience working with RIM communities.
Session: O21, Submission Number: 1042886 qualitative software. We identified emergent
themes using latent thematic analysis.
The COVID-19 Response of Health Systems
Caring for Refugee, Immigrant and Migrant Results/Impacts/Outcomes
Communities: A Qualitative Study Among the 20 interviewees from all 10 HHS
regions of the US, they had an average 9.9 years
Seja Abudiab, Yesenia Garcia, Windy Fredkove, Sarah Hoffman, in practice, 22% identified as being a member
Karim, Erin Mann, Christine Thoma, Kim Yu, Katherine Yun,
Tumaini Coker, Elizabeth Dawson-Hahn of a RIM community, they identified caring for
30 RIM communities, and 70% identified
Learning Objectives >50% of patients are LEP. The emergent
1. To examine the perspectives of health themes included: 1) Notable heterogeneity
system providers on collaborating with across health systems engagement with case
public health jurisdictions, particularly investigation and contact tracing, 2) Health
with regards to refugee, immigrant and systems with regular meetings involving multiple
migrant (RIM) communities during the stakeholders (including public health, health
COVID-19 response. systems, civic leaders, community organizations)
2. To explore the perspectives of health were able to identify problems and mobilize
system providers on facilitators of the rapidly, 3) The importance of building
COVID-19 response (education, testing, community trust prior to the pandemic.
case investigation, contact tracing,
vaccination) in RIM communities. Conclusions/Discussion
3. To explore the perspectives of health Cross sector alignment between public health
system providers on barriers of the and health systems and sustainable community
COVID-19 response (education, testing, partnerships are key facilitators of the COVID
case investigation, contact tracing, response with RIM communities.
vaccination) in RIM communities.

COVID-19 disproportionately impacted refugee,
immigrant and migrant (RIM) communities.
Little is known about the collaboration between
public health and health systems during the
COVID-19 pandemic, particularly as it relates to
RIM communities. Objective: We aimed to
examine the perspectives of health system
providers on collaborating with public health
jurisdictions during the COVID-19 response in
refugee, immigrant and migrant communities,
and to explore facilitators and barriers to the
COVID-19 response with RIM communities.
Methodology
We conducted qualitative interviews from
November 2020 through March 2021 using
stratified purposeful sampling of healthcare
providers of refugees, immigrants and migrants
in the United States. Interviews were conducted
with a semi-structured interview guide, audio-
recorded, transcribed, and coded with Dedoose
Session: O22, Submission Number: 1046420 education materials, hosting workshops with
community partners specifically focusing on
Community-based Collaboration: Meeting families with children, conducting a community
Refugees’ Needs During COVID-19 needs analysis on the impact of COVID on the
social determinants of health for residents, and
Mary Helen O'Connor, Ashli Owen-Smith, Iris Feinberg, Andrew researching vaccine hesitancy and
Kim, Beverly Burks
misinformation
Learning Objectives
This presentation will describe the activities,
able to describe how to recruit, organize,
services, and research emerging from our
and manage a volunteer community task
collaborations with community partners
force
including the results of a community needs
analysis, development and dissemination of
to discuss how COVID-19 impacted the
culturally and linguistically tailored COVID
social determinants of health in a refugee
health information, distribution of PPE, testing
resettlement community.
and vaccine information, and ongoing needs as
the vaccine has become available.
able to locate a range of culturally and
linguistically appropriate health
education materials on COVID-19.
We hope sharing the HOW and WHAT of our
COVID Task Force community collaboration can
inform and prepare others for future public
Vulnerable communities including RIM and
health concerns.
minorities have been disproportionately affected
by the ongoing COVID-19 pandemic. For RIM
community residents long-standing health
inequities are exacerbated by culturally and
linguistically ineffective risk communication
practices about COVID-19. Supporting refugee
communities during COVID-19 requires a multi-
pronged community-based approach. Our
presentation will focus on the efforts of a
volunteer multidisciplinary, multi-sector
community task force, the Clarkston Community
COVID Task Force, to respond to the needs of
the refugee community in Clarkston, Georgia as
the pandemic unfolded.
Methodology
The volunteer task force composed of
community clinicians, local municipal and
health department government representatives,
resettlement and social service providers, and
academics met weekly to prioritize and respond
to the needs of the community as the pandemic
unfolded. Approaches included developing
COVID-19 mitigation and vaccine information in
multiple languages and modalities, distributing
PPE and health literate, plain language health
Session: O23, Submission Number: 1048530 access to services and a lack of durable
solutions for Somali refugees has led to a
COVID-19 Restrictions and Their Impacts on “groundswell” of mental health issues (1), while
Migrant Health in Humanitarian Contexts pandemic-related slowdowns in the processing
of US asylum applications in Mexico has created
Carol Devine, Sandra Smiley conditions favourable to disease transmission in
shelters (2).
Learning Objectives
1. Upon completion, participant will be able Results/Impacts/Outcomes
to describe the health and humanitarian COVID-19 restrictions negatively impacted
impacts of COVID-19 restrictions on migrant and refugee health in varied ways: from
displaced populations in at least two aggravating mental health conditions to limiting
countries/contexts. access to essential services like medical care
2. Upon completion, participant will be able and sanitation.
to describe why effective and ethical
pandemic public health responses must Conclusions/Discussion
be implemented with migrant and refugee In many contexts, migrant and refugee
populations in mind. populations were unable to benefit from COVID-
3. Upon completion, participants will be 19 public health responses or were harmed by
able to define how a medical restrictions. The negative health consequences
humanitarian organization, documented of such measures can be diverse and widespread
the consequences of restrictive if they are designed to exclude and executed
government (or other) COVID-19 policies without migrant, displaced and refugee
on health and used a qualitative populations in mind. To maximize the health
framework to identify and advocate on and well-being of migrant and host populations
negative impacts to try to improve health alike, governments should consider the needs of
conditions for displaced peoples during a people on the move when developing and
pandemic. implementing public health measures.

Médecins Sans Frontières/Doctors Without
Borders (MSF), an independent medical
humanitarian organization, is providing COVID-
19 support in 50 countries. Through its medical
activities, MSF has witnessed how COVID-19
restrictions have compounded health risks for
migrants and asylum-seekers in several contexts.
This presentation will illustrate this trend using
examples observed by MSF teams during the
course of their work, and consolidate
recommendations for epidemic response and
health service delivery more inclusive of migrant
and displaced populations.
Methodology
Through the use of routine data, MSF
documented the negative consequences of
COVID-19 policies for migrant and refugee
health in a number of different contexts. For
example, in Dadaab camp, Kenya, limited
Session: O24, Submission Number: 1048481 healthcare appointment (telehealth vs. in-
person).
Exploring and Addressing the Healthcare
Challenges of Refugees and Immigrant Families Results/Impacts/Outcomes
During the Covid-19 Pandemic Results: Our results showed that multiple
barriers to healthcare access exist for refugees
Dominique Dundaru-Bandi, Alyssa Daianska, Gillian Morantz, and immigrants. Solutions for barriers to
Meriem Ferkli, Patricia Li
healthcare access are multidimensional and
situation- dependent, including 1) Newcomer
Learning Objectives
(patient) navigators; (2) Increased knowledge on
1. Describe some of the challenges faced by
healthcare resources and telehealth; (3) Use of
families in seeking healthcare services
telehealth for specific situations during a
during the COVID-19 pandemic
pandemic, and (4) Interpreters to moderate
2. Describe how in-person and virtual care
language barriers.
has cast additional challenges during the
COVID-19 pandemic to families requiring
healthcare services.
Conclusion(s): The COVID-19 pandemic has
3. Describe some of the possible strategies
brought to light and amplified socioeconomic
to mitigate the challenges faced by
and health inequities faced by refugees and
families in seeking healthcare services,
immigrants. This vulnerable group also faces
during the pandemic and beyond.
multidimensional barriers to healthcare which
require multidimensional solutions.
Background: The COVID-19 pandemic has
intensified pre-existing inequities in healthcare
and outcomes for vulnerable populations around
the world. Refugees and immigrants are
particularly impacted as they already faced
various barriers in accessing healthcare.
Objective: (1) To explore experiences and
challenges in accessing healthcare, including
telehealth and in- person visits, during the
COVID-19 pandemic for refugee and immigrant
families cared for at a clinic specializing in
newly-arrived migrants within an academic
pediatric hospital, and (2) To identify possible
mitigation strategies to address these barriers.
Methodology
Design/Methods: Qualitative study using semi-
structured phone interviews with 23 parents of
refugee (including asylum-seekers) and
immigrant children, 2 pediatricians and a
newcomer (patient) navigator affiliated with the
clinic. Interviews were recorded, transcribed,
and subjected to thematic analysis using NVivo
software. We grouped themes as being
structural, financial, or individual barriers based
on a modified Healthcare Access Barriers model,
and themes were further analyzed by the type of
Session: O25, Submission Number: 1023778 developing culturally-sensitive interventions that
fit into the framework of patient-centered care?
Promoting Interfaith Collaborations Among
Refugee Service Providers Results/Impacts/Outcomes
Panelists and researchers formed a core team
Erum Agha, UNC Chapel Hill - School of Medicine; Melissa and dialogue from this panel was summarized
Jenkins, Anderson Al Wazni, Azleena Azhar, Arshiya Siddiqui
and was presented to a national interfaith non-
profit. A fellowship grant was awarded to the
Learning Objectives
team to develop a toolkit for refugee service
providers to help incorporate discussions on
able to define the differences between
religion and spirituality. This toolkit and training
religion, faith and spirituality
will be delivered to resettlement and refugee
service providers in North Carolina.
able to describe the importance of
incoporating discussions on faith and
spirituality when providing services to
Discussions on faith and spirituality are
refugee clients
important to refugee health and healing and may
serve to facilitate holistic healing of the client.
able to conduct discussions that include
Trainings and toolkits developed for practitioners
religion and spirituality with refugee
will help bridge the gap.
clients

The North Carolina refugee community is
religiously diverse. Health professionals are
challenged by the complexity of how displaced
persons view religion and spirituality. Medical
literature notes that religion and spirituality can
provide a sense of meaning for patients
diagnosed with an illness. However, these
discussions are routinely absent from
professional consultations. In order to address
this knowledge gap, a panel of community
refugee service providers was organized at a
university in southeastern United States.
Methodology
The panel first established a common
understanding of the similarities and differences
for “religion/spirituality/faith”. Then, they shared
their interfaith experiences. Finally, they
discussed how examining religion and
spirituality can be significant and how faith may
be an anchor for healing traumatic experiences.
The following questions emerged from the panel
discussion: (1) when making clinical
assessments from a biopsychosocial approach,
to what degree are religion/spirituality
incorporated? (2) what ethical issues exist in
Eighteen months after the program’s launch, it
Health Equity Through Access to Comprehensive has successfully enrolled over 50,000 New
Quality Primary Care: The NYC Care Outreach Yorkers and over 50% of members are accessing
Model primary care for the first time. Currently, thirty
Community-Based Organizations (CBOs) are
Sara Guevara, NYC Health and Hospitals Central office; Yury connecting community members to the program
Parra, NYC Health and Hospitals Central office; Marielle Kress,
NYC Health and Hospitals Central office; Jonathan Jimenez, and eight aid with the direct enrollment process.
NYC Health and Hospitals Central Office Enrollees speak over 36 languages, including:
Spanish, English, Russian, Polish, and Chinese.
Learning Objectives
1. Describe the NYC Care access program Conclusions/Discussion
and how it delivers high quality care to The diverse and culturally representative
uninsured and immigrant New Yorkers communication and marketing strategies, and
2. Demonstrate the key role of partnerships the community based-organization partnerships
with community-based organizations in make NYC Care a model for outreach and
reaching out to immigrant communities connecting to the uninsured community. The
3. Describe outreach strategies that model prioritizes community engagement, and
prioritize community engagement among helps break down language barriers to facilitate
groups with language barriers and no enrollment and increase access to health care
legal immigration status for all.

A large number of noncitizen New Yorkers
remain ineligible for health insurance, and many
individuals who are eligible remain uninsured
due to language and health literacy barriers to
enrollment. Many immigrant New Yorkers
represent hundreds of displaced communities
who share many challenges with the refugee
community, including limited access to high
quality health care. The innovative health care
access program, NYC Care, led by NYC Health +
Hospitals, aims to provide care for all, regardless
of ability to pay or immigration status.
Methodology
The program goal is to deliver an optimal patient
experience with access to primary, specialty,
and pharmacy services. Essential to the
program’s success are the unique community-
based organization partnerships that are central
to the outreach strategy. Additionally, the focus
on universal communication and marketing in
over 13 different languages, and direct ethnic
media involvement are at the core of the
program’s model.
Session: O27, Submission Number: 1047956 status as rightsholders and custodians of their
unceded territories. Restoring connection to
Reconciliation: An Indigenous Framework for land via refugee settlement, could lead to
Refugee Wellbeing tangible health outcomes for those involved in
the process of shared displacement and shared
Asta Rowe disenfranchisement.
Learning Objectives Results/Impacts/Outcomes

1. Conceptualize reconciliation as a driver Improved health outcomes for refugee and
for refugee health and wellbeing Indigenous populations through "reconciliation
2. Export best practices and apply within as accountability"
other environments that involve refugee
health outcomes
3. Understand that the political
ramifications of truth & reconciliation
exceed a political framework

This speculative presentation asks whether
holding refugees accountable for practicing
reconciliation with the Indigenous peoples where
they settle, can lead to better health outcomes
for both demographics. As a second step, it asks
what health indicators could be developed to
account for improved health outcomes within
the concerned populations. TRC calls to action
93 and 94 stipulate that certain reconciliatory
measures be adopted alongside the granting of
Canadian citizenship. Newcomers to the country
are to be educated on Crown-Indigenous
treaties, and are to acquire knowledge on the
histories and cultures of the Indigenous peoples
of the country. The Association for New
Canadians (ANC), a pan-provincial settlement
agency in Newfoundland and Labrador, has
therefore developed the Roots & Resilience
Project (RRP) project to foster accountability for
GARs and PSRs with respect to the Indigenous
peoples of the province. Can this politically-
motivated measure bear out positive health
outcomes for refugees? In other words, can
accountability towards Indigenous peoples
cultivate a sense of citizenship within refugee
populations? Reconciliation as a collective
national practice can potentially foster a sense
of belonging, community and responsibility that
are drivers for successful refugee settlement.
<br>Conversely, if Indigenous elders and
communities are involved ritualising the
integration of newcomer, this legitimises their
Session: O28, Submission Number: 1052426 pervasiveness of discrimination and oppression
directed towards Migrant Caravans.
Borders and Policies: A Critical Discourse
Analysis of the Dehumanization of Migrant Results/Impacts/Outcomes
Caravans by North American Media The consequences of media’s negative portrayal
of ‘Migrant Caravans’ cannot be ignored. They
Latoya T. Reid contribute to pathologization and
dehumanization by perpetuating single stories
Learning Objectives that foster a false consciousness which becomes
4. Upon completion, participants will be perpetuated as ‘truths’.
able to define the term migrant caravans
in relation to the Northern Triangle Conclusions/Discussion
Countries of Central America. The research suggests ways in which discursive
5. Upon completion, participants will be othering can lead to the dehumanization of
able to identify at least 3 consequencs of Migrant Caravans, and, by extension, asylum
media's negative portrayal of migrant seekers, and offers insights into the
caravans. collaborative role of stakeholders in advocating
6. Upon completion, participants will be for the resettlement of the latter It also critiques
able to describe the relationship among the role of the Canadian government as
power, language and equality. complicit to dehumanization by repealing the
U.S. Canada Safe third Country Agreement.
Media discourses are frequently accepted as
‘truths’ by their unsuspecting readers; however,
publications and discourses are often influenced
by elites of the dominant class who use this
medium as a political tactic to sway public
opionin on crucial matters, like immigration.
Knowledge, therefore, is not neutral. Many
newspapers are known to misrepresent
immigrants and refugees by employing
discriminatory language and exclusionary
strategies which in turn legitimize anti-
immigration discourses by politicians, increase
restrictive immigration and asylum policies,
welfare restrictions and polarized perspectives
towards immigrants and refugees (Foucault,
1980; Medianu et al, 2015; Smets & Bozdağ,
2018, van Dijk, 1991, van Dijk, 1993).
Methodology
To fully understand the relationship among
power, language and equality in tandem with the
Migrant Caravans of the Northern Triangle
countries, we must challenge the narratives and
the staus quo while advocating for change
through counter-narratives. Using critical
discourse analaysis of North American
newspapers, the research highlights the
Session: O29, Submission Number: 1043218 community leaders(n=4), and case
workers(n=7). The interviews were audio
Barriers to Healthcare Access for Refugees recorded, transcribed, and analyzed using
Resettled in Connecticut During the Coronavirus grounded theory methodology. Thematic
2019 (COVID-19) Pandemic: Qualitative consensus was achieved between all members of
Perspectives from Frontline Providers the research team.
Rebecca Leff, School of Medicine, Faculty of Health Sciences, Results/Impacts/Outcomes

Ben-Gurion University of the Negev, Beer -Sheva, Israel; Maggie
Smith, Emory University School of Medicine, Atlanta, GA; Amy Five major themes described how the pandemic
Zeidan, Emory University School of Medicine, Atlanta, GA; exacerbated pre-existing barriers; (1)limited
Fereshteh Ganjavi, Integrated Refugee and Immigration availability of linguistically appropriate COVID-
Services; Pooja Agrawal, Yale University School of Medicine,
New Haven, CT 19 resources and healthcare, (2)limited
transportation for healthcare services,
Learning Objectives (3)difficulties navigating the healthcare system,
1. Describe what barriers refugees resettled (4)crowded living conditions, and (5)gender-
in Connecticut faced in accessing related barriers to care. Five major themes
healthcare during the COVID-19 illustrated new pandemic-derived barriers;
pandemic. (1)inaccessibility of telehealth and online care
2. Evaluate the challenges and successes of portals, (2)infection related stigma, (3)COVID-
telemedicine as a replacement for 19 exposure through employment and public
traditional in-person medical transportation, (4)reduced community support,
consultations for the continued provision and (5) delayed in-person initial refugee health
of healthcare for refugees resettled in the assessments for newly arrived refugees.
Connecticut during the COVID-19
pandemic. Conclusions/Discussion
3. Describe the acceptability and feasibility The pandemic exacerbated chronic inequities for
of health protection strategies aimed at resettled refugees while additionally fomenting
mitigation of local COVID-19 new barriers to healthcare access. Pandemic
transmission amongst refugees resettled driven health-initiatives, including telehealth
in Connecticut. and online care portals, should be adapted for
refugee populations who face considerable
Background and Purpose/Rationale obstacles navigating care.
Refugee populations may be at higher risk for
exposure to coronavirus 2019(COVID-19) and
face unique challenges in implementing public
health guidelines. However, data on barriers to
healthcare access during the COVID-19
pandemic amongst refugee populations in the
United States are limited. We conducted a
qualitative study of frontline providers to
investigate experiences and perceptions of
healthcare for refugees resettled in Connecticut
during the COVID-19 pandemic.
Methodology
In-depth semi-structured interviews were
conducted with 20 key-informants from the
following groups: community health
workers(n=3), clinicians(n=6), refugee
Session: O30, Submission Number: 1043588 individuals/communities (e.g., bereavement
support, material support for job losses),
Promoting Refugee Health in Resettlement communicating information and maintaining
During COVID-19: Experiences and Perspectives community trust with quickly-changing health
of Community Health Workers guidelines, and frustration over feeling
dismissed by white/U.S. stakeholders (primarily
Julie Tippens, Alexandra Martin, Virginia Chaidez, Sheila Dorsey health providers, e.g., over-focus on professional
Vinton, Elizabeth Mollard, Angela Palmer-Wackerly, Lanetta (Poe
Poe) Edison-Soe, Nyabuoy Chan, Brittany Bearss, Evelyn credentials, dismissal of cultural expertise).
Estrada-Gonzalez CHWs relied on informational and emotional
support from supervisors and peers during
Learning Objectives COVID-19 (e.g., check-ins, debriefings). Several
1. Describe the roles and responsibilities of CHWs expressed a desire for additional mental
refugee community health workers health and trauma-informed care training to
(CHWs) during COVID-19 support communities.
2. Recognize CHWs' barriers and facilitators
in addressing health inequities during a Conclusions/Discussion
pandemic Supporting CHWs through increased recognition
3. List at least three ways to integrate CHWs of expertise and inclusion in decision-making
into sustainable, culturally sensitive, (e.g., patient care plans), expanding
community-based health programming opportunities for information-sharing and
efforts emotional support from peer networks, and
providing professional development
Background and Purpose/Rationale opportunities may enhance CHWs’ self-efficacy,
Community health workers (CHWs) – frontline job satisfaction, and wellbeing during health
health workers who are members of the emergencies.
communities they serve – are critical to
addressing COVID-19 health disparities among
refugee communities. Yet, the experiences and
perspectives of CHWs are rarely centered in
health research or programming.
Methodology
We conducted in-depth, semi-structured
interviews with 10 CHWs representing and
serving different refugee communities in
Lincoln, Nebraska during COVID-19. Questions
focused on CHWs’ perspectives of community
needs, priorities included poor mental health
Community priorities included poor mental
health related to job loss, social isolation, and
increased caregiving responsibilities during
COVID-19. CHWs noted workplace conditions
(e.g., meatpacking plant conditions),
multigenerational households, and cultural
practices (e.g., physical greetings) as posing
challenges to mitigating COVID-19 transmission.
CHWs’ stressors included balancing roles,
perceived inability to effectively support
COVID-19 Infection and Contact Tracing Among We found a high risk of COVID-19 infection
Refugees in the United States among refugees in the U.S. Contact tracing
remains an issue among refugee populations.
Mengxi Zhang, Katherine Yun, Ashok Gurung, Philip Anglewicz, Public health authorities should partner with
Anisa Ibrahim, Mahri Haider, Jacob Atem, Jenni Thang, Navid
Hamidi, Ahmed Ali, Siqin Wang refugee community leaders and organizations to
conduct contact tracing to slow the spread of
Learning Objectives COVID-19.
1. Measure COVID-19 infection among
refugees in the United States
2. Describe COVID-19–related risk factors
among refugees in the United States
3. Understand the implementation of
contact tracing among refugees in the
United States

Immigrants are believed to be at high risk for
infection with severe acute respiratory syndrome
coronavirus 2, the virus that causes coronavirus
disease 2019 (COVID-19). We aimed to
describe COVID-19-related risk factors and
implementation of contact tracing among
refugees in the U.S.
Methodology
From December 2020 to January 2021, we
emailed or messaged anonymous online surveys
in English, Nepali, or Somali-language to 12
bilingual leaders in the Afghan, Bhutanese,
Somali, South Sudanese, and Burmese refugee
communities in the U.S. We invited the
community leaders to complete the survey and
share the link with others who met inclusion
criteria (aged ≥18 years, currently living in the
U.S.).
Of 435 refugees in 32 states who completed the
survey, 115 (26.44%) reported testing positive
with COVID-19. Having an infected family
member (odds ratio [OR] = 7.53; 95%
Confidence Interval [CI], 4.19-13.53) and
knowing people in direct contact with infected
(OR = 2.31 95% CI, 1.09-4.90) were risk
factors for infection. Among those who tested
positive, 84.35% were contacted by state/local
public health departments for contact tracing.
Session: O32, Submission Number: 1041428 a consistent COVID-19 messaging system, to
disseminate messages to partners, and to
A Collaboration to Harmonize COVID-19 Health identify message gaps as the pandemic evolved.
Messaging and Fill Communication Gaps During
Initial U.S. Refugee Resettlement Results/Impacts/Outcomes
As a result of this work, new communication
Megan Keaveney, Cassie Le, Kate Steger, Neha Sood, Kim, materials including a fact sheet, a welcome
Susan; Dicker International Organization for Migration,
Alexander; Klosovsky International Organization for Migration; booklet, and infographics were created, released
Holly Herrer, Emily Jente in early Fall 2020, and translated into 19
languages, in order to address refugee health
Learning Objectives partners’ need for culturally and linguistically
1. Define key communication needs appropriate educational materials for refugees.
identified by federal partners as priority
for resource creation and development. Conclusions/Discussion
2. Describe key challenges and Rapidly changing health communication needs
opportunities with synergizing COVID-19 during the pandemic fostered the opportunity for
prevention messaging across the refugee collaboration among federal and refugee health
resettlement continuum. partners and reflects a long-standing need
3. Identify COVID-19 resources created by among agencies to address health messaging
work group and be able to locate across the continuum of care for refugees.
resources and disseminate to key
partners.

In December 2019, coronavirus disease (COVID-
19) was first identified in Wuhan, China. On
March 11, 2020, the World Health Organization
(WHO) declared the COVID-19 outbreak a global
pandemic. Although the U.S. refugee
resettlement program was temporarily
suspended for four months from March - June
2020, some refugees continued to arrive during
this time and more regular refugee movement
resumed after July 2020.
Methodology
To address the communication needs of U.S.-
bound refugees before, during, and after travel
to the United States, five agencies (Department
of State Bureau of Population, Refugees and
Migration (PRM); Centers for Disease Control
and Prevention (CDC); Office of Refugee
Resettlement (ORR); Cultural Orientation
Resource Exchange (CORE); and the
International Organization for Migration (IOM))
collaborated on a strategic work group to
synergize COVID-19 prevention health
messaging and COVID-19 considerations before,
during, and after travel, as well as to promote
shared resources. This group sought to establish
Session: O33, Submission Number: 1024882 performed with Wilcoxon Signed Rank and Mann
Whitney U testing.
Caring for Refugee Patients: An
Interprofessional Crash Course in Resettlement, Results/Impacts/Outcomes
Medical Intake, and Culture Of the 161 attendees, 63 completed the pre-
survey (39% response rate) and 49 completed
Alana Petrassi, Melissa Chiu, Kelsey Porada, Bryan Johnston, the post-survey (30% response rate). Of the
Michael Toppe, Michael Oldani, Caitlin Kaeppler
knowledge-based questions, statistically
significant improvements were seen for all 9. Of
Learning Objectives
the questions assessing comfort in cross-cultural
1. Describe the factors, as defined by the
interaction, all 3 showed improvement, but only
UN, that makes an individual a refugee
1 was statistically significant.
and briefly outline the refugee
resettlement process.
2. Gain an understanding of the term
The 2-hour session demonstrated improvement
“cultural humility” and begin the self-
of knowledge of refugee health. Changes in
reflective process of examining one’s own
comfort in cross-cultural interaction, however,
cultural biases.
did not demonstrate the same improvement,
3. Gain an understanding of the
indicating that further interventions focusing on
responsibilities of the federal, state, and
improving cross-cultural comfort are needed.
local organizations involved in refugee
resettlement and how medical care is
provided and augmented through them.

Refugees are eligible for the same healthcare
options as US citizens and access healthcare at
similar rates. Many students, however, do not
feel that they have received adequate instruction
in caring for this unique population. The
objective of this study was to evaluate whether
an interprofessional 2-hour presentation could
improve knowledge of refugee health topics and
comfort with cross-cultural interaction.
Methodology
Presentation topics were determined by a team
of healthcare providers, medical educators, and
refugee resettlement workers based on literature
review and expert opinion. The session consisted
of an introductory didactic lecture, followed by
three small group sessions, two of which were
didactic lectures and one of which was a panel
discussion. One hundred and sixty-one students
enrolled in various healthcare degree programs
attended the presentation via Zoom. Participants
were asked to complete pre- and post-surveys
that assessed comfort in cross-cultural
interaction and knowledge of refugee health.
Pre-post analysis of Likert scale questions was
Session: O34, Submission Number: 1036310 developed referral relationships with over 20 law
and advocacy organizations. BHRAC now also
Model for a Medical Student-Run Asylum Clinic conducts evaluations for immigrants
experiencing domestic violence and trafficking
Elizabeth Toll, Brown University; Alizeh Shamshad, Brown and offers a social and medical resource list for
University; Liana Lum, Brown University; Odette Zero, Brown
University clients.

1. Describe the benefit for asylum seekers Our asylum clinic provides a model for
of having an affidavit done by a medical coordinated and accessible evaluations and
or psychological professional when affidavits for undocumeted individuals seeking
presenting their court cases legal status in the U.S. BHRAC’s future work
2. Describe one method the medical includes training more evaluators and student
student-run asylum clinic has used to scribes, expanding partnerships with local
develop a workforce of trained medical organizations, and connecting with other
and psychological evaluators student-run asylum clinics.
3. Describe one step the medical student-
run asylum clinic has used to expand
clients who can access its services

Individuals seeking asylum in the U.S. survive
torture, trafficking, and other forms of
persecution. In 2020, only 26.3% of applicants
were granted asylum. However,
medical/psychological affidavits corroborating
client narratives with clinical findings double
clients likelihood
Methodology
BHRAC coordinates lawyers, clinicians,
interpreters, advocacy networks, and medical
students to conduct medical/psychological
asylee evaluations through: 1) An annual
training on evaluation and affidavit-writing
training for clinicians and medical students; 2)
An established workflow for receiving referrals
from Physicians for Human Rights and
community organizations, assigning evaluators
and medical student scribes to cases, and
drafting affidavits; 3) Maintaining a REDCap
database to track evaluation outcomes.
BHRAC has completed over 100 evaluations
since its founding. In 15 of the 18 completed
court cases, individuals were granted asylum
(83.3%). We have trained 139 clinician
evaluators and 147 medical student scribes and
Session: O35, Submission Number: 1044139 Provide insight into multidisciplinary
partnerships and collaboration
Navigating Barriers to Access Higher Education:
Academic Credential Evaluation for Displaced & Results/Impacts/Outcomes
Refugee Students The workshop will be a PowerPoint slideshow
that will describe the philosophy and importance
Zachary Holochwost of academic credential evaluation/assessment.
There will be a brief case study of our own
Learning Objectives successful program, ECE® Aid, to demonstrate
1. Upon completion, participants will have one of countless initiatives assisting refugees.
an introductory understanding of what Likewise, the workshop will open up discussion
academic credential for participants to speak about collaborative
evaluation/assessment is and will be able efforts across multiple disciplines and
to describe the importance of credential organizations.
evaluation, especially in the context of
refugees. Conclusions/Discussion
2. Participants will be given examples of refugees, higher education, professional
successful case studies to demonstrate licensure, credentials
one of many ways refugees can be
assisted in bettering their lives and
communities through higher education.
able to better identify possible
collaborations within various
multidisciplinary fields and organizations
for the benefit of refugees and other
displaced populations.

According to the UNHCR, "Only 3% of refugees
have access to higher education compared to
the 37% global higher education access rate."
Through innovative programming and support,
ECE and ECE® Aid provide a model for offering
free academic evaluations/assessments to help
foster more access and equity to higher
education for refugees and other displaced
populations. This workshop will explain the
importance of academic credential
evaluation/assessment, highlight the program
successes, and show how collaboration between
various stakeholders has worked to assist
refugees in accessing higher education and
professional licensure.
Methodology
- Show the crucial importance of academic
credential evaluation/assessment. Demonstrate
the successes of the ECE® Aid program model.
Session: O36, Submission Number: 1048354 disclosing their HIV status. 3. We have
achieved excellent care outcomes among our
Engaging Refugee Youth Living with HIV into youth born outside of the US including 100%
Care - A Community-based Approach retention in care and over 80% adherence to
care from August 2020 to April 2021. We will
Neerav Desai, Aima Ahonkhai, DeWayne Parker, Leslie Pierce also review some barriers and limitations of this
model.
Learning Objectives
1. Describe a community based approach to Results/Impacts/Outcomes
support young refugees and immigrants Power Point Slides, client testimonials, case
living with HIV to improve retention in based discussions.
care, adherence to treatment, and
transition to adult HIV care. Conclusions/Discussion
2. Describe how a community based HIV/AIDS, Community Based Care
approach allows our clients to access
important community resources in a
setting that is knowledgeable and
respectful of their cultural norms without
the stigma of disclosing their HIV status.
3. Describe where gaps remain for youth
refugees living with HIV in rural areas and
how to improve their access to services
and care through outreach.

Refugee and immigrant youth make up a
substantial portion of young people living with
HIV in our Southeastern United States region. In
our adolescent clinic alone at Vanderbilt
University Medical Center (the largest provider
of HIV care in Middle Tennessee), 50% of our
clients (Ages 10-20) were born outside of the
US. A care model that is prepared to meet
diverse cultural needs is critical for ensuring
optimal health outcomes for our clients
including retention in care, adherence to
antiretroviral therapy, and successful transition
to adult care.
Methodology
1. Review our care model which integrates a
multidisciplinary team of clinical providers with
a social worker, case manager, community
health navigator (CHN), and community based
organizations (CBO) which provide
comprehensive resources to support refugees
and immigrants. 2. The community based model
allows our clients to access important resources
in a setting that is knowledgeable and respectful
of their cultural norms without the stigma of
Session: O37, Submission Number: 1048415 diagnosed with an infectious stage (primary,
secondary) of syphilis. Among all 697 refugees
Syphilis Among US-Bound Refugees, 2015 – diagnosed with syphilis, 406 (58%) were male
2018 and 438 (63%) were from Africa. All infected
patients were treated prior to arrival to the
Shannon Fox, Priti Shah, Michelle Hollberg, Deborah Lee, Drew United States.
Posey
Learning Objectives
Preliminary findings suggest a low but not zero
risk of syphilis infection among US-bound
to evaluate the risk of syphilis infection
refugees. Analyzing additional refugee data and
among refugees based on age, sex, and
trends compared to the US population over time
region.
and adjusting for age could lead to a more
complete understanding of the burden of the
to interpret the rates of syphilis among
disease for this population. CDC improvements
US bound refugees in comparison to the
to data collection processes and quality will
US rates.
facilitate additional assessments needed to
determine further recommendations.
to describe the CDC Syphilis Technical
Instructions for refugees and the
necessary steps to identify a syphilis
case.

US-bound refugees applying for entry into the
United States are required to complete an
overseas medical examination. For refugees ≥
15 years old, the examination includes syphilis
screenings compliant with CDC’s Technical
Instructions. We assessed syphilis screening
data to characterize syphilis seropositivity,
staging, and treatment among US-bound
refugees.
Methodology
We reviewed data for syphilis screening based
on CDC Technical Instructions reported to the
CDC Electronic Disease Notification (EDN)
system for refugees ≥15 years old at
examination date who arrived in the United
States between January 1, 2015 and December
31, 2018.
Of the 176,109 refugees aged ≥15 years with
data in EDN, 160,418 (93%) were screened for
syphilis. Among those who were screened, 697
(0.4%) were diagnosed with syphilis by non-
treponemal screening and confirmatory
treponemal test, and 53 (0.03%) were
Session: O38, Submission Number: 1042390 (difference 16.5 days, p<0.01, 95% CI 9.3,
23.7). There was a higher incidence of LTBI
Fewer Losses in the Cascade of Care for Latent diagnosis in the solo-IGRA group (41 versus 20,
Tuberculosis with Solo Interferon-gamma p=0.002). Screening completion was predicted
Release Assay Screening Compared to by solo-IGRA screening (aOR 3.74, 95% CI
Sequential Screening 2.30, 6.09; p<0.001) and if refugees were
privately sponsored (aOR 2.81, 95% CI 1.53,
Rachel Talavlikar, University of Calgary; Rachel Lim, Onyinye 5.15; p=0.001). Treatment completion rates did
Chiazor, Ulia Bietz, Holly Gardiner, Dina Fisher
not differ between groups.
Learning Objectives
1. Describe a potential model for IGRA-
This study has identified fewer dropouts in the
alone screening for LTBI.
LTBI cascade of care if a solo-IGRA strategy is
2. Understand the benefits of using an
used for screening. An IGRA should be strongly
IGRA-alone screening strategy compared
considered as the screening method for refugees
to sequential screening for LTBI
arriving in low-incidence settings if resources
diagnosis and treatment.
are available.
3. Recognize the benefit of centralized
primary care services for refugees.

Targeting high-risk populations for latent
tuberculosis infection (LTBI) screening and
treatment is an important measure towards
eliminating TB in low incidence countries,
however, there are low rates of screening and
treatment completion in the LTBI cascade of
care. The authors hypothesized that an
interferon-gamma release assay (IGRA)
screening strategy would lead to a higher
proportion of refugees completing screening and
treatment, compared to sequential screening
with tuberculin skin test (TST) and confirmatory
IGRA.
Methodology
This retrospective cohort study included eligible
refugees screened with a sequential strategy
versus a solo-IGRA strategy at different time
periods from a specialized refugee clinic. The
primary outcome was the proportion completing
LTBI screening in each cohort.
472 subjects were included (240 in sequential
screening, 232 in solo-IGRA screening). 54% of
refugees completed screening with sequential
testing, compared to 85% of those screened
with a solo-IGRA. Time to completing screening
was also shorter in the solo-QFT group
Session: O39, Submission Number: 1037796 about which parasites the refugee may have
been treated for pre-departure, and which tests
Development of a Story Map as a Clinical or treatments are still needed, depending on
Decision-Making Support Tool for Treatment of patient symptoms, medication contraindications,
Intestinal Parasites Among Refugees or eosinophilia. Providers can click on
medication names to view countries where those
Laura Smock, Massachusetts Department of Public Health; medications are given pre-departure, and a map
Zakaria Ahmed-Gas, Massachusetts Department of Public
Health; Marisa Chiang, Massachusetts Department of Public of Loa loa endemicity. ESRI ArcGIS Online was
Health; Reed Sherrill, Massachusetts Department of Public used to create and disseminate information
Health; T. Scott Troppy, Massachusetts Department of Public using Story Maps. The story map had 145
Health; Ashley Romero, Massachusetts Department of Public
Health; Jennifer Cochran, Massachusetts Department of Public unique views from 1/13/2020 to 2/13/2021.
Health; Paul L. Geltman, Massachusetts Department of Public
Health Conclusions/Discussion
An interactive story map facilitated MDPH
Learning Objectives modifications of CDC guidelines and
1. Describe a new clinical decision-making dissemination to refugee health assessment
support tool for treatment of intestinal providers. The story map, which guides users to
parasites among refugees check for state-specific guidance, should be
2. Explain how to find and navigate the generalizable as a clinical decision-making
online story map support tool to providers throughout the United
3. Use this tool to determine whether States.
parasite testing or treatment is needed
for newly-arriving refugee patients

The Centers for Disease Control and Prevention
(CDC) provides online guidance to help refugee
health assessment providers determine whether
they need to test and treat refugee patients for
intestinal parasites after arrival in the United
States. The Massachusetts Department of Public
Health (MDPH) has written documents
incorporating this information. We hypothesized
that a web-based visual tool would be an
efficient way to guide providers in clinical
decision-making.
Methodology
Using an ESRI Story Map series template, we
created the Refugee Health Assessment Program
Domestic Parasite Treatment Guidance.
The story map is publicly available:
https://mdphgis.maps.arcgis.com/apps/MapSerie
s/index.html?appid=cd601690dccf46c8939cb5
2bc9004094. It includes links to CDC guidance
and MDPH written guidance. Providers can
interact online by clicking a refugee’s departure
country to see a pop-up window with information
Session: O40, Submission Number: 1048552 knowledge (p= < 0.001). Most respondents
(n=115, 64%) had 2 years’ experience or more
Assessing Barriers, Attitudes, Confidence, and working in humanitarian response, and most
Knowledge of Humanitarian Staff Responding to (n=103, 58%) reported no formal training in
Suicide Risk in Bangladesh responding to suicide risk. However, 29%
reported experience of working with someone at
Lauren Fischer, Ariel Zarate, Mohamed Elshazly, Simon risk of suicide, with a further 18% unsure.
Rosenbaum, Kamruzzaman Mozumder
Learning Objectives
Humanitarian staff having regular refugee
1. Identify areas for suicide prevention
contact reported low confidence with responding
training recommended for humanitarian
to suicide risk, generally agreeing that suicide
staff.
was a problem in the communities where they
2. Describe current training gaps among
worked, but mostly having received no training
humanitarian staff working face-to-face
in suicide prevention. Comprehensive training
with Rohingya refugees in Cox Bazar,
on suicide risk and intervention for frontline
Bangladesh.
staff and gatekeepers is an urgent first step
3. Describe potential implications for
toward addressing suicide in the Rohingya
practice due to training gaps among
response. Monitoring and evaluation of suicide
humanitarian staff working face-to-face
training and interventions should be considered
with Rohingya refugees in Cox Bazar,
in this and other humanitarian contexts.
Bangladesh.

Suicide is a significant but underexamined
health issue in global humanitarian crises.
Accordingly, little is known about humanitarian
workers’ capacity to respond to suicide risk in
affected communities. We developed a tool, H-
BACK-Suicide, to assess staff barriers, attitudes,
confidence, and knowledge in responding to
suicide risk in the Rohingya refugee response in
Bangladesh.
Methodology
The H-BACK-Suicide questionnaire, adapted
from an existing assessment tool, was
disseminated as an electronic Qualtrics survey
in Bangla and English in June 2020, engaging
181 respondents from multiple sectors of the
coordinated response efforts, all of whom had
regular face-to-face contact with the refugee
community.
Respondents with prior training in suicide risk
response scored higher on the overall scale
compared to those without (p= < 0.001). There
was a significant impact of prior training on
attitudes (p=0.005), confidence (p=0.002) and
Session: O41, Submission Number: 1052683 Community Champions’ proposed solutions for
addressing employment inequity were also
Changing Upstream Social Determinants of included in the City of Aurora Colorado’s ten
Health for Refugees and Immigrants year Integration Plan for Immigrants and
Refugees.
Jan Jenkins
Methodology
Learning Objectives Changing upstream social determinants of
1. Identify upstream Social Determinants of health, through systems and policy change, is
Health as essential to health equity. key to improving health and employment equity
2. Describe how addressing systems and for refugees. Grassroots community engagement
policies impacting refugees is key to and advocacy for systems change is essential to
decreasing health disparities. ensuring that refugee/immigrant voices are
3. Envision mental health care for refugees included in the decision-making process
as including both direct clinical services regarding policies which affect their lives.
and engaging in community partnerships Mental health care for refugees includes not
to change upstream social determinants only direct clinical services, but also community
of health. partnerships to change systems and policies
contributing to refugee health inequities.
Changing upstream social determinants of Results/Impacts/Outcomes
health has been identified by the World Health Presentation and interaction regarding the
Organization (2010) as having the greatest complexity of this type of a project involving
impact on health equity for the largest number changing upstream systems, which can take
of people. Our three year grant with the multiple years.
Colorado Department of Public Health examined
systems and policies affecting refugee Conclusions/Discussion
employment opportunities as upstream social Social Determinants of Health, Employment
determinants of health. The study involved:
gathering grassroots community insights on
employment obstacles through community
convenings, communities electing eight leaders
of refugee and immigrant communities, and
working with these Community Champions and
community partners to change systems which
affect employment opportunities and health
disparities. Various strategies utilized included:
training on employment disparities, workers’
rights, income gaps for refugees and
immigrants, digital storytelling, participation
with community non-profit and governmental
entities, direct community action, and advocacy
for systems solutions to address employment
disparities. A primary strategy was elevating
grassroots refugee/immigrant voices to be
included in the decision- making process
affecting systems and policy . An
immigrant/refugee advisory board was created to
provide input to the Colorado State Stakeholder
Committee on New American Employment.
Session: O42, Submission Number: 1043024 positive mental health and wellness outcomes in
Indigenous populations.
Addressing Survivors of Torture Mental Health
Through Indigenous Land-based Healing Conclusions/Discussion
Practice While there exists vast differences between
Canada’s Indigenous populations and refugee
Mbalu Lumor, Chizuru Nobe-Ghelani, York University populations in terms of their relationships to
land, culture and histories, they have also
Learning Objectives shared the similarities in their experience of
1. Enhance Trauma Informed Practices with displacement and subsequent trauma. Would
refugees through Indigenous land-based healing practice grounded in
epistemology Indigenous epistemology be an effective method
2. Explore alternative treatment methods in addressing refugee mental health? If so, what
such as land-based healing for survivors considerations should be taken in implementing
of torture, war, crimes against humanity land-based healing practice with refugee
and genocide. populations? The presenters will share their
3. Reflect on the potential benefits and reflections on these questions and discuss the
risks in applying Indigenous land-based practice implication.
healing to refugee mental health

This paper explores the potential value of land-
based healing grounded in Indigenous
epistemology as a therapeutic intervention when
working with survivors of torture.
Methodology
The Canadian Centre for Victims of Torture
(CCVT) is currently involved in a community
action research project with Indigenous
knowledge holders centered on Indigenous land-
based experiential education and focus groups.
The data from project are analyzed to document
the key learnings and reflections, which will be
used to inform and complement CCVT service
deliveries including trauma healing.
One of the learnings that is emerging from the
project is how Canada’s Indigenous
communities, who have also gone through
traumatic experiences throughout the history,
have benefitted greatly from land-based healing
practice. From the perspectives of Indigenous
worldview, ‘land’ is understood as a relational
component of healing and wellbeing. Indigenous
scholars and practitioners have documented the
effectiveness of land-based activities such as
harvesting, education, ceremony, recreation, and
cultural-based counselling have increased
Torture categories were missed for 5 (14.3%) of
Missed Torture Histories in Asylum Applicants: the 35 applicants who received multiple
Assessing the Frequency of Omissions in evaluations. Of the 60 unique torture categories
Forensic Medical Exams found for these 35 applicants, 7 (11.7%) were
identified by only one evaluation and missed by
Tara Pilato, Weill Cornell Center for Human Rights; Andrew the other(s). However, the average number of
Milewski
categories identified for the applicants receiving
multiple evaluations was only 3% higher than
Learning Objectives
that for the applicants receiving one evaluation;
1. Describe how clinicians can document
this difference was not statistically significant.
the sequelae of trauma to help
substantiate an asylum applicant's claim
for asylum.
Forensic evaluations may fail to identify between
2. Explain why a forensic medical evaluation
3% and 11.7% of unique torture categories or
may not detect every abuse endured by
at least one category in 14.3% of applicants.
an asylum applicant.
Forensic evaluations might therefore benefit
3. Describe strategies for ensuring
from including a checklist of torture categories
comprehensive evaluation of an asylum
to facilitate more comprehensive screening.
applicant's experiences of torture or
abuse.

Individuals applying for asylum in the U.S. carry
scars on their bodies and minds, often as the
only proof of the abuses they experienced.
Forensic medical evaluations performed by
trained clinicians can help corroborate an
applicant’s narrative of abuse by documenting
trauma sequelae. Clinicians are usually
permitted only one session to evaluate an
applicant. We sought to estimate the rate at
which forensic medical evaluations fail to
identify torture categories experienced by
asylum applicants.
Methodology
Unique torture categories (foreign detention,
sexual violence, etc.) experienced by 464
asylum applicants were identified by reviewing
affidavits prepared by clinicians through the
Weill Cornell Center for Human Rights. For the
35 applicants who received multiple
evaluations, the categories identified by one
evaluation were compared to those identified by
the other evaluation(s) for the same individual
and discrepancies were noted.
Session: O44, Submission Number: 1039651 age had a higher proportion of obesity (14.3%,
95% CI 10.5% to 18.1%) compared to Yazidis
Growth Indicators of Yazidi Pediatric Refugees (1.2%, 95% CI 0% to 3.5%), p=0.001, and
Resettled in Calgary, Canada compared to a healthy population (3%).
Roopa Suppiah, Erin Hetherington, University of Calgary; Gabriel Conclusions/Discussion

Fabreau, University of Calgary
This is the first study to demonstrate that Yazidi
pediatric refugees have abnormal growth
Learning Objectives
indicators on resettlement in a high-income
1. List the common medical issues facing
refuge country. The large proportion of stunting
pediatric refugees on arrival to high-
in Yazidis may reflect a harsh and protracted
income refuge countries.
pre-migration experience. Study findings can
2. Describe the growth indicator
inform clinical care when working with Yazidi
abnormalities that have particular
pediatric refugees.
relevance in Yazidi pediatric refugees.
3. Identify the avenues for supporting the
health needs of Yazidi pediatric refugees.

Yazidis are an ethnic group who have faced
genocide by the Islamic State. Canada began
resettling Yazidi refugees in 2016. No studies
have assessed Yazidi pediatric refugees for
growth indicator abnormalities on resettlement,
despite evidence that general pediatric refugees
can arrive with growth issues. This study
assesses Yazidi pediatric refugee growth
indicators on resettlement in Calgary, Canada.
Methodology
A retrospective chart review of 112 Yazidi
pediatric refugees at MOSAIC Refugee Clinic
intake in Calgary was conducted. A control
group of 449 regionally-comparable pediatric
refugees were 4:1 age and sex-matched to
Yazidis. The proportion of stunting, underweight,
wasting, overweight and obesity, WHO-defined
growth indicators, were calculated and
compared between the two cohorts and
compared to the proportion expected in healthy
children according to WHO Growth Charts for
Canada.
The proportion of Yazidi pediatric refugees with
stunting was 18.8% (95% CI 11.5% to 26.0%)
which was higher than controls (10.9%, 95% CI
8.0% to 13.8%), p=0.025. Both cohorts were
more stunted than expected in a healthy
population (3%). Controls older than 5 years of
A total of 20 IDIs were conducted (7 parents
For the Parent, by the Parent: Creating a and 13 care providers). The main topics that
Program to Empower Parents of Refugee were identified to be incorporated into the
Background Using Novel Participatory program include features of child development,
Approaches how to address resettlement issues, child
advocacy, and parenting in the Canadian
Pardeep Kaur Benipal, Bernice Ho, Ripudaman Minhas context. Participants felt that tackling the
language barriers, addressing the overlapping
Learning Objectives responsibilities of the mothers attending the
1. Upon completion, participants will be sessions, providing incentives, increasing
able to describe the parenting concerns awareness of the program, and using an anti-
of parents of refugee background. racist and anti-oppressive approach is key to the
2. Upon completion, participants will be program’s success. Participants emphasized the
able to demonstrate why the CBPR need for trauma-informed mental health support
methodology is effective in designing a within the program model.
parenting interventions for
disenfranchised populations. Conclusions/Discussion
3. Upon completion, participants will be This study describes the key considerations for a
able to list the features of the novel novel parenting program for families of refugee
parenting program model. background, by engaging them as key
stakeholders in the program design process.
Background and Purpose/Rationale Future iterations of this project would involve a
Families of refugee background have complex, pilot and evaluation of the program.
multigenerational mental health and
developmental needs that are not accounted for
in current programming frameworks. Providing
appropriate support services and educational
resources that address the concerns of families
of refugee background will address these
challenges, allowing for improved family
cohesion and developmental outcomes for
children. This study gathers data about the
experiences of parents of refugee background in
order to develop a novel, multi-dimensional
parenting program model using Community-
Based Participatory Research (CBPR) principles.
Methodology
This was a qualitative, CBPR study using a
formative research framework. In-depth
interviews (IDIs) were conducted with parents of
refugee background and care providers that work
closely with this population. Data were recorded,
transcribed, and coded using deductive and
inductive coding methods by two independent
coders.
Session: O46, Submission Number: 1044178 primary care staff, and provided ongoing support
through weekly check-ins.
Implementing the Strengths and Difficulties
Questionnaire for Refugee Pediatric Mental Results/Impacts/Outcomes
Health: Maryland Pilot Program The SDQ was integrated into an established
web-based data collection tool. Virtual ninety-
Emily Fitzpatrick, Heather Kathrens, Dipti Shah minute trainings were conducted with 17
refugee health clinical and administrative staff.
Learning Objectives Stakeholder feedback included innovative use of
1. Upon completion, participants will be interpreters and colloquial language
able to understand the background and discrepancies. We added guidance for
utility of the Strengths and Difficulties connecting patients with low overall SDQ scores,
Questionnaire in multiple settings but high subcategory scores, to appropriate
relevant for assessing refugee pediatric services. While administrative changes and
mental health. pandemic travel restrictions led to fewer
2. Upon completion, participants will be pediatric arrivals, the capacity to expand the
able to describe considerations for program to include additional translations exists.
determining refugee pediatric mental
health programming needs. Conclusions/Discussion
3. Upon completion, participants will be Lessons learned from the SDQ pilot program will
able to discuss strengths and limitations increase awareness among primary care staff of
of implementing refugee pediatric mental pediatric mental health screening needs and
health screening in primary care settings. inform approaches for program integration.

Unaddressed mental health problems in children
leads to increased morbidity, mortality,
decreased quality of life, and poorer social
adaptation in resettlement countries. Since
2012, Maryland has provided mental health
screening for humanitarian immigrants ≥14
years of age; however, almost 35% of arrivals in
2019 were younger and not formally assessed
for symptoms of depression, anxiety, or PTSD.
This indicates the need for a screening tool that
is brief, culturally and linguistically diverse, and
validated in primary care settings. The Strengths
and Difficulties Questionnaire (SDQ) is an
evidence-based 25-item behavioral screening
tool developed for 4–17-year-olds and available
in over 40 languages.
Methodology
This pilot program implemented the SDQ Parent
Report during the refugee health assessment for
pediatric refugees, 5–13 years of age.
Translations included Dari, Pashto, English, and
Spanish. We created a standardized SDQ
protocol, conducted comprehensive training for
Session: O47, Submission Number: 1048550 with multiple health problems (number of
referrals to subspecialists: median 3.0, range 0-
Evaluation of a Newcomer Navigator Program for 14). From pre- to post-intervention, there was a
Newly-arrived Immigrant and Refugee Children significant decrease in no-show rates at our
clinic (14.5% vs 4.3%, p<0.001), an increase
Jennifer Merariu, Bayan Sabsabi, Meriem Ferkli, Patricia Li in the number of patients with no ED visits
(75.3% vs 86.8%, p=0.016) and an increase in
Learning Objectives investigations being done on the day they were
1. Describe the role of patient navigators in ordered (70.4% vs 79.1%, p=0.014).
the care of immigrant and refugee
children Conclusions/Discussion
2. Describe the impact of patient navigators The Newcomer Navigator Program in the context
on immigrant and refugee children in of our immigrant and refugee clinic has led to
terms of outcomes and processes improved processes of care and healthcare
3. Describe area for future research in the utilization outcomes. Future studies should
field of patient navigators and newcomer determine the cost-effectiveness and optimal
health implementation of navigators across hospital
and community settings.
Patient navigators have been implemented to
guide children and families on their healthcare
journey across a range of chronic diseases, but
few studies have demonstrated outcomes of
navigators for the newly-arrived immigrant and
refugee population. We conducted a quality
improvement initiative with a Newcomer
Navigator program aimed at improving processes
of care and healthcare utilization outcomes at a
clinic in a tertiary care pediatric hospital
specialized in serving newly-arrived immigrants
and refugees.
Methodology
We conducted a retrospective chart review of
newly-arrived children seen for the first time
before (23/02/2018-21/02/2019) and after
(22/02/2019-21/02/2020) implementation of
the program. Data collection included baseline
demographics, processes of care (interpreter
presence, time to investigations), and healthcare
utilization outcomes (clinic no-show rates,
vaccination attendance at local health centres,
ED visits). Data was compared pre- vs. post-
intervention using Fisher’s exact and Mann-
Whitney U tests.
Our analysis included 297 children (138 pre-,
159 post-intervention), mainly comprised of
refugees (81.8%; resettled and asylum-seekers)
Session: O48, Submission Number: 1048637 revealed four challenges: informational gaps,
financial constraints, coverage inconsistencies
Patient and Provider Perspectives on Migrants’ and social differences. These barriers led to
Access to Prescription Drugs in Ontario refusals of care, medication anxiety, coverage
unawareness, coping behaviours to manage the
valentina Antonipillai, Andrea Baumann, Lisa Schwartz, Olive loss of access to prescription drugs and long-
Wahoush
term health consequences. Supports identified
include navigational aid, providers who are
Learning Objectives
coverage knowledgeable and culturally sensitive,
1. Participant will be able to identify
and short-term solutions such as funds, samples
barriers refugees and immigrants face
and compassionate programs. Gaps in short-
when trying to access medications in
term supports were perceived by participants
Ontario
who proposed key policy and practice
2. Participant will be able to determine how
recommendations.
to assist refugees and immigrants who
are uninsured or under-insured to access
medications
Solutions to address barriers to medication
3. Participant will be able to learn about the
access for migrant populations involves
prescription drug coverage system for
intersectoral policy approaches, such as
migrants in Ontario
universal pharmacare complimented by drug
monitoring system safeguards and informational
supports, to alleviate difficulties migrant
In Canada, migrant populations are less likely to
patients experience to access the medications
use health services or obtain prescription drug
they need.
coverage, compared to their Canadian-born
counterparts. This research examines factors
that influence migrants’ access to prescription
drugs. It explores factors that impede migrants’
access to essential medications and the
mechanisms in place to assist uninsured and
under-insured immigrants and refugees. This
study aims to inform key policies and practices
pertaining to healthcare and prescription drug
programs for migrants in Canada.
Methodology
A constructivist grounded theory methodology
was employed to develop an integrated set of
theoretical concepts related to prescription drug
access for immigrants and refugees. Following
ethics approval, 25 migrant patients and
migrant-serving providers were interviewed using
semi-structured key informant interviews.
Qualitative interview data were analyzed using
grounded theory techniques and a constant
comparative approach.
Participant perspectives on migrants’
experiences accessing prescription drugs
Session: O49, Submission Number: 1032868 sample. Food insecurity was the most prevalent
reported social need in this population with
Social Risk Screening and Impacts on the nearly 30% of the 942 individuals who
Im/migrant Community: A Retrospective Analysis responded to this question indicating food
insecurity. This was followed by 29% reporting
Stephanie Loo, Boston University School of Public Health; Linda educational needs; 19% reporting employment
Piwowarczyk MD MPH, Boston Center for Refugee Health &
Human Rights, Department of Psychiatry, Boston Medical needs; 18% reporting barriers to paying for
Center; Sarah Kimball, Immigrant and Refugee Health Center, medications; 17% reporting lack of medical
Boston Medical Center; Section of General Internal Medicine, transportation; 15% reporting difficulty with
Boston University School of Medicine and Boston Medical
Center; Megan Cole medical transportation; and 10% reporting
housing insecurity.
Learning Objectives
1. Describe types and levels of unmet social Conclusions/Discussion
needs impacting the im/migrant Our findings emphasize the importance of not
community only addressing health disparities within
2. Analyze im/migrants' unmet social needs im/migrant populations, but rigorously assessing
and accompanying associations with ED and addressing unmet social needs as well.
and primary care visits Accurately assessing and addressing unmet
3. Assess the impact of social risk screening social needs may narrow existing health
and food pantry referral rates for the disparities.
im/migrant community

Im/migrants are a highly vulnerable population
who face numerous social and political barriers.
These barriers likely contribute to higher levels
of unmet social needs. This proposed paper will
examine the impact of social risk screening in
the im/migrant population, considering the
intersection of on-going health policy, immigrant
and refugee populations, and unmet social
needs.
Methodology
Our objectives are to describe types and levels
of unmet social needs within an im/migrant
cohort and to examine the relationship between
level of unmet social needs, emergency
department and primary care visit rates, and
food pantry referral rates from 2015-2019. Our
primary exposure variable was number of unmet
social needs. We categorized number of unmet
social needs into 0, 1, 2-3, or 4 or more unmet
social needs.
Our final study sample included 1405
individuals. One or more unmet social needs
was reported by 36.8% of patients in our
Session: O50, Submission Number: 1049661 Methodology
Stakeholders reach out to ORR to request MHFA
Virtual Mental Health Trainings for Refugee or PFA trainings which are delivered via Zoom by
Communities and Service Providers in the an ORR instructor. MHFA participants must
United States complete pre-coursework before the five-hour
virtual training; MHFA involves a fee and the
Parangkush Subedi, Curi Kim, Tim Kelly virtual format has a limit of 20 participants.
There is no pre-coursework or fee for PFA.
Learning Objectives
1. Upon completion, participants will be Results/Impacts/Outcomes
able to describe the purpose of Mental From September 2020 to February 2021, 114
Health First Aid (MHFA) and participants were trained in MHFA and 180
Psychological First Aid (PFA) trainings. participants were trained in PFA; in comparison,
2. Upon completion, participants will be from September 2019 to February 2020, 312
able to compare the action plans participants were trained in MHFA. Five virtual
espoused by MHFA and PFA MHFA and PFA trainings involved participants in
3. Upon completion, participants will be the same session joining from different states.
able to discuss the advantages and Cost and time savings were realized without the
limitations of virtual mental health need to travel, secure training venues, and
trainings provide refreshments.
Background and Purpose/Rationale Conclusions/Discussion

In response to the COVID-19 pandemic, the By adopting virtual mental health trainings, ORR
U.S. Office of Refugee Resettlement (ORR) reached almost as many participants as in the
halted in-person trainings and launched two preceding year. By offering a new PFA training,
virtual mental health programs in 2020: Mental ORR provided a shorter and free mental health
Health First Aid (MHFA), which ORR has training alterative to MHFA. The advantages of
provided since 2014 to promote mental health virtual training are cost-effectiveness and
literacy, and Psychological First Aid (PFA), a transcending geographic boundaries; limitations
complementary training to address psychological include the participant cap for MHFA and digital
distress during disasters. literacy.
Session: W1, Submission Number: 1026678 asylees’ access to services are needed; these
may require collaboration across partners,
Improving Opportunities for Health Outreach including federal entities, resettlement
Among Individuals Granted Asylum in the agencies, and state refugee health programs.
United States
Methodology
Gayathri Kumar, Centers for Disease Control and Prevention, The objectives include: 1. Improve participant
Division of Global Migration and Quarantine, Immigrant,
Refugee, and Migrant Health Branch; Clelia Pezzi, Dipti Shah, understanding of the health profile of asylee
Benjamin Levey, Christine Murto, Blythe Raphael populations and US program efforts that
connect asylees to their health benefits. 2.
Learning Objectives Enable participant sharing of lessons learned in
1. Upon completion, participants will have conducting health outreach to asylee
an improved understanding of the health populations.
profile of asylee populations in the US.
2. Upon completion, participants will have Results/Impacts/Outcomes
an improved understanding of US In this 90-minute workshop, presenters from the
program efforts that connect asylees to Centers for Disease Control and Prevention and
their health benefits and how to initiate two state refugee health programs will describe
such efforts within their own state or the medical needs of asylees and program
local jurisdictions. efforts to connect asylees to health benefits that
3. Upon completion, participants will be can support care in the long term. This will be
able to apply any lessons learned in followed by a Q&A session and an interactive
conducting health outreach to asylee discussion with participants to share lessons
populations. learned in conducting health outreach to these
populations.
Asylees are eligible for many of the same Conclusions/Discussion
benefits and services as refugees admitted Asylee; refugee; domestic medical examination
under the US Refugee Admissions Program
(USRAP), including the domestic medical
examination (DME), which should be provided
within the first 90 days of asylum adjudication.
Preliminary data suggest that the leading
nationalities of asylees who received a DME
from 2014-2016 in a multi-site analysis were
China, Iraq, and Iran; however, even accounting
for regional differences, national data from the
Department of Homeland Security reported that
the leading nationalities during the same time
period included Egypt and El Salvador. The
majority of asylees do not access services
funded by the Office of Refugee Resettlement.
While there is likely variability in benefit access
among asylees, unfamiliarity with available
benefits, lack of access to case management
services through US resettlement agencies, and
duration of US residence may influence access
to these benefits and services for asylees.
Asylees may present with complex medical
issues. As such, greater efforts to facilitate
Session: W2, Submission Number: 1044749
Clinician Advocacy to Support Refugees, Advocacy Underserved populations, Immigrants,
Immigrants, and Asylum Seekers Lawmakers
Katherine McKenzie, MD, Yale University School of Medicine
Learning Objectives
1. Discuss why clinicians make ideal
advocates
2. Review successful clinician advocacy
campaigns
3. Practice advocacy skills

Refugee and asylum work naturally lends itself
to advocacy. During this workshop participants
will be taught specific ways they can use their
unique expertise and dedication to help
individuals outside of the exam room.
Underserved populations benefit from clinician
support to advance policies that support their
well-being, and healthcare workers are ideally
situated to play this role.
Methodology
Participants will be introduced to ways that
health professionals can be strong and effective
advocates, especially for underserved
populations such as immigrants, refugees, and
asylum seekers. Successful clinician advocacy
campaigns will be discussed and reviewed. We
will present how different models can be used
by clinicians that fit well with the communities
where they live, their individual skill-sets, and
their personal time commitments. We will spend
some time in problem-based learning to discuss
different advocacy methods.
The first half of the workshop will involve a
presentation of different forms of advocacy,
including writing lay and professional opinion
essays, participating in broadcast journalism,
using social media, organizing community
activism, and engaging lawmakers. Participants
will then break into small groups to discuss
individual advocacy cases. Finally, we will
reconvene to discuss plans for advocating within
each of our communities.
Session: W3, Submission Number: 1048385 violence occurred at home at the hands of
husband/intimate partner and the contribution
Gender Based Violence During Displacement of government, society, culture and religion to
and Resettlement end or not to end gender based violence.
Highlight the challenges women face after
Rahel Hailemichael resettlement such as cultural differences,
isolation and lack of social support, gender
Learning Objectives roles, stereotype, discrimination and racism
1. Be aware of the atrocities women face in Share best practices and approaches in service
situation of armed conflict, and war and delivery before and during COVID-19 pandemic
during displacement and refugee
2. Get information in best practices and the Results/Impacts/Outcomes
benefit of linguistic and cultural relevant PowerPoint presentation and case study
services to support and empower women
survivor of violence and torture Conclusions/Discussion
3. -Advocate for funding and equality and Gender based violence, health, settlement,
equity as well as representation of women culture
in municipal, provincial and federal level
using intersectionality framework
- Work to design a coordinated service
system to support victims of domestic
and sexual violence

Violence against women happen globally and
affect women regardless of income, education,
ethnicity and race. But vulnerable women,
displaced and refugees, additionally face
violence during armed conflict and war as well
as in detention. Women are killed, tortured, and
raped and suffer other forms sexual violence
that are used as a weapon for different purpose
such as racial cleansing, punishment, to create
fear in the society and to further silence and
oppress human rights and freedom. The health
consequences of such violence is far reaching
and its effect persists long after the violence has
stopped and it affect physical and mental health
of women and may cause illness, death,
disability and suicide. In the country of
resettlement women continue to face challenges
which is related to the effect of previous
violence, isolation, family separation, language
and cultural differences as well as stereotype
and discrimination based on gender and race.
Methodology
Create awareness on the human right violations
and gender based violence women and girls face
during conflict, war, and detention as well as
Session: W4, Submission Number: 1036608 health treatment options across language
differences; (2) Present new communication
Talking About Stress: Mental Health tools (multi-lingual PTSD treatment glossaries
Conversations in Languages Other Than English with everyday language suggestions) for
clinicians and interpreters; (3) Facilitate
Katherine Yun, Ashok Gurung, Mutaz Al Mudaris, Nadège conversation with workshop participants to
Mudenge, Martin Nyun, Priscilla Ortiz, Patricia Stubber, Leena
Anil, Susan Miller, Linda McWhorter reflect on other promising approaches for
discussing mental health. Our objective is to
Learning Objectives foster better communication regarding mental
1. Educate others regarding challenges health treatment.
communicating mental health treatment
options in languages other than English Results/Impacts/Outcomes
2. Use new communication tools (multi- This workshop will start with a brief panel
lingual PTSD treatment glossaries with presentation to level-set and share new
everyday language suggestions) for communication tools. We will use polls and chat
clinicians and interpreters to encourage audience participation. We will
3. Demonstrate better communication then transition to a facilitated conversation to
practices when discussing mental health elicit and reflect on other promising approaches
treatment with refugee patients for discussing mental health care with
individuals who are English language learners.
Background and Purpose/Rationale During this conversation, we will privilege the
PTSD affects ~1 in 10 resettled refugee adults insight of presenters and participants who are
in high- and middle-income nations, including themselves multilingual and bicultural.
more than 1 in 3 adults in some communities.
The good news is that effective treatment Conclusions/Discussion
reduces symptoms and improves family PTSD; medical interpreting; mental health
functioning. Additionally, treatment is effective treatment
for a wide variety of refugee populations with
different trauma histories, languages, and
cultural backgrounds. The bad news is that
~half of U.S. adults with PTSD never receive
treatment. Without treatment, PTSD can take as
long as 14 years or more to remit.
Communication presents a significant barrier to
treatment for many refugees with PTSD.
Clinicians and medical interpreters may struggle
to present both diagnosis and treatment to
adults who speak languages other than English.
They may have difficulty finding vocabulary that
is clear and accurate but also non-stigmatizing.
Clinicians may also struggle to avoid jargon and
to explain mental health treatment concepts in
everyday, approachable language.
Methodology
For this workshop, panelists with expertise in
mental health care, community mental health,
medical interpreting, and refugee health will: (1)
Discuss challenges communicating mental
Session: W5, Submission Number: 1043831 governance, payment, patient population,
education, research, and COVID-19 specific
Canada’s Refugee Health Clinics Amidst COVID- adaptations and challenges. 2.Expert Panel
19: Structure, Care Models, Strengths and Discussion: National experts will present
Challenges differing, regionally representative clinic models
including 1) a well-established clinic; 2) a
Gabriel Fabreau, University of Calgary; Vanessa Redditt, relatively newly established clinic ( < 5 years);
University of Toronto; Rachel Talavlikar, University of Calgary;
Christine Aubrey-Bassler, Memorial University; Mahli 3) a high-performing fee-for-service clinic, and;
Brindamour, REACH Refugee Health Clinic Saskatoon; Michael 4) a clinic within an established provincial
Stephensen, Sanctuary Refugee Health Centre; Kevin Pottie, refugee health network.
Bruyère Research Institute - University of Ottawa; Lavanya
Narasiah, McGill University; Tim Holland, Newcomer Health Objectives: We aim to characterize different care
Clinic, Nova Scotia Health Authority; Meb Rashid, University of models, expertise, strengths, COVID-19 specific
Toronto adaptations, and challenges among Canadian
refugee clinics to promote collaboration,
Learning Objectives disseminate best practices, and contribute to
1. To understand different clinical care improved national refugee healthcare.
models for recently resettled refugees
across Canada including their relative Results/Impacts/Outcomes
strengths and limitations. We will 1) summarize national-level refugee
2. To understand COVID-19 specific clinical clinic data to contextualize the workshop; 2)
adaptations employed and COVID-19 present the above care models; and, 3) facilitate
related challenges faced by different an open discussion encouraging questions,
refugee clinic models in Canada. collaboration and share COVID-19 specific
3. To be aware of existing research and adaptations. We will invite workshop
national collaboration focused on further participants to participate in existing research
characterizing Canada’s refugee health and national collaboration focused on further
system and to identify and connect with characterizing Canada’s refugee health system
other clinicians with similar interests and identify and connect interest-based sub-
post-workshop to facilitate ongoing groups post-workshop to facilitate ongoing
collaboration among Canadian providers. discussion and collaboration among Canadian
providers.
Canada has developed many specialized refugee Conclusions/Discussion
health clinics that care for resettled refugees, Refugee Clinics; Care-models; COVID-19;
employing many different care models. During Innovations; Research;
the COVID-19 pandemic refugee health clinics
had to rapidly adapt care processes. This
workshop continues work from NARHC 2017
and 2019, where we invite national experts to
discuss different Canadian refugee clinic care
models, innovations, challenges; and facilitate
national collaboration.
Methodology
Refugee Health Care-Models and COVID-19
Adaptations: Pre-workshop, we will collect and
summarize preliminary structured information
about active Canadian refugee health clinics,
leveraging an existing national study. Data of
interest include clinic structure, care model,
Session: W6, Submission Number: 1044028 Results/Impacts/Outcomes
The presentation will demonstrate the findings
Addressing the Impact of Family Loss and in the study and where the most important areas
Separation on Refugee Youth: Implications for of intervention are. Case studies (i.e. an
Programming and Policy Development imaginary refugee youth) may also be utilized
with study findings such that the audience
Huda El-Zein, Ron Merkand would provide suggestions as to what issues they
think are relevant, the consequences of these
Learning Objectives problems, and how they could be solved.
1. Understand the complex and uncertain Participants will also be asked to reflect on
migration and settlement process refugee where they were at that age and how they would
youth face, and how the role of family feel if they were in the position of the refugee
influences their outcomes. youth. This is particularly impactful in the areas
2. Empathize with the bureaucratic, socio- of the settlement process and family loss.
cultural, and economic barriers that
refugee youth face in Canada Conclusions/Discussion
3. Understand the importance of community Refugee youth, policy, programming, health,
engagement in qualitative research equity
methods

Refugee youth endure significant barriers,
challenges, and injustices during the migration
and settlement phases in Canada, and are
impacted by the loss, disappearance or
separation of one or more family members as a
result of war, conflict, and forced migration.
When it comes to programming and policy
changes, there needs to be a collaboration
between mental health services, service
providers, and settlement service, and an
increase in understanding and awareness from
the general public.
Methodology
Services, and service providers alike, need to be
accessible in terms of price, availability and
language; use trauma-informed approaches; and
be prudent of the diversity among the refugee
youth by acknowledging their race, culture,
sexual orientation, gender identity and so on.
Meaningful policy changes need to be
implemented at the appropriate level in order to
address the aforementioned needs, reduce the
wait time for claimant decisions, and allow
youth to access services in the language that is
most comfortable for them.
Session: W7, Submission Number: MW2105
Splenomegaly in refugees: Etiology, diagnosis

and management
William Stauffer MD, Alice Lehman MD, Steve Dunlop MD,

Christine Sekaggya MD, Anne Frosch MD
Learning Objectives
1. Be able to define the top 3 infectious
disease etiologies of splenomegaly in
refugees from tropical and sub-tropical
areas.
2. Understand the pre-departure screening
and treatment process of Congolese
refugees resettling to the U.S.
3. Be able to take initial steps in evaluating
and treating SM in refugees after arrival
in the resettlement country.

Splenomegaly (SM) is encountered regularly in
refugees, particularly from tropical and sub-
tropical areas. SM is a syndrome and identifying
the etiology is challenging, and treatment
options are difficult. Recently, since 2014,
more than 50,000 Congolese refugees have
resettled to the U.S.This population has a rate
of SM of ~14%. This workshop will discuss the
etiologies, diagnosis and management of SM
through case presentations and discussion.
Methodology
This will be ~40 minute case based lecture with
interactive case studies at the end
Session: W8, Submission Number: MW2102 for sharing successes and challenges via the
National Resource Center for RIM (NRC-RIM)
COVID-19 Response Perspectives of public
health jurisdictions, health systems and
community based organizations with Refugee,
Immigrant and Migrant Communities
Erin Mann, Jasmine Matheson, Seja Abudiab, Christine

Thomas, Fathiya Abdi, Sarah Hoffman, Farah Mohamed, Faten
Rashid, Sheeba Shafaq, Danushka Wandurgala, Elizabeth
Dawson-Hahn
Learning Objectives
1. To highlight successes and challenges
from public health jurisdictions, health
systems and community based
organizations from around the US in
addressing the COVID-19 pandemic
particularly for RIM communities.
2. To create a space to share models,
stories, and concrete strategies for
partnering with and addressing
theCOVID-19 pandemics disproportionate
impact on RIM communities
3. To review avenues for sharing successes
and challenges via the National Resource
Center for RIM (NRC-RIM)

Public health jurisdictions, health systems and
community based organizations have had varied
experiences during the COVID-19 pandemic in
developing or adapting approaches to addressing
the inequitable burden of the pandemic on
refugee, immigrant and migrant (RIM)
communities. Platforms and forums for
discussions of successes and challenges are
buoying forces to address the ongoing and future
pandemics.
Summary
To highlight successes and challenges from
public health jurisdictions, health systems and
community based organizations from around the
US in addressing the COVID-19 pandemic
particularly for RIM communities. To create a
space to share models, stories, and concrete
strategies for partnering with and addressing
theCOVID-19 pandemics disproportionate
impact on RIM communities To review avenues
Session: W9, Submission Number: 1041701 inform screening guidance, develop clinical
training tools, and devise and implement
Advancing the Centers of Excellence in strategies to rapidly disseminate and integrate
Newcomer Health: Moving the Needle in the guidance into clinical practices, especially in
Next 5 Years domestic outbreak settings. The COE will also
describe forthcoming activities related to the
Blain Mamo, Lori Kennedy, Jenna Beeler, Clelia Pezzi, newcomer health orientation, as well as
education and training for both clinicians and
Learning Objectives newcomers.
1. Describe how health conditions of
recently arrived newcomers will be Results/Impacts/Outcomes
analyzed using the COE data repository. This panel, consisting of COE members, will
2. Describe how the COE will use repository discuss the expansion of their activities under
data to inform screening guidance. the new agreement, year 1-2 goals, and the
3. List the planned COE activities of development of resources meet the needs of
newcomer health orientation, education, everchanging and diverse newcomer
and training. populations.
Background and Purpose/Rationale Conclusions/Discussion

From 2015-2020, CDC funded two Centers of refugee; screening; health education; clinician
Excellence in Refugee Health (Colorado and training
Minnesota). This cooperative agreement focused
on revising the domestic screening guidance for
newly arrived refugees, creating novel digital
tools, and developing a network repository
collecting information from the domestic exam
to assess major health conditions among newly
arrived refugees. To continue the momentum, in
2020, CDC funded a second 5-year cooperative
agreement entitled Advancing the Centers of
Excellence in Newcomer Health (COE) with
Colorado and Minnesota. This new cooperative
agreement broadens the scope of activities to
newcomers receiving Office of Refugee
Resettlement domestic benefits, including
refugees, Special Immigrant Visa holders,
asylees, Cuban/Haitian entrants, victims of
torture, Amerasians, and human trafficking
victims.
Methodology
The objectives of this workshop will be to
describe how the COE will analyze health
conditions among newcomers using repository
data; expand the existing repository dataset by
linking to other databases including cancer,
immunization, and tuberculosis registries; and
create new opportunities for collaboration and
data analysis. In addition, presenters will
describe how repository data will be used to
Strategies for Publishing Your Work in Refugee

Health
Sana Loue, JD, PhD, MPH, MSSA, MA; Paul Geltman, MD, MPH
Pre registration for this sessoin is required.
Background/Rationale
Publication of clinical experiences and research
is important to disseminate knowledge and
advance individual career goals.
This workshop will provide attendees with

guidance on how to best present their clinical
work and research in refugee and immigrant
health for publication in peer-reviewed journals.
Workshop content will focus on the
identification and selection of appropriate
journals, how to target the message to fit the
audience, research methodologies, manuscript
preparation, and relevant aspects of research
and publication ethics. Workshop participants
will have the opportunity to present and receive
feedback on their possible submissions.
Participants will engage in interactive exercises
that will reinforce the concepts presented.
Instructional methods: didactic lecture, group

discussion, Q&A
Session: W11, Submission Number: 1041823 Methodology
Presenters will share information in an
Facilitating the Path to Citizenship Through interactive session using case studies and
Medical, Legal and Community Partnership breakout groups to demonstrate how medical,
legal and community partner collaboration can
Anne Ryan, University of Arizona; Suzanne Teeple, University of facilitate the path to citizenship. Upon
Arizona; Jessie Pettit, University of Arizona; Reem Aussy,
Catholic Community Services, Southern Arizona completion, participants will be able to:
Understand requirements and process for
Learning Objectives requesting waiver of citizenship tests based on
1. Upon completion, participants will be medical impairments; Identify patients/clients
able to understand requirements and who may qualify for these medical waiver
process for requesting waiver of requests and need early intervention and
citizenship tests based on medical assistance; and Recognize challenges refugees
impairments. with disabilities face in preparing for citizenship
2. Upon completion, participants will be and how to create community collaborations to
able to identify patients and clients who overcome these barriers.
may qualify for these medical waiver
requests and need early intervention and Results/Impacts/Outcomes
assistance. Interactive session with power-point visual aid,
3. Upon completion, participants will be group breakouts and case studies
able to recognize challenges refugees
with disabilities face in preparing for Conclusions/Discussion
citizenship and how to create community Interdisciplinary Collaboration, Medical-Legal
collaborations to overcome these barriers. Partnership, Advocacy, Citizenship

The requirement to pass English and civics tests
is a significant barrier to U.S. citizenship for
refugees with disabilities. Our medical-legal
partnership has observed challenges this
population faces in navigating the medical and
legal systems, which can lead to an inability to
obtain citizenship and subsequent loss of
Supplemental Security Income benefits based
on age or disability. To address these barriers,
we created a model that includes: Teaching
family medicine providers about the citizenship
process, challenges refugees face in becoming
citizens, and requirements for medical waivers
of citizenship tests when appropriate due to
medical impairments; Collaboration with
community resettlement partners to identify and
support individuals who may have difficulty
navigating or completing the citizenship
process; and Educating patients on legal
requirements of the citizenship process and
facilitating connection to essential community
resources.
The following presentation will examine multiple
We Can Do (no) Harm: Building Cultural levels of structural and cultural responsiveness
Responsiveness in Refugee Mental Health in training in refugee health care. The main goal
Training is to discuss training models that promote a
reflective stance, develop cultural humility,
Sandra Mattar, Boston University School of Medicine; Elizabeth examine oppressive systems of care, cultural
Louis, Boston University School of Medicine; Bediha Ipekci,
Boston University School of Medicine; Joelle Taknint, Boston barriers, working with interpreters, and ways to
University School of Medicine promote cultural/social agency among refugee
patients, among others. Authors are supervisors,
Learning Objectives trainees, and early-career clinicians working at a
1. Discuss the main needs and challenges refugee clinic at a major teaching public
in providing training for cultural hospital in Boston (USA), and have been trained
responsiveness in refugee care in a cultural responsiveness and self-reflection
2. Describe tools to help deepen providers’ model at the Center for Multicultural Training in
critical thinking and reflexivity in Psychology at Boston Medical Center.
understanding refugee mental health
systems in order to mitigate structural Results/Impacts/Outcomes
inequities in service provision This workshop will be interactive in nature. We
3. Describe culturally responsive clinical will combine didactic content delivery with
interventions for working with refugees reflective exercises where participants can apply
the skills taught throughout the session.
A key factor in addressing health disparities in Conclusions/Discussion
refugee care is the providers’ cultural refugee, academic training, cultural
responsiveness in care delivery. In order to responsiveness, advocacy
effectively deliver services that meet the social,
cultural, psychological, and linguistic needs of
refugees, providers must address structural
inequities in healthcare, reinforced practices
that maintain stereotypes, as well as look at
dynamics developing between refugees and the
host culture (Sheath et al., 2020). An essential
task of health providers’ education and training
in refugee work is to reflect on, and develop a
critical decolonial framework addressing the
intersection of one’s multiple identities with
levels of privilege and power in healthcare
settings, as well as on the historical and
sociopolitical context in which one is embedded.
However, these critical tasks are rarely taught in
health care training programs, which
perpetuates practices that create organizational
barriers that inadvertently promote a “rescuer”
stance. These practices could also
overemphasize cultural differences at the
expense of understanding the complexity of
refugees’ lives and context (Lau & Rodgers,
2021).
HIV and Sexually Transmitted Infections: Instructional methods for this workshop will
Updates for Refugee Health Providers include: (1) Electronic response voting as a
means to solidify core concepts in HIV/STI
Amir Mohareb, Angel Desai screening, treatment, and prevention. (2) Case-
based vignettes to highlight controversies in
Learning Objectives HIV/STI test interpretation and treatment. (3)
1. Understand the limitations of HIV testing Question & Answer period at the end of the
modalities, the duration of the eclipse session to address any remaining queries.
and window periods of HIV testing, and
the risk factors and prognosis for HIV-2 Conclusions/Discussion
infection among refugees and be STI, HIV, syphilis, gonorrhea, hepatitis, PrEP
comfortable prescribing HIV pre-exposure
prophylaxis (PrEP) in key populations for
HIV prevention.
2. Interpret test results in the context of
symptomatic and asymptomatic
diagnoses of syphilis among refugees.
3. Recognize the risk of drug-resistant
gonorrhea in clinical practice.

Refugees and asylum seekers can have
heightened risk factors for HIV and sexually
transmitted infections (STIs), such as exposure
to sexual violence and unregulated medical
procedures. Post-arrival screening for HIV and
STIs is recommended in all refugees, but
practice patterns may differ.
Methodology
This interactive workshop will summarize
practical recommendations on HIV/STI
screening, treatment, and prevention in refugees
and asylum seekers, focusing on updates since
publication of the 2015 Centers for Disease
Control and Prevention (CDC) STI Treatment
Guidelines. By the end of this workshop,
learners will: 1) Understand the limitations of
HIV testing modalities, the duration of the
eclipse and window periods of HIV testing, and
the risk factors and prognosis for HIV-2 infection
among refugees 2) Be comfortable prescribing
HIV pre-exposure prophylaxis (PrEP) in key
populations for HIV prevention 3) Interpret test
results in the context of symptomatic and
asymptomatic diagnoses of syphilis among
refugees. 4) Recognize the risk of drug-resistant
gonorrhea in clinical practice.
Session: W14, Submission Number: 1042937 Results/Impacts/Outcomes
Oral presentation with Powerpoint.
Lessons Learned in Setting up a Unique Mental
Health Treatment Centre for Refugees and Conclusions/Discussion
Immigrants Refugee, mental health, counselling, PTSD,
client-centred.
Adrienne Carter
Learning Objectives
1. Understand and reflect on a different
approach to refugee mental health.
2. Describe the importance of taking a
client-centred approach to mental health
counselling.
3. Apply the learnings from this organization
to their own context and situation.

Well acquainted with Psychosocial and Mental
Health interventions in areas of mass violence
and natural disasters while working for several
years with Medecins Sans Frontiere and the
Centre for Victims of Torture in Jordan as
psychotherapist/trainer, Adrienne Carter
provided supervision and training to local
counsellors who, in turn provided individual and
group counselling to thousands of traumatized
Syrian and Iraqi refugees. In 2015 Adrienne
returned home to Victoria, B.C. and together
with a colleague, co-founded the Vancouver
Island Counselling Centre for Immigrants and
Refugees. VICCIR has grown exponentially in the
past 5 years. Initially the centre relied solely on
registered clinical counsellors and interpreters
working pro bono due to lack of funding. The
unique client-centred approach that was created
at the beginning is still being maintained but
through the past years the format changed to
some extent since we are now able to pay our
staff due to various generous grants.
Methodology
The objective is to share what we have learned
during our 5 years of operation. In addition to
our unique client centred model where every
member of the family can be seen in their own
native language, but also additional services
have been added with the help of a social worker
and large group of volunteers.
Session: W15, Submission Number: 1048598 both internally and with community partners.
The work that took place will be highlighted, as
Collaborative Complex Case Management in a well as gaps in services and potential areas for
Pandemic improvement. Challenges in the current
resettlement and health care systems will also
Astrid Velasquez, Laura Velasquez, Janna Mulholland be shared for consideration.

1. Identify how to work with and coordinate Refugees, Collaboration, Mental Health,
with multiple services and partners to Resettlement
meet the needs of complex clients
2. Explore how to teach clients, and work
with complex mental health concerns
within an appropriate cultural context.
3. Reflect on how staff ingenuity and
dedication made collaboration and
addressing urgent client needs a priority
during a pandemic.

Catholic Social Services Immigration and
Settlement Service in the IRCC funded provider
for GAR resettlement in Edmonton, Alberta.
Prior to the COVID-19 pandemic, all refugee
education took place in person with staff in
either first language, or with an interpreter and
consecutive interpretation. Because of the
pandemic and the mandatory isolation period
staff are not able to directly interact with clients
during their integral initial days of resettlement.
Facilitated by the pandemic, the Refugee Health
Promotion team developed virtual solutions to
these barriers.
Methodology
The workshop is an examination of the necessity
of collaboration and coordination for the
successful management of complex client cases.
The key points that will be addressed are: how
to work with and coordinate with multiple
services and partners; how to teach clients and
work with complex mental health concerns
within an appropriate cultural context; and, how
staff ingenuity and dedication made this
possible during a pandemic.
The workshop will involve a presentation and
examination of some complex client cases.
Presenters will focus on areas of collaboration,
Centers for Excellence in Newcomer Health: This workshop will include a 40-minute
Updates to the CDC Domestic Medical interactive presentation with 20 minutes for
Screening Guidance questions. The interactive presentation will walk
attendees through the updates and specific
Hope Pogemiller, Marc Altshuler, Janine Young, Blain Mamo, changes to each section of guidance, and
Jenna Beeler, William Stauffer, Emily Jentes
dissemination of new content. Attendees will
have the opportunity to pose questions to a
Learning Objectives
panel of guidance authors and reviewers.
to demonstrate insight into the
collaborative process used to develop and
Refugee health; screening; guidelines and
enhance CDC’s screening guidance for
recommendations
newly arrived refugees.
to screen for a variety of health
conditions in newcomers during the
domestic medical screening.
to promote best and promising practices
in refugee screening.

The Immigrant, Refugee, and Migrant Health
Branch of the Centers for Disease Control and
Prevention (CDC) has worked closely with its
Centers of Excellence in Newcomer Health
(formerly the Centers of Excellence in Refugee
Health) partners to revise domestic screening
guidance for newly arrived refugees. Each
section of the guidance provides
recommendations for comprehensive domestic
medical screening, which occurs within 90 days
of arrival for most newcomers. CDC first began
developing these recommendations in 2006 and
the revised guidance is the culmination of an
iterative, collaborative process based on
available evidence and best practices in refugee
health.
Methodology
An overview of the major changes to each
recently revised section of the domestic
guidance will be provided. Case studies will be
also presented to demonstrate most recently
updated sections of the domestic screening
guidance, specifically: 1. Tuberculosis 2. Sexual
and Reproductive Health 3.Mental Health
4.Best and Promising Practices
materials for vulnerable populations 5. Access
Session: W17, Submission Number 1051633 resources for lead poisoning prevention and
treatment. Key Points: Potential Lead Sources,
Lead Exposure and Prevention in Refugee Low Literacy Materials, working with Patients
Communities: A Guide to Resources with limited English Proficiency, cultural
competency
Lois Wessel, Georgetown University School of Nursing and
Health Studies
Power point presentation with discussion and
Learning Objectives
access to low literacy culturally appropriate
1. Understand why refugee children are at a
patient education.
higher risk of lead exposure
2. Identify numerous potential sources of
lead exposure
Refugee, Lead, Low Literacy, Education
3. Know how to access culturally and
linguistically appropriate patient
education materials for vulnerable
populations

Refugee children in the United States are at risk
due to lead exposure prior to coming to the
United States and post-resettlement housing
issues. Refugees are defined as individuals who
have fled their home countries because of war,
persecution, or the demonstrable threat of
persecution. The prevalence of elevated Blood
Lead Level (BLL) in refugee children is double
that of children born in the US (Geltman,
Brown, Cochran, 2001). The CDC provides
screening recommendations for all newly arrived
refugee infants, children, adolescents, and
pregnant and lactating individuals. Patients
with limited English proficiency and low health
literacy need additional attention to health and
safety education. This presentation will focus
on accessing low literacy patient education
materials on lead screening and prevention in a
variety of languages spoken by many of the
refugees present in the US and Canada.
Methodology
By the end of this session, participants should
be able to: 1. Understand why refugee children
are at a higher risk of lead exposure 2. Identify
numerous potential sources of lead exposure in
refugee communities 3. Understand the
importance of universal screening for lead
exposure 4. Know how to access culturally and
linguistically appropriate patient education
Publishing Workshop
Paul Geltman, Sana Loue
Workshop details not available at time of

publishing.
How telemedicine can support access to refugee

health and underserved populations.
Sharon Allen, Tim Foggin
Learning Objectives

Analyze the lack of access and means of
healthcare in under-resourced areas, including
refugee camps. Examine telemedicine as a
solution for access to care. Evaluate strategies
for use, benefits, and obstacles that may be
encountered when trying to provide remote care.
Methodology
Provision of medical expertise to low-resourced
clinics & hospitals by a network of volunteer
physicians enabled by state-of-the-art telehealth
technology. Applications include:peer to peer
didactics, scheduled clinical consultations,
surgical mentoring, synchronous high-acuity
care.
On-site providers increase knowledge,
confidence, skills. Supported on-site providers
less likely to join the brain-drain exodus
Patients benefit from medical expertise while
local health systems simultaneously increase
capacity. Utilization of physician diaspora to
serve specific geographies is advantageous
Recently there has been rapid adoption of
telehealth in high-income countries as a means
to deliver more accessible, lower cost and higher
quality healthcare...but under-resourced
locations or populations do not benefit from this
new technology because of cost. Due to support
from Teladoc Health, World Telehealth Initiative
is in the unique position to provide telehealth
technology to these areas regardless of their
ability to pay
Session: W20, Submission Number: 1041537 create change?” In refugee health, this people-
power framework emphasizes the need to
Creating Organizers out of Advocates: What explore the values of our patients to enable
Community Organizing Can Teach Us About them to create the changes they desire under
Advancing Health Equity for Our Refugee conditions of uncertainty. We will introduce the
Patients five leadership practices of organizing: public
narrative, relationship-building, structuring
Eleanor Emery, Center for Health Equity Education & Advocacy, teams, strategy and action. This will be a brief
Cambridge Health Alliance; Anita Krishnan, The Leading Change
Network overview but will allow participants to better
understand how organizing could be valuable in
Learning Objectives their practice.
1. Define community organizing and
describe one way this practice could be Results/Impacts/Outcomes
useful for health professionals interested This workshop, co-hosted by a clinician and an
in justice and health equity for refugees. organizer, with introduce the above content
2. Describe how community organizing using video vignettes, demonstrations and
differs from a traditional individual-level interactive exercises.
advocacy approach.
3. List the five key leadership practices of Conclusions/Discussion
community organizing and identify one in Community organizing, leadership, advocacy,
which they feel additional training would power, refugee
benefit their work with refugees.

As allied health professionals, we are committed
to advancing health equity for refugees, but our
training often fails to equip us with the skills to
do this on a population level. Community
organizing offers a model by which clinicians
can learn to work collaboratively and
systematically to challenge the structural forces
that produce health inequities.
Methodology
This workshop will introduce participants to
community organizing, a leadership practice
that enables a constituency, typically one that
lacks resources and power, to identify solutions
to shared problems and take collective action.
Harvard Professor Marshall Ganz has developed
a framework used to teach organizing in a
variety of settings, including to health
professionals, and our team at Cambridge
Health Alliance has employed this approach to
train medical residents and clinicians. Training
in organizing differs from traditional individual-
level advocacy in that it pushes us to ask the
fundamental questions “who are my people?”
and “how can I build power amongst them to
How to Write an OpEd: Supporting Migrants

Through Opinion Essay Advocacy
Learning Objectives
1. Describe their area of expertise and
experience when pitching an OpEd
2. Compose a cogent argument in the form
of an OpEd
3. Write a successful pitch to an editor

Healthcare professionals involved in the care of
immigrants, refugees, and asylum seekers
contribute by caring for medical and health
needs. In addition to direct care, those working
with migrants can use their knowledge,
expertise, and experience to influence the
public, their colleagues, and lawmakers about
issues that affect them. A powerful way of doing
this is by writing opinion pieces.
Methodology
Successful OpEds follow a general formula that
includes using a timely news hook to pitch an
evidence-based argument presented in a short,
succinct essay. Participants will learn to
describe their background in ways that
demonstrate their strength in the field, to
present an argument in a straightforward
manner. They will learn the best ways to pitch
their piece to an editor, and how to publicize it
once it is published.
The first two-thirds of the workshop will be
spent in an instructional format to learn how to
write an Op-Ed. We will then break into small
groups and discuss individual pieces, and finally
reconvene to review the next steps for pitching
to editors.
Advocacy, Op-Ed, Underserved populations
Session: W22, Submission Number: 1040024 barriers to providing competent care and identify
strategies for addressing these concerns.
Integrating Ethics into Treatment for Refugee
Clients: Mental Health Implications Results/Impacts/Outcomes
Presenters will provide an overview of factors
Rachel Singer, Renee DeBoard-Lucas that may impact mental health interventions for
refugee clients. Participants will engage in
Learning Objectives interactive discussion, including reviewing
1. Review potential ethical dilemmas that specific case examples (Singer & Fuentes,
may arise when working with refugees 2018) to facilitate application of ethical
2. Develop strategies for addressing guidelines.
potential ethical dilemmas associated
with working with these populations. Conclusions/Discussion
3. Apply strategies to specific case ethics, mental health, therapy, case review
examples of refugee patients

The United Nations estimates that as of 2020
approximately 80 million individuals have been
forcibly displaced from their homes worldwide,
with approximately 26.3 million refugees
(UNHCR, 2021). While refugees represent a
very diverse population, they share a unique
vulnerability to mental health concerns due to
their high levels of experienced trauma and
multiplicity of stressors. These stressors may
pre-date their forced migration, occur during
their migration, and/or arise in their host
country. As one comprehensive review of
refugees found, 31% met criteria for PTSD,
32% met criteria for depression, and 11% met
criteria for anxiety disorders (Blackmore et al.,
2020). Despite the high levels of mental health
concerns among this population, a variety of
systemic and cultural factors limit access to
high quality care (Singer, DeBoard-Lucas, &
Pujeh, 2020). While ethical codes of conduct
exist to guide practitioners to support this
population, at times these ethical codes of
conduct may appear to clash with other systems
of immigration, courts, and the police system
(APA, 2010).
Methodology
The present workshop will provide an overview of
ethical recommendations from the American
Psychological Association and the World Health
Organization. Participants in the workshop will
engage in active discussion regarding potential
Participants will learn: 1. Systemic barriers
The National Newcomer Navigation Network: A newcomers experience when interacting
Tool to Support Collaboration Across Sectors to with Canada’s health and social service
Improve Health Outcomes Among Newcomers to systems that have been exacerbated during
Canada COVID-19 2. Unique models of care that work
to overcome the cultural and linguistic barriers
Christine Kouri, BScN, MHA, CHEO; Sahar Zohni, MD, MHA, newcomers experience when interacting
National Newcomer Navigation Network; Mariah Maddock, MPH,
National Newcomer Navigation Network with Canada’s health and social service systems
3. Novel tools and resources that support
Learning Objectives connection, learning and collaboration
1. Upon completion, participants will be among professionals in the health and
able to understand systemic barriers settlement sectors during COVID-19
newcomers experience when interacting
with Canada’s health and social service Results/Impacts/Outcomes
systems that have been exacerbated Presenters will use polling or chat box features
during COVID-19 (if enabled). Attendees will have the opportunity
2. Upon completion, participants will be to pose questions during an audience-led
able to describe question and answer period.
unique models of care that work to
overcome the cultural and Conclusions/Discussion
linguistic barriers newcomers experience newcomer health, newcomer navigation, health
when interacting with Canada’s health equity
and social service systems
able to list and utilize novel tools and
resources that support connection,
learning and collaboration
among professionals in the health and
settlement sectors during COVID-19

The current pandemic has highlighted the
vulnerability of newcomers to Canada. Data
analysis of Ontario COVID+ residents has shown
a hyper-representation of newcomers, despite
barriers to access testing. These findings have
raised the awareness and urgency for cross-
sectoral collaboration to ensure health equity for
newcomers. This session will profile one
hospital’s efforts to promote equity for their
newcomer patients, as well as the subsequent
formation of the new National Newcomer
Navigation Network (N4) whose aim is to support
newcomer-serving professionals across sectors to
connect, learn and collaborate, with the ultimate
goal of ensuring an equitable experience.
As counselors at CCVT, we are routinely
Trauma Informed Approaches for Working with advocating for the rights of survivors of war
Youth Survivors of War and Torture and/or torture, and are also providing additional
support for children and youth in navigating the
Nadia Umadat, Leah MacDonald many challenges they face in the integration
process. The learning objectives of the workshop
Learning Objectives aim to introduce participants to the work of
1. List and understand barriers to CCVT, gain a more comprehensive knowledge
engagement faced by refugee youth who about the experiences of survivors, recognize
have experienced war and torture. barriers to engagement and offer practical
2. Demonstrate their knowledge of the youth strategies for support from an anti-oppressive
refugee experience during the pre, peri and holistic framework.
and post migration stages intertwined
with the impacts of Covid- 19 Results/Impacts/Outcomes
3. Utilize practical strategies and tips to Power point slides and question and answer
promote engagement and provide trauma period
informed care to youth survivors of war
and torture. Conclusions/Discussion
youth, refugees, trauma, war, torture,
Background and Purpose/Rationale settlement,
The refugee experience is complex and can be
broadly separated into three periods. In the first,
post-migration, individuals are often exposed to
experiences of psychological and/ or physical
torture, genocide, persecution, and interpersonal
violence. In the migration phase, there is often
more exposure to prolonged violence, family
separation, loss of homes and the arrival to a
refugee camp or other temporary dwellings.
These experiences all adversely affect a person’s
ability to cope in the post-migration/ settlement
period where additional layers of racism and
discrimination in the host country, poverty,
language barriers and unemployment may be
evident. Youth refugees often experience
multiple and varied losses on their journeys to
seek asylum in a safe country. In that sense,
they differ from other immigrant populations
who have sufficient time to prepare and process
such losses. Periods of extended trauma can act
as precursors for inadequate mental health if
left untreated. Youth refugees are an especially
unique population as the aforementioned
traumatic complexities can be exacerbated with
additional stressors such as issues of
generational conflict, exploration of sexual
identities, literacy and educational concerns.
Recommended Travel Vaccinations in migrants

and Refugees
Aisha Khatab
Learning Objectives
1. Know the vaccine preventable diseases

that migrants and refugees may be
susceptible to due to lack of effective
programs in their country of origin.
2. Learn the current vaccination
requirements for various countries upon
arrival.
3. Know when to consider vaccination when
records are invalid, inadequate, or
unavailable.
Best practices in advancing maternal health

equity during the COVID-19 pandemic
Crista Johnson-Agbakwu, Jeanne Nizigiyimana, Roseanne

Schuster

publishing.
Methodology
A Resilient Model of Care and Advocacy for - VICCIR offers a unique model of care
Refugees and Immigrants in Canada responding to trauma and the clients' cultural
needs. Refugees, survivors of torture and
Ana Maria Pavon Marin, BCACC; Adrienne Carter immigrants from diverse backgrounds benefit
from counselling services and support. COVID-
Learning Objectives 19 has been a challenge and an opportunity to
1. Be more confident and resourceful to test this model in a telehealth environment,
respond to the current mental health reducing barriers to accessing mental health
conditions, reframing how apparent services. An opportunity for raising awareness
setbacks can become stepping stones and facilitating spaces for settlement workers
and making some of the challenges of and professionals in the sector dealing with the
COVID-19 to become opportunities to join effects of the pandemic, taking care of those
forces with individuals and community who care and strengthening relationships with
allies to reduce barriers for accessing other organizations and community. To share
mental health support. how a collaborative outlook led to co-creating a
2. Be more aware of the opportunities for self-sustaining community mental health
practicing advocacy and strengthening program based on a holistic approach and
collaboration with like-minded learning of cultural elements that support health
organizations to understand better the and prevention through a team of trained,
refugee and immigrant community's cultural and health ambassadors having
needs and the effective use of available reduction of stigma and advocacy at the core.
resources.
3. be familiar with the VICCIR model for Results/Impacts/Outcomes
serving the mental health needs of Power-Point
individuals, families and communities of
refugees and immigrants. A model based Conclusions/Discussion
on continuous capacity building using a Advocacy, resilience, stigma, prevention, mental
diverse team of trained and supervised health
counsellors, translators and qualified
volunteers.

The challenges faced by immigrants and
refugees accessing mental health are many,
such as barriers that stem from language,
culture, stigma, or the lack of information and
access to services, to mention some. To this
complex reality, we must add the experience of
a worldwide pandemic shattering the meaning of
safety and becoming the breeding ground for
increasing feelings of isolation and disrupted
individual and family dynamics. Moreover, it has
created situations hindering financial support to
dependent family members, increased gender-
based violence, and made visible the painful
effects of racism and discrimination, fueling,
and worsening mental and physical health
issues.
Session: W28, Submission Number: 1042165 Activities for Refugees, Immigrants, and
Migrants (NRC-RIM), a CDC-funded project
Resources for Newly Arrived Refugees During implemented through the University of
the COVID-19 Pandemic Minnesota. NRC-RIM’s main goals include
providing technical assistance to state and local
Erin Mann, William Stauffer, Michelle Weinberg, Lori Kennedy, health departments working with refugee,
Blain Mamo, Megan Keaveney, Nina Marano, Emily Jentes
immigrant, and migrant communities, and
strengthening partnerships with health
Learning Objectives
departments working with community based
1. Describe key CDC collaborations
organizations to develop and disseminate best
developed to create effective
and promising practices focused on case
communication, resources, and data
investigation, contact tracing, community-based
analyses in order to address gaps in
testing, and vaccination.
reaching refugee communities during the
COVID-19 pandemic.
2. Learn how to engage as stakeholders with
To better serve the refugee communities, CDC
COE and NRC-RIM to leverage refugee
will continue to leverage partner support to
resources in your COVID-19 response
improve communications, outreach, and
efforts.
vaccination within these communities. Each
3. Identify specific COVID-19 resources that
project will describe its work and resources for
be utilized to support refugee, immigrant,
refugees during the COVID pandemic. Time will
and migrant communities during the
be allotted for questions and discussion.
COVID-19 response.
COVID-19, refugee health, health
Recently resettled refugees to the United States
communications
may experience living arrangements or working
conditions that put them at greater risk of
getting COVID-19. As a result, CDC used or
adapted existing resources and facilitated new
collaborations to create effective
communications, resources, and data analyses
to address gaps in reaching refugee
communities during the pandemic.
Methodology
One existing resource was the Centers of
Excellence (COE) in Newcomer Health, whose
activities focused on organizing a COVID-19
webinar series for newcomer community
members and clinicians, supporting newcomer
cultural navigation in contact tracing efforts,
and conducting data analyses with multiple
state partners. The focus and audience of the
COE work is refugee health partners who
connect with refugees during the initial
resettlement period on all health topics, not just
COVID-19. One new collaboration was
establishment of the National Resource Center
for Contact Tracing, Prevention, and Mitigation
Session: W29, Submission Number: 1045556 Understanding the influence of culture on
perception of health, mental health and help-
Cultural Considerations in Mental Health seeking behaviors; (3) Strategies for engaging
Therapy with Resettled Refugees refugee clients in mental health therapy. After
attending the workshop, the participants will be
Erum Agha, UNC Chapel Hill - School of Medicine able to better engage refugee clients in mental
health therapy which will lead to better health
Learning Objectives and mental health outcomes for the clients.
to describe influence of culture on Results/Impacts/Outcomes
health, mental health and healthcare This will be a live interactive workshop offered
decision making virtually. The facilitator will use the virtual
2. Upon completion participants will be able platform for didactic instruction using slides,
to list suitable approaches to engaging case studies, questions & answers, interactive
refugee clients in mental health therapy discussion and breakout sessions for working in
3. Upon completion participants will be able smaller groups.
to conduct individual and group
therapeutic and social support services Conclusions/Discussion
for refugee clients with knowledge and Culture, mental health, refugees, therapy,
skills support-groups

Culture influences how we view health and
healing. With increasing demographic diversity
among resettled refugees, it is likely that
clinicians will treat clients from diverse cultural
backgrounds in counseling and clinical settings.
Clinical social workers routinely diagnose clients
for mental health issues based on symptoms and
behaviors. It is important to understand how
presentations of these symptoms and behaviors
may be interlaced with cultural nuances. When
clients perceive their social workers and
therapists to be culturally competent and
inclusive, they are more likely to form strong
therapeutic alliances with them which leads to
better therapy outcomes. This workshop will
provide an overview of cultural considerations
that examine all aspects of a refugee client’s
worldview and offer suggestions that may
produce more culturally informed clinical
practice.
Methodology
This workshop will provide definitions and
concepts of culture, influence of culture on
health, mental health, health care decision
making, and how to engage refugee clients in a
therapeutic setting. Key points include: (1)
Deeper understanding of culture; (2)
Oral Health of Humanitarian Migrants: Canada Didactic presentation; audience interaction
as a Case Study
Mary Ellen Macdonald, Nazik Nurelhuda, Negin Oral health
Eslamiamirabadi, Keshani Fatemeh, Manav Preet Singh Saini
Learning Objectives
1. Upon completion, participant will
understand the relation between general
health and oral health.
to describe oral health issues that
migrants experience globally.
3. Upon completion, participant will
understand the scope of work being
conducted in Canada by the Migrant Oral
Health Project.

Oral health is an integral part of overall health
and well-being and is therefore a fundamental
right for refugees and asylum seekers
(humanitarian migrants). Although most oral
health conditions are largely preventable and
can be treated in their early stages, the burden
of oral diseases and need for dental care are
high in this population. The Migrant Oral Health
Project (MOHP) is an interdisciplinary,
interprofessional team of researchers, trainees,
clinicians, policy makers, and community
organizations based in Canada. Dental care
services are not publicly funded in Canada.
Methodology
We will deliver a workshop to orient healthcare
providers, refugees, researchers and other
professionals interested in refugee health on the
global oral health situation of this population
with a focus on MOHP’s work in Canada. The
proposed outline of the workshop is as follows:
global overview of the oral health situation of
humanitarian migrants. Oral health experiences
of refugee children in Montreal and their
parents’ perspectives on access to care.Dental
care pathways of refugees and asylum seekers in
Ontario, Canada. Advancing a program theory for
community-level oral health promotion programs
for humanitarian migrants using realist review.
Refugees are safe in Canada; but how about

their nutritional health status?
Hassan Vatanparast, Ginny Lane, Mustafa Koc
Summary
Numbers of refugees, asylum seekers, and

undocumented immigrants are on the rise
globally and in Canada. Most recent newcomers
are from diverse ethnocultural backgrounds.
Upon arrival in Canada or other high-income
countries, newcomers, particularly children tend
to experience subtle or drastic changes in their
food environment depending on their pre-
migration living circumstances. Dietary
acculturation and nutrition transition tends to
impact nutrition and health status of the
immigrant youth negatively. Financial
constraints migrant families face, also increase
the risk of food insecurity. These changes may
have short and long-term effects on the health
status of immigrants, especially of refugee
children. Insufficiency and deficiency of key
nutrients required for growth and development,
as well as bone health and metabolic issues, are
examples of short-term health issues that may
lead to chronic health problems.
This session will highlight the nutrition and

health status of newcomers, particularly
children, as well as barriers to healthcare
experienced by immigrants and refugees living
in Saskatchewan. Barriers to healthcare that will
be discussed in this session will include
difficulties in accessing healthcare system,
limited awareness of services, language
difficulties, interpretation issues, difficulty in
accessing health benefits, healthcare service
limitations and stigma, gender and cultural
concerns, health attitudes, and life stressors
related to their beliefs, work, school, childcare,
and transportation. Finally, the session will
discuss the need for integrated food policy
responses associated with food and nutritional
security status of refugees and undocumented
immigrants.
Fever in new refugees
Andrea Boggild

publishing.
This session will review asylum law as it pertains
Gender as the Sixth Ground for Asylum: to gender-based claims and provide a historical
Historical, Legal and Medical Perspectives and a perspective on current policies. Using case
Call to Action presentations, legal and medical experts will
demonstrate how the current legal environment
Eleanor Emery, Center for Health Equity Education & Advocacy, impacts survivors with a particular emphasis on
Cambridge Health Alliance; Kathryn Hampton, Physicians for
Human Rights; Irena Sullivan, Tahirih Justice Center; Joanne (1) retraumatization that can accompany the
Ahola, Weill Cornell Center for Human Rights additional questioning required to make a case
based on membership in a PSG and (2) the way
Learning Objectives in which this complicated framework prevents
1. Describe how asylum claims for survivors claimants from participating in their own cases.
of gender-based violence (including but Presenters will then review efforts underway to
not limited to domestic violence, sexual add gender as a sixth ground for asylum and
assault, forced marriage and "honor" discuss concrete ways participants can support
crimes) are currently litigated. these efforts as advocates.
2. Describe at least two ways in which the
current system of litigating asylum claims Results/Impacts/Outcomes
for survivors of gender-based violence Medical, legal, and policy experts will present on
under the "membership in a particular each topic followed by a panel question-and-
social group" category could be answer discussion. Case presentations will be
disadvantageous or harmful for the used to demonstrate the impact of this legal
claimants. issue on refugee health.
3. List at least three groups of asylum
claimants who would benefit from the Conclusions/Discussion
addition of "gender" as a 6th ground of Asylum, gender-based persecution,
asylum and explain how. retraumatization, trauma-informed practice

Despite the pervasiveness of gender-based
persecution on a global scale, gender is notably
absent from the United Nations’ definition of a
refugee and as a ground of asylum under U.S.
law. UNHCR asserts that survivors of gender-
based persecution are eligible for asylum as
members of a particular social group (PSG),
however this ill-fitting categorization poses
additional legal and medical challenges for
survivors. Keeping survivors’ claims under the
PSG ground also leaves them vulnerable to the
whims of changing executive policies, as
illustrated by the former administration’s
attempts to gut gender-based asylum entirely.
To prevent this, advocates propose that the U.S.
follow other countries in adding gender as a
sixth ground of asylum.
Session: W34, Submission Number: 1043550 2. Discuss techniques to recruit and engage
effective QI teams.
Harnessing Quality Improvement Methodology to 3. Discuss specific interventions to
Advocate for Equity in Immigrant and Refugee implement for immigrant/refugee health
Healthcare utilizing QI methods.
Cara Harasaki, The Ohio State University and Nationwide Results/Impacts/Outcomes

Children's Hospital; Anup Patel, The Ohio State University and
Nationwide Children's Hospital 15 min Introduction of QI methodology; 15 min
Interactive simulation case to create a Key
Learning Objectives Driver Diagram; 15 min Discussion of data
1. Describe quality improvement collection and presentation as well as specific
methodology including key driver diagram examples and techniques to advocate for equity
creating, collecting and presenting data, for immigrant/refugee patients within health
and garnering support from leadership. systems; 15 min Interactive question and
2. Discuss techniques to recruit and engage answer session. Nationwide Children’s Hospital
effective quality improvement teams. (NCH) is a national leader in quality
3. Discuss specific interventions to improvement instruction and implementation.
implement for immigrant/refugee health Drs. Harasaki and Patel are instructors for the
utilizing quality improvement methods. Quality Improvement Essentials Course which
provides similar education at NCH.
Adverse events in healthcare disproportionately Conclusions/Discussion
affect vulnerable populations including Quality Improvement, Advocacy, Innovation,
immigrant/refugee patients. Caring for families Patient Safety
with language barriers, social vulnerabilities,
and cultural differences poses unique
challenges. Quality improvement (QI)
methodology has proven effective in improving
patient safety and optimizing health systems.
For instance, methods like creating clinical care
guidelines can be utilized to guide general
clinicians in encounters with special
populations. Additionally, QI projects can be
utilized to pilot increasing access to technology
to improve usage of language interpretation.
Aids like order sets in electronic medical record
systems can promote adherence to best practice
refugee screening guidelines. These methods
can be utilized to improve care and address
inequities in our most vulnerable patient
populations.
Methodology
1. Introduce quality improvement
methodology (QI) including key driver
diagram creating, collecting and
presenting data, and garnering support
from leadership.
Session: W35, Submission Number: 1043573 Conclusions/Discussion
COVID-19, detention, detainees, expert
COVID-19 Expert Declarations: The Clinician's declarations, petition
Role in Securing Temporary Release of ICE
Detainees
Jeremy Chang, Weill Cornell Center for Human Rights; Tara

Pilato, Weill Cornell Center for Human Rights; Pooja Shah, Weill
Cornell Center for Human Rights
Learning Objectives
1. List the ways that a COVID-19 expert
declaration can be used by an attorney to
aid in legal proceedings.
2. Describe the different sections that a
structured COVID-19 expert declaration
can include.
3. Write a COVID-19 expert declaration that
incorporates our organization's best
practices.

Immigration and Customs Enforcement (ICE)
detainees face a disproportionate risk of
contracting COVID-19. In late March 2020, the
Weill Cornell Center for Human Rights (WCCHR)
launched an effort to write expert declarations
for ICE detainees, in which teams of clinicians
and medical students reviewed medical records
to attest whether detainees faced a
disproportionate risk for COVID-19
complications. WCCHR sent 25 cases to
clinicians for review, of which 17 (68%) cases
resulted in an expert declaration. Six cases
(35%) resulted in temporary release from
detention: two from successful habeas petition,
two from a temporary restraining order from the
court, one successful ICE petition, and one
granted low bond from ICE.
We will prepare a slide presentation and lecture
to introduce the key points of our workshop and
to recount our organization’s experience with the
initiative. Next, we will transition into an open
Q&A session that will invite discussion about the
nuances of COVID-19 expert declarations.
Session: W36, Submission Number: 1042996 assessment, including how to use elements of
the DSM-5 cultural formulation interview to
Culturally Responsive Assessment of Cognitive include a patient’s explanatory model of their
Impairment illness, 4) discuss the psychometric properties,
including cultural validity, of established
Joelle Taknint, Lily Sonis, Maedeh Marzoughi Ardekani, Sarah cognitive screening tools, 5) discuss culturally
Kimball, Immigrant and Refugee Health Center, Boston Medical
Center; Section of General Internal Medicine, Boston University informed clinical recommendations from
School of Medicine and Boston Medical Center; Maxine Krengel, multidisciplinary perspectives (i.e.,
Laura Grande, Linda Piwowarczyk neuropsychology, medical social work, primary
care, psychiatry) for addressing cognitive
Learning Objectives impairment occurring within common disorders
1. Appropriately select cognitive screening seen among adult immigrant and refugee
tools for suspected cognitive impairment patients in our clinic (e.g., vascular dementia,
for their patient population. acquired brain injury, CI in the context of Post-
2. Conduct culturally informed diagnostic traumatic Stress Disorder, Major Depressive
interviewing for common differential Disorder).
diagnoses resulting in cognitive
impairment. Results/Impacts/Outcomes
3. Implement culturally responsive The workshop will be interactive and use a
treatment recommendations for cognitive series of de-identified case examples from our
impairment. practice to engage participants in real time
application of all concepts.
This workshop for medical and mental health Conclusions/Discussion
professionals provides an introduction to Cognitive Impairment, Cognitive Screening,
culturally responsive assessment of cognitive Culturally-responsive assessment
impairment (CI). Drawing from a pilot project
within a primary care immigrant and refugee
health clinic, we have encountered substantial
training and research gaps in best practices in
CI assessment, particularly when testing is for
legal/immigration reasons. Barriers to CI
assessment for immigrant and refugee patients
further include poor cultural validity and
confounders between education level and
positive CI indicators on commonly used
cognitive screeners (Paddick et al., 2017).
These factors contribute to disparities in
evaluation quality, and higher rates of CI
misdiagnosis for migrant patients (Nielsen et al.,
2011).
Methodology
In order to bridge this knowledge gap, this
workshop will: 1) identify contexts for
assessment of CI in refugee healthcare, 2)
review common CI symptoms, etiologies, and
functional impairments health care providers
should screen for, 3) discuss diagnostic
interviewing and cultural responsivity in
Session: W37, Submission Number: 1043647 resiliency and the importance of nurturing it
explain the importance of language and
Somatic and Movement Practices to Enhance invitation in self agency offer immediate
Resilience for Refugees: How They Work and movement based interventions (and when to use
Why They Matter them) that can be integrated into clinical
practices for all ages and that can also be
Kirsten Wilkinson utilized by displaced individuals anytime

1. Describe and observe how trauma affects Lecture and experiential instruction of
the body restorative, movement based practices
2. Know when a movement based (breathwork, orienting, centering, grounding).
intervention is needed.
3. Conduct simple restorative movement Conclusions/Discussion
based practices with displaced Trauma, Health, PTSD, Resilience, Somatic
individuals and for themselves while Therapy
implementing invitational language.

Many people who have been displaced have
experienced trauma (physical, emotional,
developmental, shock, cognitive, or vicarious).
While specific types of interventions involving
conventional mental health practices can
provide assistance, many displaced individuals
do not have access to mental healthcare
services. Certain types of trauma and how an
individuals nervous system responds can also
cause symptoms of shutdown, anxiety, cognitive
interruption, and an inability to self regulate,
making conventional interventions ineffective.
Evidence has shown that restorative, movement
based practices can offer relief from PTSD,
anxiety, and depression in both children and
adults, which can improve general health and
quality of life. These practices also nurture
resilience, strengthening both individuals and
communities.
Methodology
The objectives of this workshop is to provide
individuals working with displaced people a
better understanding of how trauma effects the
body and an opportunity to learn movement
based tools and methods to promote resiliency
and self agency for overall wellbeing and trauma
restoration. This workshop will explain self
agency explain how trauma might present in the
body and the importance of self agency explain
how trauma gets stuck in the body describe
Pediatric Refugee Health During the COVID

Pandemic: Case Discussions
Patricia Li, Mahli Brindamour, Andrea Hunter, Shazeen Suleman
Learning Objectives
1. Describe the challenges in identifying
and managing pediatric refugee health
during the pandemic
2. List some resources to assist in caring for
refugee children
3. Describe ways to advocate for pediatric
refugee health during the pandemic and
beyond, to support families and systems
in times of stress

Although children have comprised a small
proportion of those with severe complications
and hospitalizations due to COVID, the
pandemic has nonetheless significantly affected
the physical and mental health of refugee
children and youth. Families of children have
experienced reduced access to routine,
preventative and consultative care.
Consequently, healthcare providers have missed
opportunities to address conditions that are
either preventable or that benefit from early
intervention.
Methodology
During this workshop, Pediatricians from across
Canada will lead interactive case discussions
related to care of children during the pandemic,
including developmental, behavioural and
mental health issues, access to services and
virtual care, and conditions related to COVID
(e.g. vaccination, multisystem inflammatory
syndrome in children).
Case studies and interactive discussions.
Pediatrics, COVID, Physical and mental health
Session: W39, Submission Number: 1033057 Evaluation, and Ethics Committee, 2)
Demonstrate a logic model framework for
Strategic Planning for Refugee Health Research: planning the Committee’s activities to reach
Prioritizing Activities for a Research, Evaluation, desired short- and long-term outcomes, 3)
and Ethics Committee Engage attendees in prioritizing activities and
resources that the Committee could develop.
Colleen Payton, Moravian College; Gayathri Kumar, Centers for
Disease Control and Prevention, Division of Global Migration and
Quarantine, Immigrant, Refugee, and Migrant Health Branch; Results/Impacts/Outcomes
Sarah Kimball, Immigrant and Refugee Health Center, Boston Researchers will learn practical skills for
Medical Center; Section of General Internal Medicine, Boston strategic planning to improve the success of
University School of Medicine and Boston Medical Center; Sarah
Clarke, Society of Refugee Healthcare Providers; Ibrahim reaching short- and long-term program goals.
AlMasri, University of Calgary; Fatima Karaki, University of This interactive workshop will illustrate how
California, San Francisco logic models can be used to visually outline
activities that match intended goals. It will also
Learning Objectives provide attendees with resources (e.g., research
1. Describe the mission and goals of the collaboration form) that can support Committee
Society of Refugee Healthcare Providers governance and planning. Attendees will have
(SRHP) Research, Evaluation, and Ethics the opportunity to provide input on and help
Committee prioritize future research, evaluation, and ethics
2. Create a logic model to visually outline activities conducted by the Committee through
resources and activities that directly an interactive web-based platform.
match intended outcomes
3. Provide input on future research, Conclusions/Discussion
evaluation, and ethics activities Strategic planning; Research, evaluation, and
conducted by the Committee ethics

Collaborative approaches to support the health
of refugees and other newcomer populations in
their resettlement country are needed to address
the complex medical and social challenges they
may experience after arrival. Refugee health
professionals within the Society of Refugee
Healthcare Providers (SRHP)—the largest
medical society dedicated to refugee health in
North America—have expressed interest in
greater research collaborations across SRHP
membership and a need for guidance in
conducting ethical and inclusive research on
refugee health. The SRHP Research, Evaluation,
and Ethics Committee (Committee)--the first
SRHP committee--formed to address these
needs identified by members. A logic model was
developed to outline the priorities, inputs,
outputs, outcomes, assumptions, external
factors, and evaluation plan for the Committee.
Methodology
The objectives include: 1) Describe the
establishment of the SRHP Research,
Session: W40, Submission Number: 1042689 immigrant, and migrant communities. In
addition to creating campaigns across 8
Developing Community-Led Vaccine Campaigns communities, the collaboration has created a
for Refugee, Immigrant, and Migrant publicly accessible and easy-to-use tool so that
Communities, Using Human-Centered Design any community leader might be able to create
and test their own ready-to-launch materials.
Erin Mann, Courtney Chang During this session, we'll share how we have
seen these tools work for community leaders,
Learning Objectives how we might continue to amplify this work, and
1. Describe how human-centered design how one could leverage these tools to build
might apply to their work vaccine confidence in their community.
2. Describe the importance of community-
led work Methodology
3. Use the materials to create a Vaccine We will aim to: 1. Highlight the value of
Confidence campaign for Refugee, community-driven work 2. Share the process of
Immigrant and Migrant communities that developing community-led materials 3.
you might serve or work alongside Demonstrate how others can use tools and
templates to create their own materials
During the COVID-19 pandemic, we have Results/Impacts/Outcomes
continued to see the value of community-led 1. Give an overview about Human-Centered
efforts and the resulting outsized impact. By Design as the theoretical basis for this process
grounding in the needs of communities, and 2. Share the materials that we created, and
especially historically marginalized insights into best practices learned in working
communities, the National Resource Center for alongside community leaders to foster ownership
Refugees, Immigrants, and Migrants, the 3. Allow participants to create materials for their
Centers for Disease Control, and IDEO.org (a communities
Human-Centered Design non-profit studio) have
collaborated with community leaders across the Conclusions/Discussion
United States to develop community-led and Human-Centered Design, Community-Led,
driven case investigation/ contact tracing and Refugees, Immigrants, COVID-19
vaccination confidence campaigns for refugee,
Lesssons learned from the Clinique Mauve

working with Racialized, Migrant and Asylum
Seeking Sexually and gender Diverse Individuals
in Montreal
Piere-Paul Tellier
Learning Objectives
Describe the Clinique Mauve

List the source of physical and mental health
issues for this population
Discuss the peculiarities dealing with this group
of patients
Summary
The workshop will deal with the creation of a
unique service established in Montreal for
racialized, migrant, and asylum seeking sexual
and gender diverse individuals. The project was
started in 2020 in response to the increasing
isolation of this population due to COVID-19. It
was established with the contribution of partners
from the community and academic milieus. A
team approach is used to address the multiple
problems faced by this population including
physical and mental health, and social
welfare. The experience to date has been
successful but has elicited several questions
within the team regarding the best approach to
offering service. After a didactic presentation,
the audience will be invited to discuss these
questions.
Session: P1, Submission Number: 1020769 Results/Impacts/Outcomes
Themes identified include: community
Gaps in Service Organisation Programs from collaborationorganisations prioritising refugee
Refugee Community Perspectives community knowledge and skillscommunity
independence from mainstream
Alyssa Clayden programsfeelings of exploitation &<br>
resignationlack of services that address
Learning Objectives community needs
to describe gaps identified by Conclusions/Discussion
participating refugee communities Community members identified feelings of being
2. Upon completion, participant will be able exploited by mainstream agencies, assumptions
to demonstrate knowledge of ways they cannot rely on mainstream organisations to
organisations can better address refugee address community needs, and the importance
community needs of finding independent community-run services
to conduct more effective services within
their own organisational practices

Refugee communities continue to show little to
no improvement in mental health outcomes. An
in-depth series of focus groups were held with
two communities to explore community
perceptions of gaps and to more fully
understand what is missing in current
programming and care.
Methodology
All information was gathered through focus
groups and individual meetings, which are the
most common forms of qualitative data
gathering in health care research. All interviews
were conducted by a single interviewer and used
four different interpreters. Eight focus groups
and 11 individual interviews in the Bhutanese
community. Participants ranged in age from 6 -
88. Four focus groups and 3 individual
interviews in the Tigrinya community.
Participants ranged in age from 19 - 43 for a
total of 86 participants.Data analysis was Braun
and Clarke's (2006) 6-step thematic analysis:
1. Reading, transcribing, and re-reading
content2. Established initial codes3. Structured
preliminary codes4. Cross-examined data to
finalize codes5. Used in vivo to define and
explain themes6. Produced a report providing
exemplars for themes
Session: P2, Submission Number: 1022706 They experience MH problems like PTSD,
depression, and anxiety. Protective factors which
Impact of Family Loss and Separation on support youth include a caring community,
Refugee Youth: A Systemic Problem and connection with peers, faith and support from
Research-based Solutions at System and community programs and services. Support from
Community Level community programs includes both support with
system navigation as well as social, recreational
Akm Alamgir; Serena Nudel and skills development programming.
Therapeutic interventions, including Cognitive
Learning Objectives Behavioural therapy with cultural modifications
1. Understand the patterns and predictors of were found to be effective.
refugee youth impacted by famuly loss
and separation Conclusions/Discussion
2. Comprehend mechanism and magnitude Considering the obstacles that they face in
of the mental health issues caused by during resettlement, they display incredible
traumatic experiences on refugee youth determination and resilience. Many challenges
3. Identify the policy needs and service faced by youth are systemic and there is an
system gaps experienced by the refugee opportunity to improve their settlement
youth and their service providers experience and reduce stress with targeted
systemic and policy change.
Research-based evidence on how family loss and
protracted separation, intersecting with the
social determinants of health impacts the
mental health and wellbeing of refugee youth
affecting their healthy integration.
Methodology
This was a sequential multiphase research with
three steps: (i) ‘Scoping Review’ of peer-
reviewed articles from three high-impact
databases and open source documents, and (ii)
experiential data from the refugee youth with
lived experience, and (ii) their service providers
was triangulated and analyzed collaboratively to
form body of data. First-hand data was collected
using a mixed method prospective approach,
through five Focus Group Discussions.
Refugee youth that experience family loss and
separation encounter numerous challenges in
their settlement impacting their mental health
and well-being. Social determinants of health
including language barriers, discrimination,
settlement process delay, limited access to
education, challenges finding affordable
accommodation and employment are key factors
impacting the youth. The separation from home,
family and culture was a significant stressor.
Preliminary study results (n=30) demonstrate
A Visual-based Universal Symptom Capture App that non- and mixed-literate patient use of the
for Refugee Patients with Low Literacy LiteraSeed picture-based app identifies
symptoms that could lead to misdiagnosis in
Aziza Ismail; Crista Johnson-Agbakwu; Sonam Singh; John 20% of patient cases. On average, we found
Waldeisen
that patient self-reporting increased relative
symptom identification by 0.26 more symptoms
Learning Objectives
per patient. LiteraSeed identified the same
symptoms in 53.3% of cases (16 out of 30),
to describe the purpose of our study.
identified more symptoms in 20% of cases (6
out of 30, averaging 2.6 more symptoms per
to describe the importance of effective
patient), and underreported symptoms in 26.7%
and accurate communication with
of cases (8 out of 30, averaging 1 less symptom
patients.
per patient).
to demonstrate how existing technology
can be employed to improve patient
LiteraSeed’s visual-based communication tool
safety.
allows patients to self-report symptoms that
would have otherwise gone unidentified.
LiteraSeed can support medical providers in
Miscommunication causes 78% of misdiagnoses
their diagnosis leading to improved safety and
resulting in 80,000 avoidable hospital deaths
patient experience.
annually. Language barriers increase patient
safety risks up to 49% for more severe and
frequent adverse outcomes. We aim to reduce
the tragic and preventable deaths of people who
have difficulty communicating effectively with
doctors. LiteraSeed provides a visual-based
symptoms reporting platform that effectively and
accurately elicits self-reported symptoms from
refugees, helping to reduce misdiagnoses.
Methodology
Our 300 patient feasibility study intends to
measure effectiveness and inform the design of
our visual symptom capture tool. The study,
completed at Valleywise Health’s Refugee
Clinics, gathers both quantitative and qualitative
symptom-based data self-reported by non- and
mixed-literacy patients. We compare the
accuracy of the patient’s self-reported
symptoms, captured remotely, to the symptoms
reported by the provider when assisted by an in-
person certified interpreter.
Session: P4, Submission Number: 1025190 refugee/immigrant communities. Participants
reported a number of characteristics for
Achieving Research Justice and Inclusivity: identification including preferred language,
Identification of Refugees & Immigrants in country of origin, and time in the U.S. but noted
Electronic Health Records that these may be inadequate for subgroup
identification without additional attention to
Amy Zeidan; Emory University School of Medicine, Atlanta, GA; migration narratives. Themes also emerged
Matt Dudgeon; Maggie Smith, Emory University School of
Medicine, Atlanta, GA; Sabrina Bogovic; Anna Yaffee around the approach for obtaining information,
highlighting the need for trust and rapport
Learning Objectives building when recording information.
able to understand the importance and Conclusions/Discussion
current gaps of identifying refugees and Key informant interviews characterized the
immigrants in Electronic Health Records complexity of using EHRs to identify refugees
2. Upon completion, participants will be and immigrants but suggested a number of
able to explore methods for identifying characteristics and approaches to consider.
refugees and immigrants in EHRs Further research with refugee and immigrant
3. Upon completion, participants will be populations on identification using EHRs is
able to understand ethical challenges for ongoing and warranted.
methods of identification of refugees and
immigrants in EHRs.

Refugees and immigrants face multiple barriers
to healthcare and patterns of healthcare
utilization are poorly understood. Difficulties in
identifying refugees and immigrants in
electronic health records (EHRs) and national
data sets present obstacles to obtaining data on
health outcomes. This study evaluates ethical
and appropriate methods for identifying refugees
and immigrants in EHRs within healthcare
systems.
Methodology
We conducted semi-structured qualitative
interviews with key informants to explore
methods of identification of refugees and
immigrants in EHRs. Interviews were conducted
via recorded video, transcribed, and coded by
two independent study team members for
thematic analysis.
14 key informant interviews were completed.
Key informants identified as community leaders
(3), healthcare providers (7) and
professors/researchers (4) with an average of
~13 years of experience working with
Session: P5, Submission Number: 1032719 Conclusions/Discussion
This study aims to help health care providers,
The Voices of African, Caribbean, and Black educators, and policymakers critically
Women Living with HIV in Edmonton, Alberta, understand the barriers faced by this group of
Canada: Barriers, Strengths, Strategies, and women to facilitate improved access to social
Facilitators and health care services.
Hellen Gateri
Learning Objectives
1. Understand HIV-related barriers that
impede access to health care and social
services for ACB women
2. Unpack the role of social structures in
creating and perpetuating HIV-related
discrimination, fear, and denial
3. Understand the strengths, strategies, and
facilitators that supported ACB women to
address these barriers

This qualitative study aimed to understand HIV-
related barriers that impeded access to health
care and social services for ACB women, unpack
the role of social structures in creating and
perpetuating HIV-related discrimination, fear,
and denial, as well as understand the strengths,
strategies, and facilitators that supported these
women to address these barriers.
Methodology
This study was informed by antiracist and
intersectionality theoretical frameworks. Data
collection was conducted using semi-structured
individual interviews and photovoice focus group
discussions. We used interpretative
phenomenology to analyze the findings.The
study demonstrated that ACB women living with
HIV experienced barriers to access social and
health care services because of stigma and
discrimination in broader social processes and
structures within Canadian society.
This study demonstrated the strengths and
strategies of ACB women, as well as the support
they received from facilitators, in addressing the
barriers they experienced accessing social and
health care services.
Participants were within the mean age of 38,
‘Finding Our Pathways’: Post-migration Health 43% of the women were Syrians, and 85% of
Care Barriers and Facilitators of Refugee Women the local leaders had been supporting refugees
Navigating the Canadian Health Care System for about 7 years now. Barriers to navigating the
health system included culture shock, language
Eunice Anteh; Gloria Aidoo-Frimpong; Claudia Steinke barriers, and low health literacy skills. Refugee
women developed resilience and coping
Learning Objectives strategies like assisting each other, religious
1. Describe the health needs and experience organizations and social activities to navigate
of refugee women in Canada. through the system.
2. List the barriers to health care for refugee
women. Conclusions/Discussion
3. Formulate a formalized approach to Findings highlight on the need to provide an
assess the individual health care needs of integrated delivery of care during the early years
refugee women. of arrival by creating intensive education
sessions, cultural sensitivity training for local
Background and Purpose/Rationale leaders and joint network of ideas and resources
Annually, Canada resettles an estimated 12,000 between rural and urban agencies.
refugees with 49% of these being women. With
multiple traumatic events experienced during
refugee migration, there is significant negative
impact on their physical and mental wellbeing,
and their resettlement in Canada. Yet, there is
limited information on the healthcare
experiences of refugee women resettled in
Canada. This study seeks to understand the
healthcare needs of refugee women and identify
strategies that can help improve their
understanding, access, navigation and
utilization of the Canadian healthcare system.
Methodology
An explorative qualitative research approach
informed by intersectionality feminist framework
was used. Between January – April 2018, data
was collected through six focus group
discussions with 39 refugee women, and seven
individual interviews with local leaders.
Participants were recruited from six
communities in southern Alberta, Canada using
purposive with snowball sampling techniques.
The data was thematically analyzed and
interpreted from a social constructivist lens.
Session: P7, Submission Number: 1036903 accounted for language proficiency were further
reviewed for methodology.
Limited English Proficiency as a Barrier to
Inclusion in Stroke Emergency Medicine Results/Impacts/Outcomes
Research Of the 167 studies that met inclusion criteria,
17 studies included patients with LEP. Of those
Margaret Smith, ; Amy Zeidan, Emory University School of 17, 14 included English and Spanish speakers
Medicine, Atlanta, GA; Rebecca Leff, School of Medicine,
Faculty of Health Sciences, Ben-Gurion University of the Negev, only. Nine studies accounted for language
Beer -Sheva, Israel; Alexis Cordone; Timothy Moran; Alexandria proficiency in the methodology and 10 included
Brackett; Pooja Agrawal language in the demographic and primary
analyses. Language was the primary variable
Learning Objectives evaluated in only 4 studies.
1. Describe the current state of inclusion of
LEP patients within stroke specific Conclusions/Discussion
emergency medicine research. EM studies specific to stroke care do not
2. Describe the importance of evaluating routinely account for patients with LEP. The
emergency medicine literature in order to inclusion of LEP patients is critical to
determine if the effect of LEP and understand disease prevalence, appropriateness
language on health outcomes is of treatments, and outcomes. There are
evaluated. opportunities for physicians to engage in
3. Identify study methodologies and study language-inclusive research practices to ensure
protocols that will support the future patients are equitably represented in EM
inclusion of LEP patients in research. literature and evidence based practices.

Language is commonly cited as a primary barrier
to refugee healthcare access in the US. Patients
with language barriers, or limited English
proficiency (LEP), face unique challenges
navigating the healthcare system, receive poorer
quality of care and have worse outcomes.
Despite these disparities, the inclusion of LEP
populations in emergency medicine (EM)
research is relatively unknown. This review
evaluates the inclusion of LEP populations in
EM research on stroke as it is a common ED
presentation and leading cause of morbidity and
mortality
Methodology
A systematic search in 3 databases was
conducted of US based publications during a
five-year time period using predetermined
search terms. Eligible articles were
independently evaluated by two reviewers.
Studies were evaluated using a standardized
reporting tool to determine if language was an
inclusion or exclusion criterion, primary variable,
or included within the paper. Studies that
From this convenience sample of 441
United We Stand, Divided We Fall: – Descriptive individuals who completed the survey, over 50%
Study on the Current State of Asylum Medicine were MDs/DOs, 46% have been in practice for
Workforce in the US over 15 years and 41% are faculty at an
academic institution. 82% had completed
Satu Salonen; Rayne Kim; Karen Wang; Baylah Tessier; asylum medicine training with over 50% having
completed it less than 5years ago. More than
half (55%) of respondents reported spending
Learning Objectives
less than 5 hours a month in asylum work and
roughly a third (33%) reported receiving no
able to describe the current asylum
institutional support for this work.
medicine workforce in the US
able to describe collaborations amongst
Our results indicate a significant need for
asylum medicine workforce
support of asylum medicine workforce.
able to discuss current needs in the
asylum medicine workforce

The world is currently experiencing
unprecedented levels of forced displacement. In
2019, over 300,000 people applied for asylum
in the US alone. While there is a legal right to
apply for asylum, the burden of proof lies with
the asylum seeker - they must prove a well-
founded fear of persecution. There is a growing
interest among health care trainees in the field
of asylum medicine, as shown by rising numbers
of student-led asylum clinics at academic
institutions. While there is literature on the
impact, there is no work quantifying or
describing who does asylum medicine work.
Therefore, we sought to characterize the asylum
medicine workforce.
Methodology
In December 2019-March 2020 we surveyed
individuals across multiple listservs— who self-
identified as conducting asylum medicine work,
about their practice type, division of work time,
type of asylum medicine work, and their support
and collaborations.
There were 3,355 hospital encounters by
Pregnancy Complications Among Resettled refugee women age 15-44 in our analysis,
Refugees in Illinois 19.1% (n=640) of which were associated with
pregnancy complications. Among the 165
Chantel Hoskin Snelling, Illinois Department of Public Health, primary medical diagnoses related to pregnancy
Center for Minority Health Services; Eric Adjei Boakye,
Department of Population Science and Policy, Southern Illinois complications, the most common complications
University School of Medicine; Jessica R. Lamberson, Illinois included threatened abortion (6.4%), post-term
Department of Public Health, Center for Minority Health pregnancy (4.7%), and gestational diabetes
Services; Gayathri Kumar, Centers for Disease Control and
Prevention, Division of Global Migration and Quarantine, (3.9%). The majority of hospital encounters
Immigrant, Refugee, and Migrant Health Branch related to pregnancy complications occurred in
the first 8 months after US arrival (85.2%) and
Learning Objectives were among women who had refugee visa status
1. Upon completion, participant will be able (85.2% vs. 10.9% for Special Immigrant Visa
to identify the most common pregnancy holders), Medicaid insurance (90.3%), ≥ 5
complications among hospital encounters hospital visits (60.2%), and who were from Iraq
by resettled refugee women in Illinois. (23.3%) or Burma (19.4%).
to describe the characteristics of hospital Conclusions/Discussion
encounters related to pregnancy We found that one in five hospital encounters of
complications among resettled refugee refugee women of childbearing age in Illinois
women in Illinois. were associated with pregnancy complications.
3. Upon completion, participant will be able Refugee women may benefit from education on
understand the need for interventions and prenatal care, support in access to prenatal
programs to reduce the risk of pregnancy care, and prompt referrals.
complications among resettled refugee
women in Illinois.

Describing hospital encounters related to
pregnancy complications may help inform
interventions and programs to reduce the risk of
these complications among resettled refugee
populations in the United States. We assessed
the characteristics of hospital encounters that
were associated with pregnancy complications
among women in Illinois who received refugee
health benefits (referred to as refugees).
Methodology
This was a retrospective analysis of the 2016-
2017 hospital discharge data of refugee women
of childbearing age (15-44 years) in Illinois. The
primary outcome variable was hospital
encounters associated with pregnancy
complications as defined by the International
Classification of Diseases, Tenth Revision,
Clinical Modification. Descriptive statistics were
used to describe hospital encounters.
The percent positive at the County level during
SARS-CoV-2: A Canary in the Coal Mine for this study period was 21.6%. Of 350 women
Public Safety Net Hospitals admitted for delivery, 33 (9.4%) screened
positive for SARS-CoV-2. When disaggregated by
Celeste Bailey; Crista Johnson-Agbakwu; Cortney Eakin; Pooja refugee status, 45 (12.8%) were refugees, of
Doehrman; Nyima Ali; Shelly Sood; Bikash Bhattarai; Linda
Chambliss; Dean Coonrod whom 8 (17.8%) tested positive, compared to
25 (8.19%) non-refugee patients testing
Learning Objectives positive, PR 2.16 (95%CI 1.04-4.51). Seven of
1. Participants will be able to define the role the SARS-CoV-2 positive tests were among
of public safety-net health care systems refugees from Central Africa.
in facilitating access to care for refugee
populations, specifically in regards to Conclusions/Discussion
COVID-19. The SARS-CoV-2 outbreak has
2. Upon completion, participant will be able disproportionately affected refugee populations.
to describe the utility of universal This study highlights the utility of universal
screening for COVID-19, a global screening in mounting a rapid response to an
pandemic with large numbers of evolving pandemic and how we can better serve
asymptomatic carriers. the refugee community. Focused response may
3. Participants will be able to list specific help achieve more equitable care related to
barriers to care for refugees that span SARS-CoV-2 among vulnerable communities.
across multiple contexts (family, Identification of such populations may help
community, socioeconomic, and political mitigate spread and facilitate a timely, culturally
spheres of influence). and linguistically enhanced public health
response.
The COVID-19 pandemic has exposed
disproportionate health inequities among
underserved populations, including refugees.
Public safety net health care systems play a
critical role in facilitating care for refugees, and
informing coordinated public health prevention
and mitigation efforts during a pandemic crisis.
Methodology
A cross-sectional study was performed
examining parturient women admitted to the
maternity unit between May 6 and July 22,
2020, when universal testing for SARS-CoV-2
was first employed. Risk factors for SARS-CoV-2
positivity were ascertained, disaggregated by
refugee status, and other clinical and socio-
demographic variables examined. Prevalence
ratios (PR) were calculated and comparisons
made to county level community prevalence over
the same time period.
Findings revealed five primary themes: adjusting
It's Hard Because It's Something New': to a new culture, parent-child acculturation
Parenting Challenges Faced by Refugees and differences, fear of children being taken away,
Immigrants in the United States balancing multiple responsibilities, and limited
social support. Many of the challenges that
Erin A. Weeks; Jessica L. Kumar participants discussed related to cultural
changes, such as language barriers impacting
Learning Objectives communication with teachers and children
1. Upon completion, participant will be able holding more American values than their
to identify some of the major parenting parents. Participants also described struggling
challenges refugees and immigrants face to balance work and parenting obligations, a
in the United States. difficulty that is exacerbated by having
2. Upon completion, participant will be able decreased social support from their extended
to define key terms relevant to parenting family in the U.S.
in migrant families (e.g., acculturation
gap). Conclusions/Discussion
3. Upon completion, participant will be able Migrant parents experience many challenges
to describe the ways in which the refugee when relocating that are both immediate and
resettlement process influences parenting long lasting. Results can help to guide
processes. development of parenting interventions that
support migrant and refugee families with
Background and Purpose/Rationale particular attention to how their needs change
Refugee and immigrant parents experience a over time.
variety of challenges when relocating that can
affect family functioning. Interventions that
target new arrivals are often limited in length
and focus on concrete support such as money
for food and housing, job training, and language
classes (Felter and McBride, 2018).
Understanding the unique and long-lasting
challenges that migrant families face is
important to supporting parents and children.
Methodology
Individual interviews were conducted with 24
migrant parents, half of whom identified as
refugees and half of whom identified as
immigrants. Participants’ countries of origin
included Afghanistan, Burma, and Democratic
Republic of Congo, and their time living in the
United States ranged from two to 27 years. The
sample included more mothers than fathers; all
parent participants had between one and seven
children. Data were analyzed using thematic text
analysis.
The findings included a description of the
Refugee and Forced Migration: The Concept of literature, investigation of resilience definition,
Resilience scales used to operationalize resilience, the
relationship between resilience and mental
Rasha Mansour; Andrea Baumann; Laura Banfield health illnesses, internal and external protective
factors contributing to fostering resilience
Learning Objectives processes, and resilience across cultures and
1. Upon completion, participant will be able languages.
to list some of the scales used to
measure resilience in refugee population. Conclusions/Discussion
2. Upon completion, participant will be able Further research is needed to validate resilience
to discuss some of the different resilience instruments across cultures and languages. The
definitions proposed by researchers. definition of resilience should not only be
3. Upon completion, participant will be able explored from the point of view of researchers
to describe how various cultures but also from the targeted population
conceptualize resilience. perspective. The interactions between mental
health illnesses and resilience in the context of
Background and Purpose/Rationale forced migration also require additional study
There is a growing interest in the phenomena of before generating them. More longitudinal and
resilience due to the increasing instability in the evaluation studies in this field need to be
world. The concept of resilience is of ambiguous carried as well.
nature, and more research is needed to clarify
the meaning of resilience in the field of refugee
research and to bridge knowledge with action.
The aim of this study is to summarize how
resilience has been defined and operationalized
in the forced migration literature and to
highlight the link between resilience and mental
health illnesses among refugees, this will inform
program development, implementation and
evaluation.
Methodology
Arksey and O’Malley (2005) scoping review
framework was followed to search 5 online
databases. The search strategy resulted in 3222
hits. However, only 20 articles met the eligibility
criteria. Numerical and thematic analyses were
both conducted to examine the breadth of the
literature.
A total of 1084 unique patients were seen in the
Differences in Medical Diagnoses and Social study period. There was a statistically significant
Determinants of Health Between Immigrant and difference between the two groups by gender,
American Born Patients Served by a NYC FQHC age, and language. American born patients were
more likely to be diagnosed with SU, HIV,
Deborah Ottenheimer, MD, FACOG, Harlem United, The Nest tobacco use, HTN and HEP C. Foreign born
Community Health Center; Katerina Chapman, MPH, Harlem
United; Dejanice Castro, New York Medical College patients were more likely to be diagnosed with
TB, GERD, and HEP B. Incidence of diabetes
Learning Objectives was approximately equal between the two
1. Upon completion, participants will be groups. Additionally, based on a comparison by
able to compare the incidence of seven SDOH, foreign born patients were more likely to
chronic disease states and substance / report being employed and were less likely to
tobacco use among immigrant and have stable housing.
American born patients.
2. Upon completion, participants will be Conclusions/Discussion
able to describe differences in the We found that foreign-born patients show
distribution of social determinants of marked differences in the incidence of 9
health between immigrant and American common medical diagnoses compared to
born patients using the PRAPARE American born patients. In addition, differences
questionnaire. in SDOH were found. These findings indicate a
3. Upon completion, participants will be need for changes in health interventions and
able to assess the changes in programming to better serve the immigrant
organizational programming needed to population.
meet health needs of immigrant patients.

Foreign-born individuals encompass nearly 14%
of the US population. Nonetheless, immigrants
remain underserved in healthcare and seem to
have different health profiles than American
born patients. Elucidation of these differences
may lead to the development of targeted health
interventions resulting in improved health
outcomes for immigrants.
Methodology
A retrospective review of electronic records for
all primary care patients seen between 1/1/19-
6/30/2020 was undertaken. Incidence of HIV,
HBV, Tobacco use, SU, Tuberculosis, HTN, DM,
HepC and GERD were extracted. For the subset
of patients who had been screened, social
determinants of health (SDOH) were also
tabulated. Comparison between immigrant and
American born patients was performed.
Preliminary results suggest that, though there is
Engaging a Refugee Community to Assess some variation between language groups with
COVID-19 Vaccine Knowledge, Attitudes and respect to willingness to get the vaccine, there
Beliefs are also some common themes including (1)
profound fear about vaccine safety and possible
Ashli Owen-Smith; Leen Almoner; Iris Feinberg; Mary Helen short- and long-term side effects and (2) a great
O'Connor; Erica Sheldon Heath; Rodney Lyn; Michael Eriksen
deal of confusion about the cost of and where,
when and how to access the vaccine.
Learning Objectives
Participants generally favored using a
1. Describe barriers to vaccination
combination of modalities to disseminate
experienced by
COVID-19 vaccine-related information including
refugee/immigrant/migrant (RIM)
through community leaders, doctors, social
communities.
media and print materials in different
2. Describe different RIM communities'
languages.
knowledge, attitudes and beliefs about
the COVID-19 vaccine.
3. Describe different RIM communities'
Findings will be used to develop, disseminate
preferences regarding how to receive
and evaluate culturally and linguistically
COVID-19 vaccination-related
appropriate health messaging about the COVID-
information.
19 vaccine with the RIM community. Analyses
are in-progress and results will be updated prior
to the conference.
Refugee, immigrant and migrant (RIM)
communities experience barriers to routine
vaccinations even under the best of
circumstances for reasons including language
barriers, cultural factors, and a lack of
consistent access to healthcare and/or
understanding of how to access healthcare. We
do not fully understand RIM communities’
knowledge, attitudes and beliefs (KABs) about
the COVID-19 vaccine or how to best develop
and disseminate messaging about the COVID-19
vaccine to this population. Our aim was to better
understand COVID-19 vaccine KABs in the
Clarkston, GA RIM community.
Methodology
Virtual focus groups were conducted by trained
facilitators in different languages (Somali,
Nepali, Swahili, Karen, Burmese, Arabic and
Amharic) to assess KABs, vaccine confidence
and message dissemination. Focus groups were
recorded and then professionally transcribed and
translated for qualitative (thematic) analysis.
This report demonstrates a failure of the system
Documenting Human Rights Violations to Enact to protect individuals held in custody. Members
Change: The Example of Covid-19 in Minnesota of this coalition are participating in ongoing
Jails meetings with the DOC to address areas of
concern.
Hannah Lichtsinn, Hennepin Healthcare; Calla Brown
Learning Objectives This presentation will describe the formation of
1. Understand the impact of Covid-19 in a coalition of advocates that coalesced around
immigration detention in Minnesota. Covid-19 in immigration detention in Minnesota,
2. Develop a strategy for forming the findings of the human rights report, and next
community-based advocacy coalitions steps for advocacy, both locally and nationally
around immigration and human rights. within the United States.
3. Utilize a human rights framework in
advocacy.

The Covid-19 pandemic has laid bare the
human rights failures of the United States
system of immigration detention. Overcrowding,
a network of disparate state-based systems and
non-standardized federal contracts, lack of
transparency, and lack of oversight and
accountability work together and in tandem to
D R AW N
WITH
place detainees at high risk of infection and
illness. In the state of Minnesota, people who
are held in immigration detention are
imprisoned in county jails, which hold direct
contracts with Immigrations and Customs
Enforcement (ICE). Due to the primacy of local
control of county jails, neither the Minnesota
Department of Corrections (DOC) nor the
Minnesota Department of Health (MDH) have
meaningful opportunities to ensure adequate
resources for medical care or infection control in
these settings.
Methodology
Immigration advocates have worked to make
visible the needs of detainees as they relate to
the Covid-19 pandemic, while remaining
steadfast in the struggle towards abolition. In
the winter of 2020, a coalition of medical, legal,
and community advocates documented specific
instances of human rights abuses in county jails
with ICE contracts, creating a report detailing
the findings.
Session: P16, Submission Number: 1042246 participation. All parents accurately recalled
COVID-19 symptoms, protective measures, and
EMPOWER Pilot: An Adaptation and Evaluation modes of transmission; none thought that
of a Social-Emotional, Wellness, and COVID-19 COVID-19 was a hoax. A majority (69%)
Curriculum for Refugee Youth accurately identified asymptomatic spread as a
source of COVID-19.
Tricia McDonough Ryan; Julia Rosenberg; Caroline O'Brien;
Fereshteh Ganjavi; Mona Sharifi
In this pilot adaptation of a wellness and SEL
Learning Objectives
curricula for refugee children during the COVID-
1. Identify barriers to mental and/or
19 pandemic, families found the program to be
behavioral health preventive initiatives for
feasible and endorsed satisfaction. Most parents
refugee children and families.
accurately recalled COVID-19 safety measures
2. Identify models and initiatives for
after participation. Future implementation,
community-based refugee health
dissemination, and assessments will include
education.
other community-based refugee groups and will
3. Understand opportunities for whole-
monitor SEL outcomes over time.
family-system initiatives to improve
mental health and wellness.

In summer 2020, we delivered a community-
partnered, innovative, multilingual Social-
Emotional Learning (SEL) and wellness program
for Afghan refugee families: EMPOWER
(Emotions Program Outside the Clinic with
Wellness Education for Refugees).
Methodology
Using the Intervention Mapping framework, we
adapted an evidence-based SEL curriculum with
trauma- and culturally-informed wellness and
COVID-19 safety education in-person and on
Zoom. We evaluated feasibility, acceptability,
and COVID-19 knowledge after participation by
conducting interviews with parents/guardians
and completed descriptive analyses.
Participants included parents from the 13 of 15
(87%) families who completed the curriculum
(with the 35 children (ages 5-15)) . All
participants denied problems with
understanding materials, traveling, or timing,
but 31% reported challenges with Zoom. On all
three measures of satisfaction, 100% responded
positively. Reported changes
(increases/decreases/no change) in discussion of
emotions at home varied. Over half (69%) stated
that their children continued yoga after
Compared to prior in-person sessions, the virtual
Virtual Family-centered Art Therapy & Trauma- space has conferred an increased sense of
informed Yoga Intervention Programming for safety, increasing youths’ comfort in sharing and
Persons Resettled as Refugees of the reflecting on the meaning of art products with
Democratic Republic of Congo the group. Translators offering participants the
opportunity to discuss in their native language
Lana Ruvolo Grasser, Wayne State University School of and co-participation of parents with youth also
Medicine; Breanna Kremmer; Jessica Smigels; Natalie McCabe;
Bharti Thakkar; Ismail Yusuf; Arash Javanbakht, Wayne State fostered a safe and productive therapeutic
University; Holly Feen-Calligan space. Evidence to date (programs are ongoing)
indicates improvements in posttraumatic stress
Learning Objectives and anxiety symptoms for youth, and
1. Understand the rationale for and benefits improvements in strength for mothers.
of creative arts and movement-based
interventions for addressing trauma- Conclusions/Discussion
related psychopathology in persons By developing therapeutic art and yoga practices
resettled as refugees in the home, families may be more inclined to
2. Understand the rationale for and benefits continue practicing these techniques in their
of family-centered intervention naturalistic setting following the intervention
programming when addressing trauma- period. Arts and movement-based interventions
related psychopathology offer opportunities to enable the transition of
3. Identify and apply recommendations for persons resettling as refugees, as they reconnect
adapting therapeutic program for the with their home culture while visualizing future
virtual space pathways.

Arts and movement-based interventions
integrate experientials that probe creativity,
flexibility, and adaptability schema; our team
has previously shown benefit of art therapy and
dance/movement therapy for reducing trauma-
related psychopathology in youth resettled as
refugees. Given the added stress of COVID-19
on already traumatized groups, like families
resettled as refugees, we have adapted arts and
movement-based programming to implement
virtual art therapy in mother-child dyads with a
trauma-informed yoga component for mothers.
Methodology
Mothers and children met weekly on a virtual
platform and engaged in art therapy
experientials geared towards focusing on
individuals’ strengths, goals, and values while
building stress coping skills and resilience
within families. Sessions integrated mindful
movements, meditation, and family group
reflection, followed by yoga for mothers.
Session: P19, Submission Number: 1043076 employers were offered appointments. For those
who postponed or declined scheduling, nursing
Advancing COVID-19 Vaccination Equity for the staff organized focused outreach (mailed
Refugee Community: Successful Collaboration information about the vaccine in the patients’
Between the Health Department, Academic primary language followed by phone calls).
Medical Center and Community Partners
Catherine Elmore, University of Virginia; Elizabeth Carpenter; Calls to eligible patients began in mid-March.
Sarah Blackstone; Claire O’Donnell; Justin Vesser; Kathleen
Pennock; Putnam Ivey de Cortez, putnami@gmail.com; Erica Mean age was 46.8 (SD=17); 44.7% were male;
Uhlmann; Fern Hauck the 3 most common languages were Nepali
(n=127), English (n=125), and Dari (n=102).
Learning Objectives Outcome measures at 3 months will be reported
1. Upon completion, participant will be able including the number of people who 1) made
to identify common barriers experienced appointments at initial contact; 2) postponed
by refugee communities in accepting and scheduling; 3) declined scheduling; and 4) were
accessing the COVID-19 vaccine. fully vaccinated. Additional details on outreach
2. Upon completion, participant will be able and outcomes will be presented.
to describe a university-health
department-community partnership to Conclusions/Discussion
provide COVID-19 vaccination Population-level outreach for diverse groups with
appointments directly to refugee patients known barriers to care can improve equity in
to facilitate the process and expedite COVID-19 vaccination uptake. Individual
receipt of vaccinations. outreach and education regarding vaccine safety
3. Upon completion, participant will be able and efficacy also improves adherence rates
to describe measures to help overcome among the refugee population.
COVID-19 vaccine hesitancy among
refugee patients.

A health equity focus in COVID-19 vaccination
efforts is paramount to reaching vulnerable
populations. For a U.S. academic medical
center partnership with the district health
department, equity efforts have included the
local refugee population. Leveraging an existing
clinical database that identifies patients as
refugees, and engaging strong collaborative
networks with community stakeholders, we used
a population-based approach to improve COVID-
19 vaccine uptake.
Methodology
Patients who arrived as refugees and met CDC
phased COVID-19 vaccine distribution
guidelines (N&#3f610) were contacted by
clinical access staff using telephone interpreters
in the patients’ primary language to offer
appointments at an upcoming vaccine clinic. In
addition, refugees who were “essential workers”
and had not yet been vaccinated through
About 80% of the studies were performed in the
Mental Health Determinants Among Arab US, highlighting a gap in Canadian AIR-MH
Newcomers in North America: A Scoping Study research. Prior exposure to political
and Stakeholder Consultation violence/persecution was significantly, positively
associated with depression and post-traumatic
Sarah Elshahat, Department of Anthropology, Faculty of Social stress disorder (PTSD). Significant post-
Sciences, McMaster University; Tina Moffat, Department of
Anthropology, Faculty of Social Sciences, McMaster University migration MH triggers were English illiteracy,
poverty and intergenerational variation in
Learning Objectives acculturation patterns and discrimination.
1. Upon completion, participants will be Family separation was significantly, positively
able to learn about mental health triggers related to comorbid anxiety and PTSD among
that are specific to Arab newcomers in ASIR suffering from the Muslim ban that was
North America introduced by the Trump administration in the
2. Upon completion, participants will be US. MH protective factors were socio-culturally
able to demonstrate knowledge of various related and involved positive ethnic identity,
mental health protective factors among faith, family support, community cohesion and
Arab newcomers in North America. resilience.
able to identify research gaps in Arab- Conclusions/Discussion
mental health research in North America. Community-engaged research that employs
social and cultural framework that incorporates
Background and Purpose/Rationale the concept of resilience is required to provide a
Suboptimal mental health (MH) is a major thorough understanding of potential MH triggers
public health issue, affecting over 15% of the and protective factors among AIR. This would
world’s population. Arab immigrants/refugees help inform effective culturally-sensitive MH and
(AIR), like all newcomers, are at high risk for resilience-promoting programs.
MH problems, but they experience distinct
stressors such as post-9/11 racism, and unique
social/cultural attributes that may foster
adaptive mechanisms and resilience. A scoping
review was performed to investigate MH
determinants among AIR in North America and
we propose a potential theoretical framework for
future research.
Methodology
Five automated databases (Medline, Embase,
PsycINFO, Anthropology Plus and Sociology
Database) were systematically searched and 49
studies were included. Data were subjected to
numerical synthesis and thematic analysis. A
stakeholder consultation was conducted with 23
MH professionals to validate the findings.
This ongoing research is expected to produce
Responding to Humanitarian Entrants Health evidence research that will make contribution to
Literacy and Cultural Needs in the Context or knowledge concerning the responsiveness of the
Racialization and Marginalization in Australia primary health care system to Africans from
refugee-like backgrounds in Australia.
Prince Peprah
Learning Objectives A better understanding of how primary health
1. Understand theories underpinning care organizations and providers identify,
refugee health support and respond to the cultural, linguistic
2. Conduct research with the field of and health literacy needs of refugees and
refugee health asylum seekers is of great value to the
3. Understand practices within refugee Australian health equity and multicultural
health policies and practices.

People from refugee-like backgrounds,
particularly those from African nations in
Australia need to have access to primary health
services appropriate to their health literacy and
cultural and linguistic needs if the services are
to be equitable and effective. This is because
they are from highly diverse cultural and
linguistic backgrounds and associated with
D R AW N
WITH
pronounced inadequate and problematic health
literacy compared with other humanitarian
entrants in Australia. The delivery of equitable
and appropriate health services to Africans from
refugee-like backgrounds cannot be separated
from the politics of ambivalence of Australian
immigration systems and policies as well as the
politicisation and racialisation of Africans from
refugee-like backgrounds resettlement across
Australian political and public spaces. Within
this context, the proposed research questions
the health literacy, cultural and linguistic
responsiveness of the health system and service
to this diverse group.
Methodology
The proposed research seeks to adopt a mixed-
method approach and draw on the science and
technology studies (STS) and critical humanism
concepts including stabilized network and
critical race theories and methodologies.
A conceptual framework involving engagement,
Refugee Healthcare Perceptions in Regional access, trust and privacy, and the old versus the
Northern Australia. Transition Through new, can be used to describe refugees’
Engagement, Access, Trust, Privacy, the Old, experiences. Discrimination, transport, and
and the New reliance on family and peers may be experiences
that are more prominent in regional Australia.
Michael Au; Robyn Preston; Robin Ray; Meg Davis Refugees require high quality information
sharing practices, formal support systems, and
Learning Objectives better models of service delivery for interpreting
1. Describe access and engagement barriers support. Clinicians need to be culturally
and enablers to healthcare in a regional respectful with their interactions.
Australian setting for refugees.
2. Suggest how access and engagement
barriers and enablers to healthcare may
differ between regional and metropolitan
settings for refugees.
3. Propose strategies to overcome access
and engagement barriers to healthcare in
a regional setting.

Current Australian Government policy aims to
resettle refugees in regional Australia, but little
is known about their primary and hospital
healthcare experiences in these settings.
Methodology
By taking an interpretive approach to a narrative
inquiry methodology, a qualitative study was
performed to examine refugee perceptions of
healthcare in a regional centre of northern
Queensland, Australia. Purposive sampling and
an interview guide were developed in
partnership with the local refugee resettlement
agency. Semi-structured interviews were
performed with fourteen refugees and involved
interpreters. Transcripts were thematically
organised into a story, validated by participants.
Using QSR NVivo 12, all researchers analysed
the transcripts. Themes were validated at a
community event.
Six themes were described: service issues, self-
advocacy, knowledge and understanding that
changes with time, interpreter issues, regional-
metropolitan differentials, and the influence of
the past on present behaviour.
Session: P23, Submission Number: 1043235 consensus was achieved with all members of the
research team.
Perspectives on Access to Healthcare for African
Asylum Seekers in Israel During the Coronavirus Results/Impacts/Outcomes
2019 (COVID-19) Pandemic: A Qualitative Seven major themes described how the
Study pandemic exacerbated pre-existing barriers for
asylum-seekers. Loss of employment led to:
Rebecca Leff, Michele Naideck, Allison Lenselink, Jesse (1)ineligibility for care through Israel’s universal
Wolfsohn, Evan Magaliff, Emily Kestenbaum, School of
Medicine, Faculty of Health Sciences, Ben-Gurion University of healthcare system, (2)worsening of pre-existing
the Negev, Beer -Sheva, Israel; Pooja Agrawal, Yale University conditions due to loss of insurance, and
School of Medicine, New Haven, CT (3)socioeconomic stress and crowded living
conditions. Other barriers included: (4)fear of
Learning Objectives loss of temporary visa status and refoulement,
1. Describe barriers to healthcare access for (5)limited healthcare services in Israel’s
African asylum-seekers residing in Israel geographic periphery accessible to asylum-
during the COVID-19 pandemic. seekers, (6)reliance on overburdened non-
2. Outline gaps in healthcare access for governmental healthcare services, and (7)limited
African asylum-seekers residing in Israel availability of linguistically appropriate COVID-
during the COVID-19 pandemic. 19 resources and healthcare.
3. Evaluate challenges and successes of
interventions to provide healthcare Conclusions/Discussion
services to African asylum-seekers Despite government measures to provide COVID-
residing in Israel during the COVID-19 19 specific healthcare for asylum-seekers, a
pandemic. variety of barriers for both COVID-19 and routine
healthcare needs exist. As a result, asylum-
Background and Purpose/Rationale seekers are at risk for poor health outcomes.
Israel hosts approximately 31,122 asylum- Actions should be taken to promote inclusion of
seekers, most of them from Sudan and Eritrea. asylum-seekers into existing healthcare
Prior to the coronavirus 2019 (COVID-19) structures.
pandemic, asylum-seekers encountered
significant barriers accessing healthcare,
however it is not known how COVID-19 affected
the provision of healthcare for this population.
We conducted a qualitative study of frontline
providers to investigate experiences and
perceptions of healthcare for asylum-seekers in
Israel during the COVID-19 pandemic.
Methodology
16 in-depth semi-structured interviews were
conducted with a purposive sample of frontline
providers representing different key-informant
groups (public health officials, clinicians,
asylum-seeker community leaders, social
workers, case workers) and 9 non-governmental
organizations serving asylum-seekers. Interviews
were conducted in English and Hebrew, audio
recorded, transcribed, and analyzed using
grounded theory methodology. Thematic
Session: P24, Submission Number: 1043378 Methodology
We compared the number and characteristics of
Caring for Refugee Children in a Family refugee (RF) and non-refugee children ages 0-
Medicine Residency Program Enhances 19 seen in the IFMC and FM clinic (same
Knowledge and Numbers of Children Seen location), 2015-2019.
Fern Hauck, University of Virginia, Department of Family Results/Impacts/Outcomes

Medicine; Amanda Sebring; Noopur Doshi; Jane Forbes; Sarah
Blackstone 1,025 RF children vs. 1,559 non-RF children
were seen; there were 7,131 RF encounters and
Learning Objectives 7,794 non-RF encounters. The average ages at
1. Describe the demographic characteristics encounters were 6.76 years (RF) and 6.82 years
and medical diagnoses of refugee (non-RF); 48.9% male (RF) and 49.8% male
children seen in a primary care clinic. (non-RF). Visit diagnoses and results from a
2. Report the results of a survey of attitudes planned survey of residents’ attitudes and
and knowledge of residents who have knowledge around pediatric refugee care will be
cared for refugee children in their primary presented.
care practice and participated in a
longitudinal curriculum. Conclusions/Discussion
3. Identify advantages in providing care to This model of refugee care and curriculum
refugee children, including increased provide residents with an opportunity to meet
number and variety of pediatric visits, the ACGME Family Medicine requirements for
increased training in cross-cultural care, encounters with children while developing
and care for vulnerable populations. proficiency in caring for refugee families. All
residency programs in communities with
Background and Purpose/Rationale sizeable refugee populations can potentially
Family Medicine (FM) residents are required to benefit from a similar model.
have at least 165 encounters in the FM
outpatient clinic with children < 10 years.
However, residents may have difficulty meeting
these requirements with shifts in residency
education toward chronic disease management
and geriatrics. There is a growing pediatric
refugee population in the US; prior surveys
reported that residents enjoyed caring for this
population, but felt they needed more training.
We describe a refugee clinic model based in a
FM residency, the International Family Medicine
Clinic (IFMC), which was established in 2002 to
care for refugees in Central Virginia. Residents
participate in a longitudinal curriculum to
enhance their skills and knowledge while
providing culturally responsive, comprehensive
care for refugee families.
Session: P25, Submission Number: 1043423 (5 years) newcomers to characterize risk factors
associated with more severe illness as measured
Characterizing Risk Factors and Outcomes by hospitalization and deaths among case-
Among Newcomers with COVID-19 in Eight patients identified between March 1 and
Sites Across the United States, March - September 30, 2020.
September 2020
Yuli Chen; Lori Kennedy; Emily Jentes; Clelia Pezzi; Nuny We will present preliminary results on the
Cabanting; Blain Mamo; Carly Stokum, Maryland Department of
Health; Leena Anil; Colleen Payton, Moravian College; Rachel number of cases identified among newcomers
Ashby; Azadeh Tasslimi across participating sites and characterize the
COVID-19 case--patients[MK4] according to
Learning Objectives demographic characteristics, health-related risk
1. Upon completion of the presentation, factors, and illness symptoms. We will describe
participants will be able to describe the risk factors associated with statistically
COVID-19 disease trend among different odds of hospitalization and fatality
Newcomers in eight sites in the US among more established newcomers compared
between March 1 and September 30, to newly-arrived newcomers with COVID-19.
2020.
2. Upon completion of the presentation, Conclusions/Discussion
participants will be able to quantify Understanding how COVID-19 affects
severe illness among Newcomers with newcomers and risk factors that contribute to
COVID-19. more severe illness will inform clinical and
3. <div>Upon completion of the public health approaches to more effectively
presentation, participants will be able to prevent, detect, and control COVID-19 in this
understand odds of more severe illness population who might have higher risk for
among newly-arrived newcomers (<5 exposure or severe disease.
years) compared to newcomers resettled
in the US longer than five years.</div>

Newcomers resettled to the United States may
face working and living conditions that increase
their risk of contracting COVID-19 and may have
health conditions or face other circumstances
that cause them to experience more severe
illness. Through this analysis, the Colorado
Center of Excellence in Newcomer Health, in
partnership with seven public health and clinical
entities and the Centers of Disease Control and
Prevention, aims to better understand the
burden of COVID-19 in this population after
arrival in the U.S.
Methodology
Using public health COVID-19 case data, we
retrospectively identified COVID-19 cases
among newcomers by linking to existing refugee
medical screening data. We described disease
trends over time and used multivariable logistic
regression analysis to compare newly resettled
EAPIC began as a semi-annual conference in
Collaborating Internationally to Improve Mental Uganda. The conference has grown from 75
Healthcare Delivery for Refugee Families attendees in 2012 to over 400 in 2020.
Conference organizers have created the Uganda
Sebastian Ssempijja, Sebastian Family Psychology Practice; Behavioral Health Alliance, an international
Sarah Cornell, Medical College of Wisconsin; Nathan Fleming,
Medical College of Wisconsin; Ojo Tunde Masseyferguson, Abuja collaboration with the intent of promoting
Teaching Hospital; Hafsa Luka, Ministry of Uganda; Muktar mental health services for displaced persons in
Beshir, Gabiley Mental Hospital; Fred Coleman Africa.

1. Participants will learn how an immigrant- SFPP was founded by a Ugandan immigrant who
run behavioral health clinic evolved to naturalized to the US through the asylum
support an international learning process. The success of bi-directional learning
collaboration. was catalyzed by a deep understanding of both
2. Participants will learn strategies to build cultural contexts. The exchange of best
capacity to address mental health needs practices between mental health professionals in
in refugee communities. host countries and home countries enhances
3. Participants will recognize the benefits of services for refugees. The engagement of multi-
multi-cultural, multi-disciplinary care disciplinary teams that include refugees and
teams that understand community asylum seekers improve outcomes, leverage
dynamics in both the home country as existing infrastructure, and maintain
well as the resettlement community. international relationships.

Sebastian Family Psychology Practice (SFPP)
employs 37 mental health professionals from 13
countries to serve immigrant and refugee
families. The theory of change is that SFPP
helps clients to achieve acceptance, wellness,
and family transformation within their new
community. In 2012, SFPP launched the East
African Psychology International Conference
(EAPIC) on Mental Health and Trauma. EAPIC
builds capacity to deliver mental health services
in Milwaukee and throughout Uganda, Kenya,
DRC, Somaliland, and Nigeria. The bidirectional
exchange of best practices enhances SFPP and
its international partners.
Methodology
The EAPIC is a venue for multi-cultural, multi-
disciplinary teams to exchange knowledge
related to refugee wellness and mental health in
Milwaukee and eastern Africa. EAPIC hosts
bimonthly distance learning opportunities.
Participants review difficult cases and share
tools to enhance clinical care, community
engagement, and professional development.
Session: P27, Submission Number: 1043883 TB education, screening, treatment and care
should be available in community located and
A Cross Sectoral and Stigma-informed Approach team based primary care settings through
to Improving Ongoing Tuberculosis Care and coordinated service pathways, whereby primary
Support for Newcomer Populations in Toronto care settings work in collaboration with other
parts of the TB system (IRCC, Public Health, TB
Cliff Ledwos, Access Alliance Multicultural Health and specialists) and with settlement and social
Community Services; Miranda Saroli, Access Alliance
Multicultural Health and Community Services service providers. Coordinated care pathways are
critical for supporting newcomers to navigate
Learning Objectives complex health care settings and to ensure they
1. Understand what are the unique elements can access the full range of services and
which shape the newcomer TB experience supports they need to address intersecting
in Toronto, in terms of the structures, issues in their lives.
policies, and community.
2. Take away clear concrete Conclusions/Discussion
recommendations for practitioners and Stigma should be central to any discussion
policy makers at the local, provincial and around infectious disease management,
federal levels on how to improve TB care particularly with regards to layered and complex
for newcomers in Canada. newcomer experiences. This initiative revealed
3. Define the critical role of stigma in an opportunity to advocate for interdisciplinary
infectious disease management, and see team-based primary care settings as the optimal
how project findings around TB are place for TB care management, and to improve
directly transferable to other diseases as fractured communication between public health,
well as jurisdictions. settlement, and primary care sectors.

This initiative addressed the lack of awareness
and high levels of stigma attached to TB for
newcomers in Toronto, with the goal of
increasing access to quality resources, support
and care for newcomers living with/at risk of
acquiring an infectious disease.
Methodology
A cross-sectoral approach, with co-design
elements, engaged physicians and nurses in
primary care and public health, settlement
service providers, newcomers (India, China,
Philippines), and people with LTBI and/or are
receiving TB treatment.
The newcomer TB journey is influenced by
family and community, as well as formal
systems which shape the social determinants of
health, including employment and education.
TB-related stigma among newcomer
communities adds a challenging layer, often
causing delays in seeking care and treatment.
Patients were from 24 countries: the majority
Covid-19 and Mental Health Among Refugee were from Uganda (55%), Cameroon (8.5%),
and Asylum Seekers Bosnia (4.7%) and Somalia (3.8%). The average
age was 43, and 67.9% were female. 83% were
Linda Piwowarczyk MD MPH, Boston Center for Refugee Health asylum seekers and 8.5% were refugees, 60.4%
& Human Rights, Department of Psychiatry, Boston Medical
Center; Houda Chergui, Immigrant and Refugee Health Center, had a college education or higher, 87.7% were
Department of Psychiatry, Boston Medical Center; Tithi Baul survivors of torture. In preliminary analyses,
MPH, Department of Psychiatry, Boston Medical Center prominent themes included: behaviors to reduce
the risk of contracting Covid-19, fears of taking
Learning Objectives public transportation, ambivalence of coming to
1. Identify concerns related to Covid-19 of the hospital, reminders of war and disease
asylum seekers and refugees within an outbreaks, stressors related to work in the
urban trauma and torture treatment service industry and the role of faith as a coping
center. mechanism.
2. Describe prevention strategies against
contracting Covid-19 and coping Conclusions/Discussion
mechanisms among asylum seekers and Refugees and asylum seekers face similar
refugees within an urban trauma and stressors as the general population, such as
torture mental health treatment center. service industry related work putting them at
3. Describe stressors for asylum seekers and higher risk of contracting Covid-19. These
refugees related to distance from their stressors are further compounded by reliance on
families and support systems, and public transportation, distance from their
traumatic memories of war and previous families and support systems, and traumatic
epidemics in their home countries. memories of war and previous epidemics in their
home countries.
Covid-19 has disproportionately affected Black,
Indigenous and People of Color (BIPOC) and
im/migrant communities. It is less known how
Covid-19 has affected asylum seekers and
refugees. The objectives were to identify
concerns related to Covid-19, fears of coming to
appointments, prevention strategies, coping
mechanisms and whether the pandemic
reminded participants of anything in their past.
Methodology
Participants were 106 patients most of whom
were torture survivors seen between 3/11/2020
and 4/21/2020 in mental health treatment at
Boston Center for Refugee Health and Human
Rights. Patients answered four structured
qualitative questions during clinical treatment.
We conducted an inductive thematic analysis
and identified themes.
Participants identified strict housing
Rental Applications and Their Unique Impact on applications as the key mechanism used by
Refugee Claimants some landlords to exclude certain populations
from accessing housing, thus creating additional
Heidi Schneider; Bruce Newbold barriers to an already difficult housing search.
This paper will discuss these findings and argue
Learning Objectives that refugee claimants are uniquely susceptible
1. Recognize the importance of suitable and to this practice because rental applications
stable housing for the overall often require material goods or experiences
resettlement journey, and the impact this refugee claimants lack during their initial
can have on a refugee claimant's health resettlement or require information that resulted
and wellness, particularly during the first in multiple forms of discrimination.
few months after arrival.
2. Describe the ways some landlords use Conclusions/Discussion
rental applications to inequitably filter This paper aims to highlight the unique impacts
applicants based on their own personal these rental applications and discriminatory
biases. practices can have on refugee claimants,
3. Identify the barriers that strict rental particularly during the first months after arrival,
applications create for refugee claimants when access to suitable and stable housing is
and their access to housing, and describe essential to successful resettlement.
the negative impacts this practice can
have on their housing outcomes.

Between 2015-2016 roughly 43% of all
refugees who came to Canada settled in Ontario,
and of these, roughly 40% settled in the Greater
Toronto-Hamilton Area (Oda, et al., 2018). As
with many Canadian cities, the housing market
in the city of Hamilton is becoming increasingly
competitive, with vacancy rates hovering
between 3.1 – 3.19% between 2018-2019 for
private apartments (CMHC, 2019). Considering
this increase in competition, this study sought
to better understand the experiences of refugee
claimants when searching for housing in
Hamilton during resettlement, and any factors
that might influence this process.
Methodology
Semi-structured interviews were conducted with
refugee claimants currently living in Hamilton,
as well as individuals involved with refugee
resettlement or housing organizations in the city.
Content analysis and thematic coding was used
to pull descriptive codes and themes from the
data.
Art work produced as a form of debrief and from
Professional Self-Care in a Pandemic: Managing self-care will be presented, along with creative
the Heavy Load of Isolation in the Workplace tips and tricks. Alternative suggestions for those
who are wary of art making will be mentioned.
Janna Mulholland
Learning Objectives Self-care and alternative forms of debriefing are
1. Upon completion, participants will be essential while working from home and other
able to reflect on the impact of COVID-19 isolating circumstances created by the
restrictions for their working pandemic. Creative forms of expression can
circumstances and identify increased serve as tools to aid professionals in managing
risks of vicarious trauma, compassion increased professional isolation during a
fatigue and burnout. pandemic.
able to describe the importance of
managing the impact of difficult cases
and be able to list various methods
including creative expression as a form of
debrief.
able to define self-care, understand the
importance of it and list various activities
for self-care.

During the COVID-19 pandemic GARs have
continued to arrive in Edmonton including a
majority arriving with medical and mental health
needs. Despite best efforts to connect and
work collaboratively, confidential professional
work in a pandemic can be isolating. For some,
working from home, social distancing, and other
pandemic policies have decreased essential
opportunities to debrief difficult cases which
may increase risk of vicarious trauma,
compassion fatigue and burnout. Addressing the
impact of complex cases while isolated can take
creativity.
Methodology
This counsellor’s experience of developing and
implementing creative independent activities as
tools to debrief sensitive information in lieu of
collaborative debriefs with colleagues and
supervisors will be presented. Various forms of
activities for self-care will be shared.
Session: P32, Submission Number: 1048010 analysis is finalized, refugee and immigrant
experiences are expected to reflect in-depth
A Community-Driven Collaboration to Improve community knowledge about the challenges and
Well-being: Developing the Philadelphia solutions connected to an experience of
Immigrant and Refugee Experiences (PIRE) displacement and accessing public services as
Survey well as the impacts of COVID-19 structural
inequities.
Sara Shuman; Julie Tippens; Carolyn Ziembo; Christa Loffelman;
Caitlin O'Donnell; Roum Lay; Gretchen Shanfeld; Alexandra
Samarron Longorio Conclusions/Discussion
This collaborative community-driven research
Learning Objectives provides a model for other organizations that
1. Describe the process of community- want to develop evidence-based research and
engaged collaborative research evaluation tools to improve service delivery and
2. Understand the importance and advocate for resources and policies to promote
advantages of community-driven research the well-being of the refugee and immigrant
to improve refugee well-being; community.
3. Identify the lessons learned for effective
collaboration between agencies

Community-based organizations (CBOs) are key
in promoting the well-being and integration of
refugee populations in Philadelphia. However,
services are often provided without an evidence-
based understanding of the experiences of
refugees and immigrants. Community-academic
collaborations have strong potential to leverage
evidence-based efforts to improve programmatic
and advocacy outcomes for displaced groups.
Methodology
This community-academic collaborative worked
over a two-year period to design, pilot, and
implement an instrument to measure the needs
and experiences of refugees and immigrants. We
used interviews, focus groups, and evidence-
based research to design the measurement tool.
We used consensus-building methods to finalize
the tool.
The two-year collaborative effort resulted in the
creation of a 21-question instrument assessing
social and structural determinants of refugee
and immigrant health (e.g., housing security,
socioeconomic status, neighborhood safety,
community cohesion, access to quality health
and education). CBOs administer the survey
regularly to case management clients. Once
Session: P33, Submission Number: 1048437 resources for ASD was statistically significant (p
= < 0.01). Interviews (N&#3f5) yielded key
Knowledge, Perception, and Awareness of themes: parents’ feelings of guilt, perceived
Autism Spectrum Disorder in Burmese environmental causes of ASD, stigma, and lack
Communities of community understanding of autism.
Thian Hnem; Jessica Lee Conclusions/Discussion

Burmese respondents demonstrate relatively low
Learning Objectives knowledge of ASD and resources—two important
1. Upon completion, participants will be considerations for detection and support for
able to describe the need for health families. Data indicate that this community is a
education in Burmese communities. high-needs and underserved population. The
2. Upon completion, participants will be researchers recognize a need for health
able to relate the need for translational education and advocacy related to ASD for
materials for autism spectrum disorder. Burmese communities.
able to advocate for autism awareness in
underserved communities.

This study’s purpose is to ascertain knowledge
and awareness of autism spectrum disorder
(ASD) among Burmese refugees in one U.S. city.
Prevalence rates of ASD and age of diagnosis
vary across racial and ethnic categories in the
United States. Asian and Pacific Islanders
exhibit some of the lowest prevalence rates of
ASD (CDC, 2019) and utilization of health
services (SAMHSA, 2020).
Methodology
Researchers employed mixed methodology to
examine Burmese refugees’ exposure to and
knowledge of ASD. 19-item surveys, in English,
Hakha, and Falam, were disseminated in-person
and online. Interviews were conducted in Falam
with families of children diagnosed with ASD.
Transcripts were translated into English and
analyzed through thematic coding.
Survey respondents’ (N&#3f219) mean score for
knowledge about autism was of 2.48 (scale of 1-
5, 5=high knowledge). 56% of participants
reported knowing a Burmese community
member diagnosed with ASD. 14% have a
family member diagnosed with ASD.
Approximately 25% of respondents knew of
services for ASD. The correlation between having
a family member with autism and knowledge of
A refugee SP scenario was chosen because the
Use of a Simulated-Patient Case to Explore authors perceive that resident physicians often
Cynicism, Patient Labels, and Physician report the refugee encounter as the
Detachment “noncompliant patient,” risking
depersonalization. Faculty facilitators
The use of the statement “noncompliant patient” is a common encouraged learners to recognize that verbalizing
label that may serve to depersonalize the physician from the
patient and impact negatively on the physician’s experience with “noncompliant patient” may serve as a cue to
a refugee. This simulated patient encounter allows participants explore further: the contextual factors that may
to verbalize and reflect on the meaning and possible impact of affect medication adherence; the risk and
using the label.
impact of perceiving the patient as “the other;”
Waseem, Sous; Lauren, Germain; Kay, Frank; Stephen, Knohl; and options for systems-based change that
Peter, Cronkright support the provider and advocate for the
patient.
Learning Objectives
able to explore the term “noncompliant risking depersonalization. Faculty facilitators
patient” encouraged learners to recognize that verbalizing
2. Upon completion, participants will be “noncompliant patient” may serve as a cue to
able to discuss the implication of the explore further: the contextual factors that may
term on the physician’s experience with a affect medication adherence; the risk and
refugee impact of perceiving the patient as “the other;”
3. Upon completion, participants will be and options for systems-based change that
able to describe options for systems- support the provider and advocate for the
based change to advocate for the patient patient.

Residents and fellows in the Department of
Medicine have participated in a curriculum of
communication skills utilizing simulated
patients. The curriculum is entitled Learning to
TALK (Treat All Like Kin). The authors created
a refugee “noncompliant patient” scenario to
explore physician depersonalization.
Methodology
Virtual Zoom sessions were held between
12/2020-01/2021. Participants were surveyed
immediately after completion of the
Standardized Patient (SP) encounter to assess
their use of the phrase “noncompliant patient.”
Participants gathered in a small group with
faculty facilitators to share their perceptions.
Data were collected via audio/video recording of
the group debrief session. Consent was
obtained from learners prior to the start of the
virtual audio-recording of the debrief session.
The video recording was transcribed, coded to
respective PGY level, and destroyed.
The IRHC saw 1772 patients from 100 different
Demographic Characteristics and Social Needs countries. 58.9% were born in Africa, and
of Boston Medical Center’s (BMC) Immigrant & 29.3% from Latin America and the Caribbean,
Refugee Health Center’s (IRHC) Patient 37% were asylum seekers and 28.4% had an
Population unknown immigration status and 15% were
college graduates. Nine out of the top ten zip
Houda Chergui, Immigrant and Refugee Health Center, codes where our patients lived had either “Low”
Department of Psychiatry, Boston Medical Center; Sarah
Kimball, Immigrant and Refugee Health Center, Boston Medical or “Very Low” overall Opportunity Index ratings
Center; Section of General Internal Medicine, Boston University and 63.3% had limited insurance.
School of Medicine and Boston Medical Center; Claire
Oppenheim, MPH
The use of EMR data helps to elucidate how our
Learning Objectives
patients are navigating the healthcare system.
1. Describe characteristics of im/migrant
The social needs of our patients were
and refugee patient population within an
highlighted through the low opportunity index
urban safety net hospital
ratings of the neighborhoods where they live and
2. Identify how EMR data helps to inform
limited insurance access. This approach will be
quality improvement initiatives to meet
invaluable in designing quality improvement
social needs
initiatives and identifying priorities to meet
3. Consider the intersection of demographic
patients’ social and structural needs.
characteristics and social needs in the
patient population

D R AW N
WITH
Im/migrants and refugees face social and
political barriers that significantly impact health
outcomes. Boston Medical Center’s Immigrant
and Refugee Health Center (IRHC) seeks to
address the structural barriers that im/migrants
face by providing evidence-based, wraparound
services that include social and legal programs
tailored to the needs of im/migrant patients. The
goal of this study is to identify and describe the
IRHC patient population to inform quality
improvement initiatives to meet medical and
social needs.
Methodology
We conducted a retrospective chart review of
patients with appointments between August
2015 and October 2019 via the hospital’s
Electronic Medical Record (EMR) system. Study
variables included: demographic, clinical,
healthcare utilization, neurological testing and
social determinant of health data. We calculated
basic descriptive statistics such as means and
proportions.
Findings demonstrate the profound interaction
Role of Faith-Based Communities in Service refugees and migrants have with churches,
Provision and Support for Refugees and refugee serving agencies, and community
Migrants in Indianapolis, IN organizations which aid in stabilizing the
resettlement process and enriching their
Pious Malliar Bellian; Jessica Lee relationships with coethnic ties. The relentless
effort of the integration process appear to create
Learning Objectives a space in the lives of the migrants to have more
1. Upon completion, participants will be connections with faith-based communities.
able to understand the informal services
and support provided to refugees by faith- Conclusions/Discussion
based communities. Findings demonstrate positive outcomes among
2. Participants of this presentation will be migrants, the mission-driven intervention of
able to analyze key considerations for FBCs, decentralization of resources, and
collaboration with faith-based organizational capabilities. FBCs work not only
communities in order to support long- as informal post-resettlement service providers
term positive outcomes for refugees and but also as instruments in helping migrants’
migrants. solve a myriad of life challenges through social
3. Upon completion, participants will be support and critical informal services for
able to recognize opportunities for faith- refugees. Implications of this presentation
based communities in promoting health relate to the post-resettlement stages and
and wellbeing for refugees. refugee wellbeing.

D R AW N
WITH
This presentation discusses Faith-Based
Communities (FBCs) and their positive
engagement in the wellbeing of refugees and
migrants. This study focuses on Burmese
communities in Indianapolis, IN, a region that is
receiving the highest number of Chin Burmese
refugees in the United States. Indianapolis
houses numerous faith-based communities,
including those that are headed by ethnic
community members. Multilevel services of
FBCs range from health support, care
navigation, education, social support, legal aids,
access to language, and other resources to help
newcomers become self-reliant.
Methodology
The researchers conducted qualitative interviews
with leaders of faith-based communities and key
informants among refugee stakeholders in
Indianapolis, IN. Anonymous surveys gathered
data about stakeholders’ perceptions of available
services and resources for refugee community
members in the local context.
Learn to explore creative solutions to meeting
Connecting with Quarantined Clients client needs during ever changing health
restrictions, and the funding restrictions of
Laura Velasquez; Soledad Gonzalez; Astrid Velasquez being a non-profit organization.

1. Explore creative solutions to meeting A presentation will be given about the current
client needs during ever changing health virtual education sessions offered to newly
restrictions, and the funding restrictions arrived refugees in Edmonton. An examination
of being a non-profit organization. of success and challenges will be discussed with
2. Identify topics or relevance, and explore time for questions and suggestions from the
topic development into virtual sessions, audience.
and the logistical challenges of
interpretation of sessions.
3. Reflect on success and challenges
surrounding the implementation of virtual
information sessions with newly arrived
refugees.

Catholic Social Services Immigration and
Settlement Service in the IRCC funded provider
for GAR resettlement in Edmonton, Alberta.
Prior to the COVID-19 pandemic, all refugee
education took place in person with staff in
either first language, or with an interpreter and
consecutive interpretation. Because of the
pandemic and the mandatory isolation period
staff are not able to directly interact with clients
during their integral initial days of resettlement.
Facilitated by the pandemic, the Refugee Health
Promotion team developed virtual solutions to
these barriers.
Methodology
Presentation will share how staff overcame
barriers presented by the pandemic to ensure
that refugees are educated about their health,
the health care system and the pandemic itself.
Key points that will be addressed include:
creative solutions to ever changing health
restrictions, and the funding restrictions of
being a non-profit organization; identification of
topics, topic development into virtual sessions,
and interpretation of sessions; and,
implementation challenges and successes.
Aggregated survey data from 2021 to 2020
Secondary Migration of Burmese Refugees in yielded responses from Burmese refugees
the United States: Positive Indicators for (N&#3f1143) residing in Indiana. Findings
Refugee Integration demonstrate that approximately 35% of
Burmese community members in Indiana are
Elaisa Vahnie; Jessica Lee; Lian Sang; Andrew Laitha secondary migrants. Economic opportunities and
kinship ties are the main motivating factors for
Learning Objectives secondary migration. Data indicate career
1. Participants of this presentation will be advancement, increasing educational
able to analyze secondary migration attainment, and strong social support among
among refugees resettled in the United community members.
States.
able to recognize implications of Findings from this study demonstrate resilience,
secondary migration and its connection to positive health indicators, and strong community
positive social and health outcomes connection among this forced migrant
among Burmese refugees residing in population in Indiana. Implications of this study
Indiana. relate to indicators for long-term positive
3. Participants of this presentation will be integration and protective factors that promote
able to develop strategies for the wellbeing of refugees post-resettlement.
collaboration with ethnic communities to
enhance post-resettlement experiences
and outcomes for refugees.

This presentation describes the implications of
secondary migration of Burmese refugees in
Indiana. This state is home to the largest
Burmese refugee community outside of
Southeast Asia. Findings from this longitudinal
study highlight changes in quality of life,
positive health outcomes, and upward social
mobility for Burmese community members.
Methodology
This study presents data collected through
participatory action research methods from
2012 to 2020 by the Burmese American
Community Institute, an ethnic community-
based organization. Researchers included
Burmese youth and community members plus
partners from local universities. Data were
collected via surveys and qualitative interviews
with Burmese community members in multiple
Burmese languages. Refugee arrival data from
the Refugee Processing Center were analyzed for
population statistics.
Session: P39, Submission Number: 1051438 to encourage multi-level shifts in telehealth
delivery. By implementing recommendations for
Digital Literacy as a Social Determinant: change, we hope to improve access to direct
Encounters with Telehealth in Refugee Mental care and amend existing resources to increase
Health Treatment access. We hope to use the data to impact
available support and resources from municipal
Peggy Fulda; Zoe Ottemiller; Gabrielle Albright funding and county supports, shift agency
priorities and inform accessibility of refugee and
Learning Objectives other mental health programs.
to have a greater understanding of the Conclusions/Discussion
barriers impacting immigrant and refugee We hope this data will inform recommendations
clients accessing telehealth. for agency systems, identify barriers to care, and
2. Upon completion, participants will have improve overall quality of services. While Covid
implications for recommendations and brought us telehealth, it is here to stay. For this
suggestions for multi-level policy change reason, we hope to mitigate barriers, increase
to improve telehealth services accessibility, and improve overall delivery of
3. Upon completion, participants will be care.
able to critique current telehealth
services and improve staff training related
to the use of telehealth services.

Due to Covid 19, Lutheran Community Services'
Mental Health program has shifted client
services to telehealth, resulting in barriers to
care. This has expanded access for some, and
enforced barriers for others; including those
with deficits in: digital literacy, dependable
technology, and privacy in the home. These
barriers are especially prevalent in immigrant
and refugee communities who already face
multiple challenges related to language,
education, economics and assimilation.
Methodology
Through quantitative and qualitative exploration
with case managers, peer support specialists,
clinicians, and medical case managers; we will
assess aforementioned barriers and their impact
on client experiences. We will show how
culturally-specific client care has been impacted
by this transition, as well as opportunities for
improvement.
We believe results from survey questions and
qualitative interviews will present the barriers
telehealth perpetuates for immigrant and
refugee clients. With these results we are hoping
Session: P40, Submission Number: 1051511 phases. Phase 1: I analyze institutional
documents from the year 2012 to the present,
Who Deserves Healthcare: An Exploration of the exploring documents from the Ontario Health
Contestation and Negotiation Strategies and Association (OHA) and the Alliance for Healthier
Practices of Health Care Advocates Communities (AOCHC). Phase 2: I conduct
semi-structured interviews with 42 health care
Sarah Marshall advocates in Toronto, using thematic and
discourse strategies to approach my data
Learning Objectives analysis.
1. Upon completion, participants will garner
an understanding of the main challenges Results/Impacts/Outcomes
facing precarious status persons in The data uncovered from my institutional
accessing health care services in Canada. documents and interviews will be used to situate
2. Further, upon completion, participants and contextualize the institutional settings and
will acquire an understanding of the ways social processes under which social actors
that immigration practices, borders, operate and the various strategies and practices
boundaries and health care are that health care advocates adopt to make porous
intertwined and connected to one and shift borders.
another.
3. Finally, upon completion, participants Conclusions/Discussion
will hold knowledge of the ways that This research uncovers the ways that multi-
health care advocates work to open up scalar, multi-actor contestations over healthcare
pathways to precarious status persons delivery and health-seeking practices,
health care access through working to institutional policies, cultures, and procedures
challenge and contest discursive and can make porous and shift the boundaries of
material barriers to health care access. citizenship and non-citizenship.

This research project explores how health care
advocates engage in a variety of activist
strategies and practices to contest legalistic
ideas of deservingness, rooted in ideas and
discourses of securitization, “illegality”, social
boundaries, and bordering practices within
healthcare institutions (Lamont & Molnar,
2002). In seeking to investigate such strategies
and practices, I will be interviewing a range of
actors in Toronto including: activists with
precarious immigration status, hospital and
clinic administrative workers, midwives, nurses,
doctors, and specialists who act as advocates
and in Toronto hospitals and community health
centres (CHC’s).
Methodology
For this research project, I will be looking at
institutional documents and conducting
interviews with health care advocates. I aim to
use a qualitative, interpretive, multiple methods
approach, with research conducted in two
Infection from Strongyloides occurs worldwide.
Strongyloides Is Global, Lifelong, and Often Prevalence data globally is poor. Infection is
Hidden: A Case for Screening All Refugees lifelong and may remain asymptomatic until
immunosuppression triggers life-threatening
Gilles Hoilat; Waseem Sous; Ayan Mohamed; Andrea Shaw; disseminated infection. The parasite has a
Peter Cronkright
unique life cycle allowing for self-reinfection
and infection of household contacts. Almost all
Learning Objectives
deaths attributed to helminths in developed
1. Recognize patients with eosniophilia and
countries are due to Strongyloides stercoralis.
the workup needed.
Treatment is very effective and can be tested for
2. Heighten awareness of this lifelong and
cure.
potentially deadly parasite
3. Raise consideration of the possible need
for presumptive treatment or testing
either predeparture or post-arrival to host
countries.

Overseas presumptive treatment of
Strongyloidiasis was not standard care for
refugees resettling to the United States before
2005, and testing or presumptive treatment is
not currently recommended for refugees
emigrating from Eastern Europe.
Methodology
NA
A recent CBC noted hypereosinophilia (1770/uL)
in a 68 year old female who immigrated to the
USA from Bosnia in 1999. Chart review noted a
PMHx of symptomatic sinus node dysfunction
requiring pacemaker 2 years ago and an
unaddressed eosinophilia for at least the prior 4
years. An initial workup of the hypereosinophilia
was unremarkable, but the test for Strongyloides
was entered in error. She was presumptively
treated for Strongyloides with Ivermectin. Given
the acute concern for hypereosinophilic
syndrome, CT scan of thorax and abdomen were
ordered and unremarkable, as was a prior
echocardiogram. Her Strongyloidiasis IgG serum
antibody was subsequently positive.
Session: P42, Submission Number: 1052516 (74/253) of nurses had ever completed a patient
admission with an interpreter, 17.8% (45/253)
Nursing Across Languages: The Experience of had ever attended a ward round with an
Nurses Working with Interpreters in a Paediatric interpreter, and 7.4% (18/243) reported
Hospital Setting interpreter assistance for daily nursing care most
of the time. Onsite and telephone interpreting
Katrina Sangster; Karen Kiang; Fiona Newall; Tony Stratford; were the primary forms utilised. Informal
Sharon Smith; Catherine Matthews; Georgia Paxton
interpreting was commonly engaged by nurses
(49.2%, 125/254). Although 59.0% (148/251)
Learning Objectives
of nurses reported no prior training in
communicating with interpreters, most nurses
able to describe the general experience of
(81.6%, 199/244) felt confident and supported
nurses caring for LOTE-I background
(73.3%, 184/251) in working with interpreters.
patients in a paediatric hospital setting.
Themes arising from commentary included:
accessibility/availability, lack of interpreting for
able to list the five themes arising from
daily nursing care, and workflow issues.
nursing commentary relating to the
experience of caring for LOTE-I
background patients and families in a
Findings suggest substantial challenges for
paediatric hospital setting.
nurses in caring and communicating with LOTE-
I patients. Recommendations include training,
able to list some key recommendations
embedding assessment of language needs
that may improve access to language
during care planning, and incorporation of
assistance for LOTE-I background
interpreter assistance into daily nursing care.
patients in a hospital setting.

To examine the experience of nurses caring for
patients and families with a language other than
English background who require an interpreter
(LOTE-I) in a tertiary paediatric hospital.
Methodology
An electronic survey of all nursing staff in
September 2018 at the Royal Children's
Hospital, Melbourne, Australia. Data collated
and analysed in REDCap, and nursing comments
thematically analysed.
295 nurses responded, predominantly from
inpatient areas (85.1%, 251/295). Overall,
31.5% (92/292) of nurses were born overseas
and 24.0% (70/292) identified as having
additional language/s to English.Nurses reported
infrequent access to interpreters when caring for
LOTE-I patients. When describing cumulative
experience, only 31.8% (68/214) of nurses
reported that their LOTE-I patients had access
to interpreters most or all of the time. 29.2%
Session: P43, Submission Number: 1052746 conducted by medical student volunteers who
obtained formal certification for vision screening
Unmet Needs Amongst North Carolina’s Refugee through Prevent Blindness NC. Volunteers
Population: The Role of Medical Student Vision schedule follow-up appointments and arrange
Screening Programs public transportation.
Noha Sherif; Martha Carlough Results/Impacts/Outcomes

Outcomes of this study describe prior access to
Learning Objectives prior ophthalmologic care, the number of adult
1. Characterize the unmet need for visual and pediatric vision screens conducted,
screens and the burden of ocular disease participants who successfully schedule and
in refugee populations. attend a follow-up appointment, barriers to
2. Evaluate the efficacy of medical student attend a follow-up appointment, and the
led vision screening programs on percentage of referrals deemed appropriate by
identifying visual impairment in refugee the referral center.
communities.
3. Advocate for community-based vision Conclusions/Discussion
screening programs to addressing an Medical student led screenings have the
unmet need for refugee populations. potential to bridge the gap to eye care and
accurately identify patients with visual
Background and Purpose/Rationale impairment amongst refugee communities.
The leading causes of visual impairment and
blindness worldwide, including cataracts and
uncorrected refractive error, are largely
preventable with adequate screening.
D R AW N
WITH
Insufficient access to ocular care profoundly
impacts the socioeconomic wellbeing of
refugees, limiting economic mobility, quality of
life, and community engagement.
Methodology
Here we present a medical student led
community vision screening program to identify
undetected refractive error, screen for risk
factors associated with preventable ocular
diseases, increase the number of appropriate
ophthalmologic referrals, and characterize
access to ophthalmologic care amongst North
Carolina’s (NC) refugee population. Participants
are identified though the Refugee Community
Partnership nonprofit organization. Screening
includes ten questions from the Hoffberger
Program for the Prevention of Eye Disease
followed by visual acuity, confrontational visual
field, and extraocular muscle testing. Referral to
the University of North Carolina Kittner Eye
Center and Student Health Action Coalition will
be made for patients with positive risk factors
from the screening questionnaires or any
abnormalities on exam. Screenings are
Session: P44, Submission Number: 1052900 include an introduction to refugees and the
resettlement process, common health problems
Implementing a Refugee Health Curriculum for prevalent among refugees, legal issues refugees
Family Medicine Residents at UNC-Chapel Hill face during resettlement, women’s health, and
sexual health (including special considerations
Rana Alkhaldi; John Miller; Martha Carlough for LGBTQI individuals).

1. Recognize the importance of including With an ever-growing number of refugees, it is of
formal refugee health care training within utmost importance to train family medicine
a residency program physicians in refugee care. We have designed a
2. Identify core areas of knowledge that can curriculum for family medicine physicians that
be incorporated into a refugee health could be adapted to other family medicine or
education curriculum primary care residency programs across the
3. Utilize a didactic model targeted toward country.
medical residents in order to teach about
refugee issues

According to UNHCR, by the end of 2019, a
record 26 million individuals across the globe
were classified as refugees. North Carolina has
remained one of the top ten states that have
settled the highest numbers of refugees. Family
medicine physicians are on the frontlines of
providing care to those with limited access to
resources, including refugees. It is imperative
that family medicine residents receive formal
education regarding issues unique to caring for
this population. Prior to this endeavor, the UNC-
CH Family Medicine residency program had few
refugee health lectures given during the weekly
didactic conference once or twice yearly, and no
other structured curriculum was in place.
Methodology
We conducted a preliminary assessment of
residents' knowledge of refugee health, as well
as their interest in learning more about refugee
care in a more structured manner. With this
information, we assembled a curriculum that
could be incorporated into the existing residency
framework.
Using multimodal learning tools including
hands-on experiences, structured didactic
sessions, and online modules, we crafted a
curriculum that could be incorporated into
existing resident education. Lecture topics
Fifty-eight CDAC (n=26) and non-CDAC (n=32)
Assessment of Clinicians’ Cultural Competency participants were surveyed on demographics,
and Philanthropy Attained While Serving Asylum experiences with asylum populations, cultural
Seekers Through a Pro Bono Student-Led competency, and characteristics of altruism and
Asylum Clinic comfort. Data collection and analysis was
conducted using Qualtrics and Microsoft Excel.
Kristiana Hanna; Divya Dasani; Aishwarrya Jayapal; Sapan Shah;
Dr. Octavian Adam
Those whom participated in CDAC scored higher
Learning Objectives
averages on altruism (103.48 points),
experience (26.81 points), and comfort with
able to identify what student-led asylum
working with diverse populations (24.45 points).
clinics are able to do, what they entail,
Non-CDAC participants scored 95.14 points,
who participates and what its goals are.
22.04 points, and 22.79 points, respectively.
Though CDAC providers have more experience
able to assess their own experiences,
with working in foreign countries, cultural
comfort levels and competency with
competence training, and confidence treating
working with forcibly displaced
marginalized populations, non-CDAC providers
populations.
reported treating more immigrant patients.
able to state the benefits gained by both
clinicians and forcibly displaced
Participation in service-learning programs is
individuals from participation in a service
important to medical education and practice,
learning such as this one.
particularly in primary care. CDAC offers a
unique learning opportunity for clinicians to gain
cultural competency skills even for those with no
In 2018, 79.5 million individuals were forcibly
prior formal training.
displaced due to human rights violations,
persecution, violence, or political unrest. Of
these individuals, 4.2 million were asylum
seekers awaiting asylum status verdicts from
immigration courts (UNHCR, 2019). Asylum
seekers have a higher likelihood of receiving
asylum when their applications are supported
with evidence provided by student-led asylum
clinics, such as the Capital District Asylum
Collaborative (CDAC) in Albany, NY, by
conducting pro-bono medical and psychological
evaluations. Minimal data reviews the impact a
program of this nature has on professional
development of providers and students. This
study analyzes how participation in CDAC
impacts cultural competency, perspectives
towards marginalized populations, comfort
working with culturally different populations,
and professional adeptness.
4147 articles were identified. After duplicate
Exploring Reporting of Ethno-racial Identity and removal, 2632 articles underwent title and
Immigration Status in Published Studies on abstract review. Final analysis included 75
Children New to Canada studies. There were no consistent descriptions of
immigration status or ethno-racial identity. 27%
Bonnie Cheung; Pardeep Kaur Benipal; Shazeen Suleman; (20/75) described participants' immigration
Ripudaman Minhas
status in some capacity. The majority (75%,
15/20) did not separate participants by
Learning Objectives
immigration status. Of these, 67% (10/15)
combined refugee and economic immigrant
to understand immigration statuses in
statuses. Regarding ethno-racial data, 35%
Canada
(26/75) reported participants’ ethno-racial
identities. Of these, 65% (17/26) reported
to understand which immigration statuses
ethnicity, 15% (4/26) reported race, and 19%
are insured or not
(5/26) reported both.
to understand why it is necessary for
studies to accurately report immigration
Studies on newcomer children to Canada do not
statuses and ethno-racial identity and its
consistently collect or analyze immigration
implications
status or ethno-racial identity. Research
informing guidelines for newcomer children
should consider immigration status and ethno-
Children immigrating to Canada face racism and
racial identity, as not doing so can conflate
xenophobia depending on ethno-racial
newcomer experiences and ignore the impacts of
background and immigration status. Canadian
racism and xenophobia on health and healthcare
immigration statuses include economic or family
access.
immigrants, government or privately sponsored
refugees, or asylum seekers, while some have no
formal status. The study objective is to examine
reporting of ethno-racial identity and
immigration status in literature on newcomer
children to Canada as it has implications on the
impact of discrimination on health.
Methodology
An integrative scoping review was performed
using Arksey and O’Malley’s methodological
framework. Literature search through several
databases was conducted. Inclusion criteria was
original research in English or French published
between 2009 to 2019 on newcomer children to
Canada. After title and abstract review,
participant immigration status and ethno-racial
identity was extracted.
Session: P47, Submission Number: 1021277 should utilize a trauma-informed, culturally-
appropriate, and intersectional approach to
The Life Experiences and Mental Health develop trust, ensure confidentiality, and
Challenges of LGBT Refugee Youth Experiencing encourage disclosure. An interdisciplinary team,
Homelessness: A Scoping Review including housing, legal, and community
resources, can help to address individuals' social
Zachary Blatman; Finola D'souza; Mitesh Patel determinants of health. Social support groups,
especially affirmative cultural and religious
Learning Objectives organizations, can also promote LGBT identity
1. Describe the current state of knowledge self-acceptance, create social connections, and
about the life experiences and mental build resilience.
health presentations of LGBT refugee
youth experiencing homelessness Conclusions/Discussion
2. Recognize the unique and intersectional This review highlights the significant gap in
needs of LGBT refugee youth research on mental illness in LGBT refugee
experiencing homelessness youth experiencing homelessness.
3. Identify the gap in literature exploring
mental illness in LGBT refugee youth
experiencing homelessness

To examine the literature exploring the life
experiences and mental health presentations of
lesbian, gay, bisexual, transgender, two-spirit,
and queer/questioning (LGBT) refugee youth
experiencing homelessness.
Methodology
The five-stage framework adapted by Levac et
al. was followed for conducting this scoping
review. CINAHL, Embase, Medline, PsycINFO,
Scopus, and Social Work Abstract databases
were searched on August 1st, 2020 from
inception.
Of 27 included articles, only one specifically
discussed the mental health challenges of LGBT
refugee youth experiencing homelessness. Many
LGBT refugees experienced violence and
discrimination in their countries of origin,
contributing to increased prevalence of mental
illness. The refugee claims process may further
contribute to re-traumatization, as individuals
are forced to disclose previous persecution
experiences and reveal previously hidden
aspects of their identity. Once seeking asylum in
their host countries, LGBT refugees often
continue to encounter resettlement challenges
and social isolation. Mental health professionals
73 (18 refugee, 55 non-refugee) patients were
Eye-care Utilization Among Newfoundland and included. Refugees had a significantly higher
Labrador’s Diabetic Refugee Population: A Pilot rate of referral to an eye-care provider (ECP)
Study (p=0.0475) and were more likely to attend their
ECP appointment than non-refugees (p=0.016).
Stuti Tanya; Bonnie He; Christine Aubrey-Bassler, Memorial The time from diagnosis to referral was
University
significantly longer for refugees than non-
refugees (p=0.0498). A trend towards a longer
Learning Objectives
time from referral to appointment attendance for
refugees than non-refugees was noted
able to recognize variations in measures
(p=0.9069).
of eye-care utilization among refugees
and non-refugees in Newfoundland and
Labrador.
Our findings are aligned with studies from
2. Upon completion, participants will gain
Canadian refugee-focused clinics, which show
an understanding of the pathway to
higher rates of health services utilization within
diabetic vision screening among resettled
primary care. However, the longer time to access
refugees in Newfoundland and Labrador.
vision care among refugees suggests the
presence of barriers to accessibility; specialist
an understanding of future directions for
care is also known to be more challenging to
research in this domain.
access for vulnerable populations. Future
studies should better characterize dynamics of
eye-care utilization among a larger refugee
Diabetic retinopathy (DR) is a leading and
cohort.
preventable cause of blindness. DR screening
lies at the intersection of many documented
challenges in access to care for refugees.
Additionally, vision screening is determined to
be an important health need and a critical locus
for underutilization of health services among
refugees resettling in Canada. Our objective was
to identify patterns of eye-care utilization among
refugee and non-refugee patients with type 2
diabetes mellitus (T2DM) in Newfoundland and
Labrador (NL).
Methodology
We conducted a retrospective comparative
cohort study at the Memorial University Family
Medicine clinic, which includes a dedicated
refugee clinic. All patients with a new T2DM
diagnosis between 2015-2020 were included.
This study received full ethics approval.
Session: P50, Submission Number: 1035515 struggling public schools failed to maintain
adequate English as a Second Language (ESL)
Barriers to Healthcare Access for Syrian and education, our group’s tutoring services were
Congolese Refugee Families in Central hindered by social distancing and inconsistent
Pennsylvania During the COVID-19 Pandemic access to distance-learning
platforms.Ultimately, the pandemic highlighted
Mariam Shalaby; Kayla Krause; Raisha Ismail; Daniel George that a charity-based arrangement is helpful but
not sustainable, and challenges persist for our
Learning Objectives partnering families.
1. List challenges facing Syrian and
Congolese refugees that have arisen Conclusions/Discussion
during the COVID-19 pandemic. In our presentation, we will present our
2. Describe steps we can take to overcome experiences as a case study to discuss a vision
barriers to health, economic opportunity, for increased access to affordable and
and education for refugee families during language-accessible social services, educational
the COVID-19 pandemic. resources , and simpler options for grant-based
3. Differentiate between translation services financial assistance to aid refugee families in
and language-accessible social services need in Central Pennsylvania and elsewhere.
in terms of how their absence impacts
support for refugee families.

The Pennsylvania State College of Medicine
Refugee Initiative is a student-run organization
that works with eleven Syrian and Congolese
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refugee families. Since 2016, we have used
grant funding to make weekly produce
purchases at a local market, provide tutoring
services, and develop trusting relationships.
When the COVID-19 pandemic began in March
2020, our organization needed to shift focus to
face new challenges.
Methodology
After many families struggled to pay the bills,
we switched to direct assistance with applying
for unemployment compensation, since many
had recently lost jobs. When our partner families
additionally struggled to access hygiene
supplies, we redirected funding to purchase
them. We also raised funds from the community
to provide financial relief from unpaid rent and
bills.
We encountered systemic challenges in
navigating federal/state unemployment and
social welfare systems, and felt the conspicuous
absence of affordable, language-accessible
assistance that could help refugees. As
The response rate was 80%. Respondents who
Improving Barriers to Reproductive Healthcare reported food and financial insecurity (20%)
for Refugee and Immigrant Women During the were referred to the food pantry and financial
SARS-CoV-2 Pandemic services respectively. Lack of transportation was
a barrier in accessing healthcare. Few women
Wan Ju Wu; Anissa Dickerson; Tejumola Adegoke; Nirupa Gadi; reported safety concerns at home or with their
Mary Elise Lynch
partner and were referred to social work
services. Childcare was an additional need
Learning Objectives
identified. Approximately 23% were asylum-
1. To identify specific needs during the
seeking, and 8% requested legal assistance and
SARS-CoV-2 pandemic for refugee,
were connected to the Immigration Legal
asylum-seeking, and immigrant women
Navigator.
2. To highlight gaps in care for women at
the Refugee Women’s Health Clinic at
Boston Medical Center during the SARS-
Immigrant and refugee women faced barriers to
CoV-2 pandemic
reproductive healthcare services preceding the
3. To demonstrate the efficacy of targeted
SARS-CoV-2 pandemic. We identified social and
social services screening for women at
immigration needs of RWHC patients during the
the Refugee Women’s Health Clinic in
pandemic and facilitated referrals to appropriate
response to the SARS-CoV-2 pandemic
services. This project demonstrates the utility of
targeted social needs screening and referrals to
integrative medical and social services for this
The Refugee Women’s Health Clinic (RWHC) at
vulnerable patient population.
Boston Medical Center provides reproductive
healthcare services for recent immigrants,
refugees, and asylum-seeking individuals. These
populations face significant barriers to
healthcare at baseline, and are at risk of having
unmet medical and social needs due to
disruptions in care from the SARS-CoV-2
pandemic. We implemented a quality
improvement project using phone screening to
identify and address social and immigration
needs for patients who receive care at RWHC.
Methodology
We contacted 133 active clinic patients by
phone, using interpreter services when needed.
We screened patients for food and housing
insecurity, employment, financial stress,
pregnancy, safety at home, healthcare access,
and immigration concerns. Patients who
screened positive for social needs were referred
to the appropriate services.
Session: P52, Submission Number: 1039461 • The health department has the
infrastructure to perform tests
Expanding a Public Health Department’s required by the United States
Refugee Health Service to Include Full Citizenship and Immigration Services;
Adjustment of Status Immigration Exams communicable disease notification is
automatic.
Ellen Einterz • Comparatively inexpensive
vaccinations are a health department
Learning Objectives staple.
1. Propose ways to expand a public refugee • Immigration visits are a source of
health service to include a full income for the department.
adjustment of status service. • During periods when new refugee
2. Justify the inclusion of a full adjustment numbers fall, refugee clinics can
of status service in a refugee health remain busy with immigration exams.
clinic. • One year after initial screening,
3. Compare a refugee health screening visit refugees are comfortable coming back
and an adjustment of status medical to the health service where they were
visit. first seen, and welcoming them again
after a year’s resettlement is
Background and Purpose/Rationale motivating for healthcare staff.
The financial and logistical burden for refugees • Vulnerable communities’ trust in the
and immigrants seeking to become lawful public health department is
permanent residents (green card holders) in the established or reinforced.Our
U.S. is often onerous. experience should be of particular
interest to other county public health
Methodology departments considering a similar
The Marion County Public Health Department initiative.
expanded its refugee health service to include a
full adjustment of status service within its
refugee health program.
During the program’s first 17 months of
operation, 435 civil surgeon appointments of
foreign citizens (193 refugees, 242 others) from
58 different countries were completed.
In addition to minimizing visits and costs for
applicants, the provision of a full adjustment of
status service accrues many benefits to the
department.
• Cases of latent tuberculosis infection
are revealed; education, notification,
and management are automatic and
in-house.
• Referrals for treatment of sexually
transmitted diseases are internal and
easily followed up.
Among 11,840 refugee arrivals, overseas TB
Overview of U.S.-Bound Refugee Arrivals, screening classified 679 (6%) with Class B TB:
Overseas TB Screening, and Domestic Follow-up 22 (0.2%) Class B0; 451 (4%) Class B1; 203
Evaluation for Fiscal Year 2020 (2%) Class B2; and 3 (0.0%) Class B3. The five
nationalities with the highest proportion of Class
Zanju Wang; Drew Posey; Christina Phares B TB were Ukraine (11%), Burma (9%), Sudan
(6%), Moldova (5%), and Eritrea (4%). As of
Learning Objectives 3/10/2021, completion of a recommended post-
1. Upon completion, participants will be arrival TB evaluation for refugees with Class B
able to learn U.S. overseas Tuberculosis TB was 61% (range, 18% to 100% across
(TB) screening requirements and U.S. states). TB follow-up and data entry for FY 2020
overseas TB screening classifications. arrivals are ongoing and will surpass the 61%
2. Upon completion, participants will be completed so far.
able to have an overview of nationality
distributions and class B TB proportions Conclusions/Discussion
of U.S. refugees who arrived in fiscal year Overseas TB screening identifies refugees at risk
2020 (i.e., from October 1, 2019 to for TB. Domestic follow-up of those refugees
September 30, 2020). represents a key opportunity to reduce TB in the
3. Upon completion, participants will be United States.
able to know the number of refugees of
each U.S. states received in fiscal year
2020 and their completion rates in
conducting a recommended post-arrival
follow-up TB evaluation for refugees with
Class B TB classification.

Reducing tuberculosis (TB) among foreign-born
persons is critical to TB elimination in the
United States.
Methodology
We use data from the CDC’s Electronic Disease
Notification system to describe overseas TB
classifications for refugees who arrived in the
United States during fiscal year (FY) 2020, and
proportion completing the U.S. follow-up
evaluation. “Class B TB” denotes refugees who
do not, or no longer, have TB disease but need
follow-up after arrival. It includes “Class B0”
(diagnosed with TB disease, successfully
completed DGMQ-defined directly observed
therapy, and negative final cultures prior to
resettlement), “Class B1” (chest x-ray or
symptoms suggestive of TB disease, or HIV
infection, but negative sputum smears and
cultures), “Class B2” (latent TB infection), and
“Class B3” (TB contacts).
Image labeling is currently in progress for
Harnessing Machine Learning to Eliminate 12,990 chest x-rays, which represent a
Tuberculosis (HaMLET) —TB or Not TB: comprehensive variety of types of TB-related
Objectives, Rationale, and Design findings. Initial findings suggest that these will
provide an adequately large and varied training
Raheem Smith; Shannon Fox; Deborah Lee; Scott Lee; Kimberly dataset to conduct accurate quality assurance
Skrobarcek; Christina Phares; Drew Posey; Nina Marano
analyses.
Learning Objectives
1. Articulate the connection between
HaMLET will use chest x-rays from population-
machine learning and tuberculosis
based TB screening for US-bound immigrants
screening for refugees
and refugees to determine whether machine
2. Explain how the training dataset for the
learning algorithms can accurately detect TB.
HaMLET project is being developed
Such automated detection could be used to
3. Justify the use of trained algorithms for
validate radiographic interpretations provided by
quality assurance of radiographic tasks
clinics during overseas medical examinations for
improved quality assurance.
Every year, over 500,000 people apply to enter
the United States as immigrants or refugees.
Applicants ≥15 years of age receive chest x-rays
to screen for tuberculosis (TB) during a
mandatory overseas medical exam. Physicians
contracted by the US Department of State
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conduct the exams and interpret the x-rays.
Existing machine learning algorithms are being
adapted to interpret chest x-ray findings for US-
bound immigrants and refugees. The resulting
models will be used to conduct quality
assurance analyses to improve accuracy by
identifying chest x-ray interpretations in need of
review (i.e. those inconsistent with expected
interpretations).
Methodology
Radiologists from selected clinic sites are
currently reviewing chest x-rays and labeling
findings that indicate TB. These labeled images
will be used to train image classification
models, which determine whether an x-ray is
abnormal or normal, and object detection
models, which identify specific TB-related
abnormalities. Both models will be checked for
fit using double-read images as reference
standards.
Session: P55, Submission Number: 1042762
Electronic Disease Notification System: Access Between October 2008 and December 2020,
to Overseas Medical Information for Newly EDN sent over 1,000,000 notifications to
Arriving Immigrants and Refugees—Update partners. In recent years, transfer of data from
2021 overseas medical examinations has become a
more streamlined electronic process; additional
Amanda Dam; Nekeia Gray; Kibrten Hailu; Megan Keaveney; information, including medical reports and chest
Shannon Fox; Kiara Butler; Raheem Smith; Brandy Holloman;
Abigail Ruths; Yoni Haber; Deborah Lee x-rays, are available in the EDN System. A
revised version of the EDN TB Follow-Up
Learning Objectives Worksheet is expected for use in the EDN
1. Upon completion, participant will be able System in 2021.
to understand the use and purpose of the
Electronic Disease Notification system. Conclusions/Discussion
2. Upon completion, participant will be able This informational poster will provide partners
to understand the types of information an opportunity to gain a better understanding of
and features that the Electronic Disease how EDN provides valuable information and its
Notification system provides for users of features, with the objective of attracting
the system. additional providers to use EDN. Ensuring
3. Upon completion, participants will be providers have access to EDN information can
able to describe the general process protect the health of newly immigrating
through which overseas medical populations and the communities into which
examination is transmitted into the they resettle.
Center for Disease Control and
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Prevention's Electronic Disease
Notification system.

Tens of thousands of refugees enter the United
States annually after receiving required medical
examinations overseas. The Centers for Disease
Control and Prevention (CDC) has regulatory
responsibility for preventing the introduction,
transmission, and spread of communicable
diseases into the United States. To facilitate
post-arrival health evaluations, healthcare
facilities need timely and accurate notifications
of newly arriving refugees.
Methodology
The EDN system is a centralized and secure
electronic reporting system that collects health
information on newly arriving refugees and
immigrants and notifies state and local health
departments and other authorized users about
those arriving in their jurisdictions. While most
local and state health departments already use
the system, more EDN accessibility by clinics
caring for this population in the US is needed.
Session: P56, Submission Number: 1042859 = 0.03) and child safety (mean 80% vs 97%, p
= 0.04). 100% of respondents (67% response
Implementing a Family-Based Child Health rate) reported increased understanding of the
Education Curriculum for Refugees topic and would recommend the class to a
friend. There were 5 participants for the virtual
Kaitlin Quallen; Frances Cheng; Sofia Athanasopoulou; Devika class.
Sparks; Alexis Rudd; Meghan Wilson; Joshua Pulinat; Camille
Brown; Julia Rosenberg; Shannon O'Malley; Pooja Agrawal, Yale
University School of Medicine, New Haven, CT. Conclusions/Discussion
Child health education classes administered to
Learning Objectives refugee families can improve knowledge of
1. Demonstrate an understanding of the pediatric healthcare topics and provide positive
importance of the relationship between experiences. A close relationship between
refugee families and community based healthcare providers and community refugee
educators. organizations has the potential to improve health
2. Describe methods that may be employed education for refugee families. Future studies
to teach refugee families about important will assess efficacy and satisfaction of virtual
child health topics. classes during the COVID-19 pandemic
3. Integrate family-based educational
activities into their practice.

Refugees are at risk for low health literacy and
high rates of illness and hospitalization. A
partnership between medical professionals at
Yale and two New-Haven, CT-based refugee
resettlement organizations aimed to create and
implement a family-based, interactive pediatric
healthcare curriculum with a goal of increasing
childhood health knowledge among refugee
families.
Methodology
Seven 1-hour, in-person classes and 1 virtual
class were taught by pediatric residents with
translation in Pashto, Dari, Arabic, Swahili, and
Kinyarwanda on the topics of child nutrition,
safety, parenting, and oral health. Each class
incorporated play-based activities for toddlers—
a My Healthy Plate puzzle, street-crossing
simulation, teeth-brushing demonstration, and
block play—which were integrated into parental
discussion with visual aids. Knowledge
acquisition and satisfaction was assessed using
pre- and post-tests.
67 adult participants had an 85% response
rate. Average knowledge test scores increased in
5 of 7 classes, reaching significance in a class
on parenting (mean 52% vs 90%, paired t-test p
A total of 1,952 refugees participated. Of 248
Changes in Antibody Titer to the Ss-NIE-1 who were antibody-positive to Ss-NIE-1 antigen
Antigen from Strongyloides Stercoralis Following and had follow-up data, over half showed
Treatment with Ivermectin in US-bound significant antibody decay over the study period.
Refugees from Burma Of 65 who were stool-positive for S. stercoralis
by PCR at the first point, all became PCR-
Raheem Smith; Christina Phares; Gretchen Cooley; Tarissa negative following presumptive treatment.
Mitchell; Elise O'Connell; Deborah Lee; Michelle Weinberg;
Diana Martin; William Stauffer
Learning Objectives Predeparture treatment decreased Strongyloides
1. Justify the use of Ivermectin in parasitic infection prevalence in US-bound refugees.
mass treatment programs to address These data, and >10 years’ successful
Strongyloides stercoralis experience of Strongyloides presumptive
2. Describe the barriers to screening for treatment in US-bound refugees, suggest
Strongyloides infection parasitic mass treatment programs with
3. Explain the lab methods used in this ivermectin are effective in migration settings
project to assess Strongyloides infection and should be considered in other mass
treatment campaigns when Strongyloides is
Background and Purpose/Rationale prevalent.
Parasitic mass treatment programs have not
systematically addressed Strongyloides
stercoralis. In 2012, CDC, in partnership with
IOM, launched a program evaluation to
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determine whether overseas identification and
management of certain medical conditions,
including presumptive treatment against S.
stercoralis, improved health prior to resettlement
for US-bound refugees. To assess impact, we
used a novel combination of serologic decay and
stool PCR in a cohort of treated refugees.
Methodology
US-bound refugees in three camps in Thailand
were offered presumptive treatment for
intestinal parasites including single-dose
albendazole and two days of ivermectin 2-6
months prior to departure and again within one
week of planned departure. Refugees provided
stool and blood samples for testing at the same
two time points; additional samples were
requested at a third time point within 90 days
following arrival in the United States. Stool
samples were evaluated using multi-parallel
qPCR and serologic antibody response using an
antigen Ss-NIE-1 multiplex bead array.
Session: P58, Submission Number: 1043145 hosted weekly health literacy classes via Zoom
with an English teacher and language interpreter
Addressing Health Literacy Barriers Among in accordance with COVID-19 precautions.
Afghan Refugees During COVID-19: APRN and These weekly Zoom classes were attended by 10
Community-Based Partnerships Through Zoom to 20 Afghan women and covered various health
Classes care topics that focused on overcoming health
literacy barriers by language interpretation,
Sydney Greenberg establishing a trusted relationship with a health
care provider, increased understanding of U.S.
Learning Objectives health care systems and help-seeking pathways,
1. Define health literacy barriers among and optimizing client accessibility and interest
refugee populations. through incorporation of cultural health beliefs
2. Describe novel intervention measures to and practices.
enhance health literacy among refugees
during the COVID-19 pandemic. Results/Impacts/Outcomes
3. Demonstrate understanding of future Outcomes that suggest the success of this
research implications for health literacy program are offered through anecdotal and non-
interventions among refugee populations parametric data.
that involve internet-based teaching
platforms and collaboration with Conclusions/Discussion
community-based refugee organizations. Future research is suggested.

The second largest group of refugees worldwide
are from Afghanistan. These refugees face
numerous obstacles to health literacy including
language barriers, potential distrust and lack of
established relationships with health care
providers, variations in cultural beliefs and
behaviors regarding illness, and a lack of
understanding of United States (U.S.) health
care systems. All of these components of health
literacy impairment are compounded by COVID-
19, which simultaneously disproportionately
affects refugee populations and limits access to
community health services, which research
shows are a critical access point for refugees.
Advance Practice Registered Nurses (APRN)
have the ability to identify evidence-based
innovative means of health education for refugee
populations through partnership with
community-based refugee organizations.
Methodology
This ethnographic study included a novel
approach to overcoming health literacy barriers
among Afghan refugees during the COVID-19
pandemic from the perspective of an APRN
student in tandem with a community-based
refugee organization. The APRN student co-
Session: P59, Submission Number: 1043196 interviews were conducted by the investigator
using a professional interpreter. All interviews
Cultural Barriers and Parental Stress: Refugee were recorded and transcribed. The translated,
Families Experiences Raising a Child with verified transcripts were analyzed using in-vivo
Special Healthcare Needs in a Metropolitan City and structural coding using MAXQDA, a
computer assisted qualitative data analysis
Montray Smith; Vicki Hines-Martin; Ruth Carrico software

1. Upon completion, participant will be able Syrian refugee families who were study
to explore the refugee parents/caregivers’ participants described factors on care giving
experiences in raising children with that involved multiple levels of influence which
special healthcare needs (CSHCN) and impacted their perceptions and decision making
medically complex disabilities (MCD).
2. Upon completion, participant will be able Conclusions/Discussion
to Identify factors that may impact Findings from the study have implications for
perceptions of caregiving and parental future research and needed supports for families
coping in the refugee families/caregivers like these during this period of transition and
having CSHCN and MCD. resettlement. Future research should focus on
3. Upon completion, participant will be able investigation with larger samples.
to describe elements associated with Communication and collaboration with families
healthcare services perceived as barriers to proactively identify and address care giving
and stress sources by refugee needs using their cultural lens is a priority.
parents/caregivers having CSHCN and
MCD

Refugee families experience many stressors
leading to and during their transition to their
new countries. These families are also
vulnerable to additional parental stress and
responsibilities if they are caregivers of children
with special healthcare needs (CSHCN) or
medically complex disabilities (MCD). The
purpose of this study was to explore Arabic
speaking refugee parent/caregiver experiences
related to having a CSHCN and MCD, and the
impact on parental perceptions, concerns, and
responses
Methodology
A comparative case study design will be used to
explore the lived experience of the selected
families. Using an Ecological Systems Theory
perspective, participant narratives will be
examined using content analysis to describe
factors that impact perceptions of refugee
families about parental coping for those who
have CSHCN and/or MCD.After IRB approval and
written informed consent, semi-structured
Among participants screened, 178 (62%) were
Prevalence and Susceptibility to Hepatitis B immune; 77 (27%) susceptible; 27 (9%)
Virus and the Need for Community Health positive; and 5 (2%) in a “grey zone.” Men
Education in Milwaukee’s Hmong Community demonstrated significantly higher rates of
positive HBV 18 (13.3%) compared to women 9
Matthew Kosasih; Xavier Sendaydiego; Kate Bednarke; (4.4%), and those below age 25 demonstrated
Stephanie Wong; Yvonne Chow; Alexander Fox; Ziyi Chen; Kia
Saeian increased susceptibility to HBV compared to the
older generation. Targeted health education
Learning Objectives through community screening events showed
1. Define the prevalence of chronic statistically significant improvement in HBV
Hepatitis B virus infection in Milwaukee’s knowledge (p<0.01).
Hmong community.
2. List subgroups associated with chronic Conclusions/Discussion
Hepatitis B virus immune, susceptible, With 38% lacking immunity to HBV, 9% with
positive, and "grey zone" statuses. active infection, and 11% reporting having a
3. Describe groups most susceptible to family member living with HBV, there remains a
chronic Hepatitis B virus and potential significant need for more effective HBV
efforts to target such groups in screening, vaccination, and education in
educational screening efforts. Milwaukee’s Hmong community.

As the leading cause of hepatocellular
carcinoma worldwide, chronic Hepatitis B virus
(HBV) infection disproportionately affects Asian
Pacific Islanders (APIs) within the United
States. Among APIs, the Hmong population has
one of the highest rates of chronic HBV
infection – up to 18% compared to 0.1% of
non-Hispanic Caucasians. This study sought to
estimate prevalence of HBV infection, as well as
factors of susceptibility and immunity,
ultimately lending itself to the assessment of the
need for community HBV education within
Milwaukee County’s Hmong.
Methodology
Between 3/2013 to 12/2019, 287 Hmong
participants were screened for HBV and 271
were provided HBV education to evaluate its
impact on HBV health literacy through health
questionnaires. Screening results were stratified
by various demographics to identify groups most
associated with HBV statuses. Student's t-tests
were performed between pre- and post-tests to
determine education improvements by varying
demographics.
Establishing a medical home for CIF requires
Immigrant Mothers’ Perspectives on Pediatric tailored messaging to individual immigrant
Primary Care communities. Minimizing logistical barriers and
creating positive experiences can also encourage
Tricia Francisco; Allison Olmsted; Karla Fredricks primary care utilization.
Learning Objectives
1. Describe immigrant mothers’ perceptions
of primary care for their children.
2. Identify barriers to establishing pediatric
primary care according to immigrant
mothers.
3. Determine immigrant mothers' trusted
sources and preferences for receiving
health information.

This study aims to identify perceptions of and
barriers to pediatric primary health care in
culturally distinct groups of immigrant mothers.
Methodology
Four immigrant groups well represented in
Houston, Texas were identified: Congolese,
Afghan, Syrian/Iraqi and individuals from
Guatemalan, Salvadoran, or Honduran
backgrounds. Eight semi-structured interviews of
key informants and four focus groups with
immigrant mothers were conducted. Sessions
were audio-recorded, transcribed and coded by
two independent researchers both manually and
using Atlas.ti. Themes were drawn from an
inductive process of data analysis.
Perceptions of pediatric primary care among
immigrant mothers were described by five
themes: 1) keeping children healthy is viewed as
a familial, not clinical role; 2) the U.S. approach
to health and the structure of its health care
system differ from those of most countries; 3)
significant logistical challenges to scheduling
and attending appointments exist; 4) positive
perceptions of health-related experiences
contribute to increased utilization of primary
care; and 5) health information is best received
from trusted sources in a culturally appropriate
manner.
Session: P62, Submission Number: 1043662 25.1% of refugees. However, telemedicine
utilization did not differ significantly among
Refugee Patients’ Use of Telemedicine During refugees by English proficiency; 28% of
the COVID-19 Pandemic encounters among English speaking refugees
were telemedicine compared to 24% of non-
Sarah Blackstone, University of Virginia, Department of Family English speaking refugees.
Medicine; Fern Hauck, University of Virginia, Department of
Family Medicine
Learning Objectives Rates of telemedicine utilization were similar
1. Describe trends in refugee patient use of between refugee and non-refugee patients, and
telemedicine during the COVID-19 did not vary significantly by language. The care
pandemic. model and database used at the IFMC could
2. Describe a model of refugee care that help practices struggling to identify and engage
supports telemedicine. refugee patients in telemedicine. This could
3. Identify opportunities to expand refugee offer opportunities for expanding refugee care
patients’ use of telemedicine. beyond the pandemic.

Throughout the COVID-19 pandemic and the
rapid switch to telemedicine services, potential
communication barriers impeding refugee
access to care has been a concern. Clinical
models that incorporate comprehensive care for
refugees can be critical in mitigating the
communication barriers in telemedicine. Using
data from a Primary Care clinic, we show trends
in refugee patients’ use of telemedicine during
the pandemic.
Methodology
The International Family Medicine Clinic (IFMC)
offers comprehensive primary care to refugee
patients including access to interpreters,
dedicated provider sessions for refugee patients,
identification in the EHR, and a database of all
refugee patients and encounters. Clinic staff
receive interpreter and communication training.
Encounter reports were generated for all refugee
and non-refugee patients from March 2020 to
February 2021. Visits were coded as
telemedicine based on their classification of
appointment type in the EHR.
There were 16,736 total encounters, 3,007 with
refugee patients. Utilization of telemedicine was
more common among non-refugee patients
(χ²(1)=75.6 p < .001); 33.3% of non-refugee
encounters were telemedicine compared to
Session: P63, Submission Number: 1043755 using validated psychological questionnaires,
personal declarations, and forensic mental
The Role of Social Determinants of Mental health evaluations of twenty-five individuals who
Health Among Asylum Seekers: Implications for applied for asylum in the United States between
Sustainable Development Goals 2017- 2021. Using univariate, bivariate, and
thematic analyses, we sought to identify
Jennifer McQuaid, PhD, Yale Center for Asylum Medicine, Yale associations between PTSD, depression and
School of Medicine; Galen Cassidy, Williams College; Shreya
Aragula, DePaul University; Gigi Gamez; Kaiz Esmail; Grace anxiety, and SDMH.
Reynolds, Williams College; Amar Mandavia, MA, Teachers
College, Columbia University; Michelle Silva, PsyD, Department Results/Impacts/Outcomes
of Psychiatry, Yale School of Medicine; Katherine McKenzie,
MD, Yale University School of Medicine Findings suggest an overwhelming burden of
mental illness among those seeking asylum and
Learning Objectives a confluence of SDMH pre, peri, and post -
1. Upon completion, participants will have a migration associated these outcomes.
greater understanding of the level,
intensity and various types of trauma Conclusions/Discussion
experienced by asylum seekers pre, peri We identified a need for the integration of
and post migration. gender-related atrocities as a distinct category in
2. Upon completion, participants will be the SDMH framework for this population, so that
able to understand the association targeted efforts can better address this growing
between mental health and social disparity among asylum seekers. Utilization of
determinants of health in psychological Lund’s framework enables linking findings to the
outcomes of asylum seekers. UN’s programmatic vision for 2030 by providing
3. Upon completion, participants will have evidence from asylees about the conditions
an increased understanding of how driving them to flee their homelands and the
violence experienced by asylum seekers consequences of this process on their mental
and SDMH can help inform UN health outcomes.
Sustainable Development Goals.

While much is known about the negative mental
health outcomes of asylum seekers, the
influence of pre, peri, and post - migratory
experiences on these outcomes is not well
established. To overcome this, our study
employs a novel framework linking social
determinants of mental health (SDMH) with UN
Sustainable Development Goals (SDG; Lund
2018).
Methodology
We conceptualize individual and environmental
factors and their proximal and distal influences
on mental health outcomes in asylum seekers.
We adapted the framework by including the
grounds of persecution on which they applied for
asylum and related traumatic events, as SDMHs
falling within specific SDG domains. We
conducted a retrospective mixed-methods study
Session: P64, Submission Number: 1043767 funding, all 14 (100%) articles reported
including refugees in the design of the research
A Chair at the Table: A Scoping Review of the study, 10 (71.4%) articles reported having
Participation of Refugees in Healthcare refugees involved in engaging
Research and Policy Design community/recruitment, 8 (57.1%) articles
reported having refugee involvement throughout
Talia Filler; Pardeep Kaur Benipal; Nazi Torabi; Ripudaman the data collection process, 4 (28.6%) articles
Minhas
reported refugee involvement in data analysis, 6
(42.9%) articles reported having refugees
Learning Objectives
involved in knowledge translation/dissemination
and 1 article (7.1%) reported having refugees
able to identify the gaps in refugee
contribute to scale up initiatives.
involvement in research.
able to describe the extent of involvement
CBPR has been shown to make substantial
of refugee communities in research.
contributions to improving health and well-being
in traditionally disenfranchised groups. As the
able to describe why refugee involvement
needs of refugee communities are so diverse,
in research is crucial in order to improve
efforts should be made to include refugees in all
health equity.
stages of the research process.
Community-Based Participatory Research
(CBPR) methods have been previously employed
successfully in designing health programs and in
building strong research partnerships in refugee
communities, however, the extent to which
refugees are involved remains unknown. The
objective of this paper is to review the evidence
about the involvement of refugees in CBPR
processes to inform healthcare research and
policy design.
Methodology
A scoping review was performed, using Arksey &
O’Malley’s methodological framework. A
literature search in Medline, PubMed,
PsycINFO, CINAHL, Embase, Global Health,
Scopus, and Policy File Index for articles
published until August 2020 was conducted.
Articles were included if they focused on CBPR,
had refugee involvement, and discussed
healthcare and health policy.
14 studies were included in the final analysis,
with an inter-reviewer kappa-statistic of 0.85. 9
(64.3%) articles reported refugees having a role
in the inception of the research, no articles (0%)
reported refugee involvement in seeking
Session: P65, Submission Number: 1043787 BMI, subjective health, and somatic symptoms
were fit.
Threat Response and Health Outcomes in Youth
Resettled in the US as Refugees of Syria Results/Impacts/Outcomes
FPS and SCR were not associated with the
Celine Bazzi, STARC/Wayne State University; Lana Ruvolo health variable; therefore BMI, subjective
Grasser, Wayne State University School of Medicine; Bassem
Saad, Wayne State University; Hiba Abu-Suhaiban, Wayne State health, and somatic symptoms were evaluated
University; Dalia Mammo, Wayne State University; Tanja separately. There was a quadratic trend between
Jovanovic, Wayne State University; Arash Javanbakht, Wayne FPS and somatic symptoms controlling for age,
State University
F(2,28)=3.28, r=.449, R2=.202, p=.05. There
was a significant association between SCR and
Learning Objectives
BMI controlling for age, F(2,23)=4.856,
p=.018, R=.562, R2=.316. We observed a U-
able to understand the impact of
shaped relation between somatic symptoms and
traumatic stress on refugee health.
FPS; there was a negative linear relation
between SCR and BMI.
able to identify potential long-term health
effects driven by prolonged stress
responses in youth resettled as refugees.
Preliminary data indicate putative associations
between threat responses, BMI, and somatic
able to form a basis for exploring
symptoms. Immediate conclusions are limited
potential treatment targets that intervene
due to small sample. Identifying relations
at the level of sympathetic reactivity.
between biological threat responses and health
outcomes can provide potential treatment
targets for trauma-exposed youth.
Activation of the autonomic nervous system
upon repeated trauma and stress leads to
adverse health outcomes. While prior trauma
exposure may be associated with exaggerated
threat responses to related stimuli, chronic
trauma exposure may lead to autonomic
blunting. We investigated relations between
threat response and health outcomes which may
be related to autonomic functioning in Syrian
youth refugees exposed to war trauma. We
hypothesized increased threat responsivity—
measured using trauma interviews and fear-
potentiated startle paradigms (FPS)—engenders
negative health outcomes.
Methodology
N&#3f35 (16F, ages 10-17) youth assessed
~2.5 years following resettlement. Data included
self-report questionnaires assessing psychiatric
and somatic symptoms, psychophysiological
data from an FPS paradigm, and skin
conductance response data (SCR) collected
during a trauma interview. Regression models
for associations between SCR and FPS and a
composite latent health variable consisting of
Session: P66, Submission Number: 1043804 on building the resilience of parents, parenting
education and support, provided services in the
Parenting Interventions for Families of Refugee family’s native language, and offered families
Background: A Systematic Scoping Review safe spaces to promote positive parent-child
interactions were most successful. Home-visit
Pardeep Kaur Benipal; Ripudaman Minhas; Aisha Yousafzai and family-centered programs showed particular
success, minimizing barriers such as
Learning Objectives transportation and inflexible work schedules,
1. Upon completion, participants will be while allowing caregivers to receive feedback
able to describe features of parenting from facilitators. The vast majority of studies
interventions for families of refugee evaluated programs implementing existing
background as described in the literature. curricula and frameworks.
able to describe the gaps in parenting Conclusions/Discussion
intervention literature designed for There is scarce literature describing parenting
families of refugee background. interventions for families of refugee background.
3. Upon completion, participants will be To date, there are no studies that employ a
able to identify important next steps as a participatory approach to program design to
result of the scoping review findings. tailor content or accessibility, and few that
evaluate parenting, developmental or
Background and Purpose/Rationale behavioural outcomes.
Children of refugee or asylum-seeking
backgrounds have multiple, complex needs that
places them at an increased risk for
developmental or behavioural problems.
Providing appropriate support services and
educational resources that address the concerns
of parents of refugee background will alleviate
these challenges. The objective of this review is
to identify the characteristics of effective
parenting interventions that address the unique
needs of families of refugee background.
Methodology
English-language articles published from
January 1, 1997 to July 10, 2019 were
included if they described or evaluated programs
or interventions for parents of refugee- or
asylum-seeking background. Data were extracted
and analyzed according to Arksey and O’Malley’s
descriptive analytic model.
Eight studies, primarily studying families settled
in high-income countries, met the inclusion
criteria. Parents of refugee background
identified parenting to be a major concern, and
expressed that they experienced language
barriers, and a lack of familiarity with school
and early years services. Services that focused
Session: P67, Submission Number: 1044631 reconciliation of transfer issues from eMedical
into EDN.
Improving the Transfer of Records for Special
Immigrant Visa Holders Results/Impacts/Outcomes
From April-August 2020, quality checks with
Shannon Fox; Amanda Dam; Yoni Haber; Emily Jentes; Deborah RPC data found that 56%-74% of SIV records
Lee; Charles Miller
were matched in eMedical, whereas from
September-February 2021, 86%-94% records
Learning Objectives
were matched. Missing records were
individually requested from IOM.
able to understand the process by which
SIVs elect refugee benefits.
Acquiring the migration health information of
able to understand the process by which
SIVs encompasses a unique nexus of close
the Electronic Disease Notification
collaborations with federal and international
System acquires transmission of SIV
systems. Preliminary findings suggest
records.
improvements to data completeness within EDN
for SIVs who elect benefits post-arrival. We
able to compare the successful
continue to refine processes to ensure all SIV
improvements in transmission of SIV
records are provided to US health partners.
records into the EDN system from April
2020 - February 2021.

US-bound immigrants and refugees undergo a
mandatory overseas medical examination. The
Centers for Disease Control and Prevention
(CDC) provides records from the examination to
US health partners through its Electronic
Disease Notification (EDN) system. Special
immigrant visa (SIV) holders from Iraq and
Afghanistan are eligible for federal refugee
benefits, but they must opt in, either before or
after US arrival. Historically, EDN receives
records electronically from the International
Organization for Migration (IOM) for SIV holders
who elect benefits before arrival. Here we
describe the new process by which EDN now
also receives records for SIV holders who elect
benefits after arrival.
Methodology
In 2018, CDC launched eMedical, an online
portal that collects overseas medical records for
all US-bound immigrants. In September 2020,
the US Refugee Processing Center (RPC) began
providing CDC with the list of SIV holders who
elected benefits after arrival. Using a newly
developed matching protocol, we ensured SIV
record completeness, data quality, and
Session: P68, Submission Number: 1044695 visits, provide COVID19 education, and restart
well child care before the rest of the clinic.
Clinical Adaptations to Refugee Care During Workflow for new arrival assessments was also
Covid-19 adjusted in partnership with MA DPH, some
even conducted through home visits.
Luis Colon-Mulero, University of Massachusetts; Olga Valdman;
Satu Salonen; Duy Nguyen; Alaina Theocles; Sulay Alamo
Despite COVID19 challenges refugee clinic
Learning Objectives
providers felt they were able to provide better
care to refugee patients, pediatric patients did
able to describe possible interventions to
not have significant lags in preventive care and
improve refugee healthcare access in the
vaccines.
outpatient setting.
2. List different pitfalls in delivery and
access to primary healthcare for refugee
Population health approach and a dedicated
populations.
specialized team can help overcome health
3. Describe the benefits of an integrated
access challenges even in vulnerable
specialized team in overcoming new
populations.
challenges to health care access for
refugee populations

Disparities in healthcare access are inherent to
our healthcare system. The COVID-19 crisis
highlighted these disparities. Refugee
populations are particularly vulnerable to this
given their cultural, linguistic, and
socioeconomic barriers. A Center for Medicaid
services report revealed a sharp decrease in the
delivery of healthcare services during the
COVID-19 crisis across underserved populations.
Family Health Center of Worcester (FHCW) has
an established refugee clinic that provides
assessments to newly arriving refugees as well
as ongoing primary care. Our team of providers,
our nurse, and MAs are trained in refugee care.
During COVID19, FHCW similar to others
significantly reduced in-person visits, pivoting
most care to telehealth; well child care was
suspended. Concerns for infection spread
required revision of clinical workflows. Refugee
patients and providers struggled to engage in
meaningful care through telehealth.
Methodology
Having a specialized team of staff, refugee
clinic patient database, and awareness of our
patients' needs and limitations allowed us to
work with the administration to create
appropriate workflows to safely expand in-person
Session: P69, Submission Number: 1044921 at the worksite. The sessions included COVID-19
specific public health education, clinical
Speeding up the Gears: Organizational information from the screening clinic, and
Partnerships with a Common Goal Can Quickly human resources-related information from the
Effect Change worksite. The subsequent case rate in these
communities has not decreased (25%).
Carly Stokum, Maryland Department of Health; Shenna Hair;
Dipti Shah
Keen observations from unrelated organizations
Learning Objectives
led to a targeted and identifiable intervention to
1. Identify a data source that can provide
slow the spread of COVID-19 in these
COVID-19 case information in
communities. Nimble partnerships between
humanitarian immigrant populations.
organizations should be explored with the
2. List potential partner organizations for
common goal of health promotion in HI
future collaborations.
communities.
3. Identify vulnerable populations through
non-traditional methods.

Maryland’s humanitarian immigrant (HI)
population is one of the most diverse in the
country. Since 2011 combined Burmese and
Bhutanese comprise 13% of arrivals. In
Maryland these populations tend to be resettled
in similar areas and work in the same locations.
COVID-19 has had a disproportionate effect on
HI communities, as highlighted in these specific
communities' experience.
Methodology
All COVID-19 cases from Maryland’s reportable
disease database (March 2020 - March 2021)
were matched to Maryland’s HI arrival and
screening database on a periodic basis during
the study period. Descriptive statistics including
country of birth, arrival year, age, county of
residence were analyzed. Early trends showed an
over-representation of cases in the Burmese and
Bhutanese communities (22%). Concurrently,
COVID-19 outbreaks were reported in worksites
with large Burmese and Bhutanese populations
and a screening clinic observed an increase in
Burmese and Bhutanese COVID-19 cases.
The confluence of these factors led to targeted
health education sessions at a large Burmese
and Bhutanese worksite. Three sessions each
were delivered via video interpretation in
Burmese and Bhutanese to accommodate shifts
Session: P70, Submission Number: 1044929 from Iran were significantly over-represented in
those vaccinated versus their arrival proportion
Phased COVID-19 Vaccination Characteristics (17%/7%). HIs from Spanish-speaking countries
Among Elderly Humanitarian Immigrants in were significantly underrepresented. All results
Maryland were significant (p<0.05).
Carly Stokum, Maryland Department of Health; Emily Conclusions/Discussion

Fitzpatrick; Dipti Shah
Disparities in languages spoken, vaccination
sites usage, and country of birth are unique to
Learning Objectives
HIs and warrant targeted efforts. Attributes such
1. Understanding additional barriers for
as age, country of birth, and language should be
humanitarian immigrant vaccination
considered when planning mass vaccination
programs.
campaigns. Health department partnerships with
2. Identifying data sources for humanitarian
RAs to deliver targeted outreach may increase
immigrant populations.
vaccination uptake in vulnerable populations.
3. Identifying partner organizations to
promote vaccination in vulnerable
populations.

During Maryland’s phased COVID-19 vaccination
distribution, equitable vaccination for the state’s
most vulnerable was prioritized. Connecting
Maryland’s elderly population (≥65 years)
presents unique challenges, often exacerbated
in humanitarian immigrants (HIs). Here, we
investigated COVID-19 vaccination in elderly HIs
and provided targeted and informed data to
resettlement agencies (RAs) to increase
vaccination rates in this population.
Methodology
All COVID-19 vaccinations in elderly persons
from Maryland’s immunization registry were
matched to Maryland’s HI arrival and screening
database. Country of birth, immigrant group,
and vaccine clinic type were analyzed. Analysis
is ongoing. Reports to RAs focused on two areas:
which HI populations were engaged in
vaccination and which were not, with the goal of
targeting vaccination information to the lagging
populations and learning from the utilizing ones.
Refugees are the majority HI group to be
vaccinated (71%) and were overrepresented
versus their arrival proportion (67%). Elderly HIs
were more likely than all elderly to use a public
health clinic (48%/34%) and less likely to use a
hospital (14%/28%) for vaccination. Arrivals
Session: P71, Submission Number: 1044953 of days between arrival and notification to health
departments was calculated.
Data Modernization of Immigrant Medical
Information: A Case Study of the Special Results/Impacts/Outcomes
Immigrant Visa Holder Records from Iraq and CDC received records from eMedical for 2,636
Afghanistan (16.4%) of 16,030 SIV holders who arrived in
the United States. For those with notifications
Kiara Butler; Monica Adderley; Deborah Lee; Drew Posey sent to state health departments, CDC received
records for 36 (15%) from eMedical, 69
Learning Objectives (28.8%) from paper collection, and 135
1. Upon completion, participant will be able (56.2%) from IOM; the average time between
to understand efficiency of electronic arrival and notification was 2 days for eMedical
data collection compared to paper compared to 17 days for paper collection.
collection for special immigrant visa
holders Conclusions/Discussion
2. Upon completion, participant will be able Analysis revealed most SIV records were not in
to describe the electronic and paper eMedical. Due to the phased rollout of eMedical,
transmission processes of overseas many records could only be collected via the
medical records for special immigrant paper process. Notification times were reduced
visa holders through data modernization, but more time is
3. Upon completion, participant will be able needed to assess the impact and usage of
to determine number of SIV holders with eMedical.
TB classification who had notifications
sent to health departments from 2018 -
2020

Between 2018-2020, over 600 US panel
physicians worldwide implemented eMedical, an
online portal, to capture data from the required
overseas medical examinations of US immigrant
visa applicants. This process replaces paper
collection at US ports of entry and electronic
transfer from the International Organization for
Migration (IOM). To assess benefits of data
modernization, we describe an analysis of
records from special immigrant visa (SIV)
holders from Iraq and Afghanistan.
Methodology
US Customs and Border Protection (CBP) arrival
data was used to determine the total number of
SIV holders who arrived in the United States
between September 2018 – December 2020.
We assessed records in eMedical, and records
received by other pathways in the CDC
Electronic Disease Notification (EDN) system.
To assess notification times for those with
tuberculosis classifications, the average number
Since July 2020,129/175 (74%) HIs received
Bridging Gaps and Busting Myths Through telephonic health education, while 88 ESOL
COVID-19 Health Education for Humanitarian students received virtual instruction. Asylees
Immigrants from Cameroon (42%) and refugees and SIVs
from Afghanistan (33%) represented the two
Shenna Hair; Heather Kathrens; Dipti Shah largest participating communities. Virtual
learning yielded a 39% increase in participation
Learning Objectives for HIs from Cameroon and a 27% decrease for
1. Upon completion, participants will be HIs from Afghanistan.
able to increase knowledge about COVID-
19, the U.S. healthcare system and Conclusions/Discussion
emotional wellness. Adjusting health education to a virtual platform
2. Upon completion, participants will be has ensured that Maryland’s HIs are up-to-date
able to receive cultural appropriate and with language-accessible and culturally-
language accessible COVID-19 related informed COVID-19 health information. As a
health education. shorter and more accessible option for some
3. Upon completion, participants will be HIs, it should be considered as one of a variety
able to receive translated health materials of different options for health education
in their written language. delivery.

In March 2020, as in-person activities were
paused, the Maryland Department of Health
(MDH) shifted from a 3 hour in-person health
education session for newly-arrived
humanitarian immigrants (HIs) to something just
as accessible, but in a more virtual setting. To
ensure that HIs were receiving accurate
information about COVID-19 against a rapidly-
changing backdrop, MDH opted for 1:1
telephonic and virtual health education sessions
for HIs.
Methodology
A contact list was generated from various
sources: EDN arrival notifications, ESOL
classes, and referrals from screening clinics and
resettlement agencies. A script was developed to
address COVID-19-related topics including:
mental health, isolation, quarantine, testing,
vaccines, places to seek health care, mask-
wearing and social distancing and myths. For
the virtual sessions, the instructional method
included language-accessible communication
utilizing question and answer and teach-back.
Post-call, HIs were provided with translated
written resources.
52 patients were referred. The average age was
The Medical-Legal Partnership for Immigrants: 46, 63.5% were female, 30.9% were
Increasing Healthcare Access While Reducing undocumented, and 25.5% either did not know
Healthcare Costs or did not report their immigration status.
23.5% were Ugandan, 17.6% were Haitian,
Houda Chergui, Immigrant and Refugee Health Center, 49% spoke English, 15.7% spoke Haitian
Department of Psychiatry, Boston Medical Center; Sarah
Kimball, Immigrant and Refugee Health Center, Boston Medical Creole. Patients were cleared of a combined
Center; Section of General Internal Medicine, Boston University $90,657 of medical debt. Nine patients
School of Medicine and Boston Medical Center; Jacob Savage obtained successfully upgraded insurance and
MSW; Katherine Purrington JD; Andrew Cohen MA JD
because two were housed at skilled nursing
homes subsidized by BMC, the hospital saved
Learning Objectives
$91,000/year for each of these two patients.
1. Describe characteristics of im/migrant
patients seeking legal services within an
urban hospital setting
Multidisciplinary teams that include public
2. Describe types and levels of legal services
benefit and immigration attorneys allow for
provided to im/migrant patients
increased access to care and immense savings
3. Consider the social, legal and financial
to hospitals and patients. Many cases are still
impacts of medico-legal partnerships for
ongoing and we anticipate even greater impact.
hospitals and for patients

Immigration pathways and public benefits
enrollment are interrelated. Fear around
healthcare benefits due to immigration status
and systemic barriers are obstacles for
im/migrant patients accessing care. Medical-
Legal Partnerships have shown success in
alleviating patients’ stress and ER visits while
reducing costs for patients and hospitals. Boston
Medical Center’s (BMC) Immigrant and Refugee
Health Center partnered with Rian Immigrant
Center and Health Law Advocates (HLA) to
provide legal support to patients. Our objectives
were to describe demographic characteristics of
im/migrant patients receiving legal services
within the hospital setting and identify
outcomes of the partnership.
Methodology
Participants included: 1) BMC patients referred
by providers or who were self-referred 2)
Uninsured patients with rehabilitation needs for
whom BMC subsidized stay at skilled nursing
facilities. When eligible, HLA assisted with relief
of medical debt and insurance enrollment and
Rian provided immigration legal aid.
Session: P74, Submission Number: 1046372 reported barriers to vaccination include
language, abilities to make vaccine
Attitudes Towards COVID-19 Vaccination Among appointments, and transportation.
the Bhutanese Community in the United States
Yadhu Dhital; Yumi Jarris Despite studies that have reported higher
vaccine hesitancy rates among minority
Learning Objectives populations, our study suggests no significant
1. Assess the prevalence of COVID-19 vaccine hesitancy among resettled Bhutanese in
vaccine acceptancy and hesitancy among the U.S.; however, barriers to accessing
resettled Bhutanese refugees in the U.S. vaccines exist. It is crucial for public health
2. Identify the factors influencing attitudes stakeholders to partner with the community to
towards COVID-19 vaccination in this address these barriers by providing updated
population. information in Nepali, assisting with vaccine
3. Identify the barriers to COVID-19 appointments, arranging transportation, or
vaccination and potential ways to address bringing mass immunization sites close to the
those barriers to improve vaccine uptake community.
in this population.

A significant number of Americans remain
hesitant to receive the COVID-19 vaccine
despite increasing availability. Some studies
have reported higher rates of vaccine hesitancy
among minorities. This study explored the
attitude and barriers to COVID-19 vaccination
among resettled Bhutanese refugees in the U.S.
Methodology
After IRB approval, data was collected with an
anonymous online survey in English.
Participants were recruited from resettled
Bhutanese adults in the U.S. primarily via social
media in February-March 2021. The survey was
adapted from the KFF COVID-19 Vaccine
Monitor survey and the 5-C scale of vaccination.
Among 302 respondents, 99 (32.78%) received
at least the first dose, 165 (54.63%) are
willing, 28 (9.27%) are unsure, and 10 (3.31%)
are unwilling to get the vaccine. Vaccine
acceptance was not associated with gender or
age. The major factors for unwillingness to be
vaccinated include concern for possible side
effects, vaccines being too new, belief in
immunity due to prior COVID-19 infection, and
belief that the vaccine is ineffective. One-third
reported that everyday stresses would prevent
them from getting vaccinated. Commonly
Five major themes were identified from the
Culturally Responsive Care During Pregnancy qualitative analysis of the interviews: (1) desire
Loss Among Refugee and Immigrant Patients for more training in how to respond to pregnancy
loss with cultural sensitivity, (2) limitations of
Colbey Ricklefs; James Austin; Zannah Herridge-Meyer; Danielle the structure, policies, and practices of
Minji Jung; Christie Miles; Christine Wilson Owens; Anna Cowan;
Ying Zhang hospitals and clinics, (3) language barriers and
interpretation challenges, (4) impact of culture
Learning Objectives and religion on the perinatal loss experience,
1. Understand the impact of pregnancy loss and (5) appreciation for variation in the grieving
on immigrant and refugee patients and process.
families.
2. Explore the unique challenges healthcare Conclusions/Discussion
practitioners face when providing care for Providers should be culturally responsive to the
refugee and immigrant patients and unique perspectives of pregnancy loss for their
families experiencing pregnancy loss. refugee and immigrant patients while also
3. Reflect on the interpersonal and addressing the systems-level barriers that are
institutional practices that can be unique to this population. This project identifies
addressed to improve care to refugee and unique themes and offers guidelines to be
immigrant patients experiencing posted to the EthnoMed website along with case
pregnancy loss. studies.

Training on how to provide culturally responsive
support for immigrant and refugee patients and
their families experiencing pregnancy loss is not
widely integrated into U.S. medical education.
We performed a narrative literature review and
qualitative exploration of factors impacting care
for refugee and immigrant families experiencing
pregnancy loss.
Methodology
A narrative literature review was conducted to
evaluate current practices in care and
counseling of refugee and immigrant
populations experiencing pregnancy loss. This
was followed by seventeen open-ended semi-
structured interviews with members from
perinatal healthcare teams and community
based organizations. Interview transcripts were
analyzed to identify major themes that were
reviewed by community leaders. Interview
themes were used to create case studies with
salient discussion questions for reflection aimed
at helping healthcare teams understand
culturally responsive approaches to care during
pregnancy loss.
Clinic services, in-person interpreters, the
Refugee Care Experiences at the Refugee Health trusting environment and clinic partnerships
Clinic in Saskatoon with settlement agencies were highly praised.
One year after their first clinic visit, 57% of
Monique Reboe-Benjamin; Lori Verity-Anderson; Darlene Perry; participants reported a positive change in health
Melanie Baerg; Jessa pillipow; Maria Gomez; Jacelyn Hanson;
Karen Leis; Mahli Brindamour; Anne Leis status, 33% perceived no change and 10% a
decline. Participants who said their doctor gave
Learning Objectives them advice on how to stay healthy were 4.8
1. Upon completion, participants will be times more likely to report a positive change in
able to describe how newcomer health status than those who did not. Similarly,
government-assisted refugees perceived those who had less clinic visits (≤4 visits) were
access to care at the REACH clinic 5.2 times more likely to report a positive change
2. Upon completion, participants will learn in health status. Thematic analysis corroborated
how refugees view their health status survey findings.
after one year of care at REACH
able to describe the important roles of a A high satisfaction level with services was
refugee specific clinic, REACH clinic, found, and over half of the respondents reported
and involvement of community partners a positive change in health status. Further
such as settlement workers in the care of research should determine how refugees'
refugees. perceived health status evolves over time.

The Refugee Engagement and Community
Health (REACH) clinic is a multidisciplinary
clinic providing health care to refugees within
their first year of resettlement. This mixed-
methods study was designed to understand how
refugees perceived access and care received at
REACH and to evaluate their perceived health
status after one year.
Methodology
Using a cross-sectional design, 75 Government
Assisted Refugees (GARs) completed a survey
from May 2018 to April 2019. Questions
included demographic characteristics,
accessibility, perception of clinic visits, and
perceived health status. Following descriptive
analysis, a logistic regression assessed the
relationship between “perceived health status”
and several key independent variables.
Interviews conducted with a subset of 16
participants provided additional context to
refugees’ care perceptions.
Session: P77, Submission Number: 1047394 by our team using a patient-centered lens,
operationalized as year-end assessments of
Virtual Patient Advisory Committee Within a research products.
Specialized Refugee Health Research Program
Kavya Anchuri; Linda Holdbrook; Rabina Grewal, University of Our assessments will score each abstract,
Calgary; Sarah Clarke; Ingrid Nielssen; Maria Santana; Erin
Hetherington, University of Calgary; Kerry McBrien, University of publication, and grant submission produced in a
Calgary; Gabriel Fabreau, University of Calgary given year to determine whether the priorities
and recommendations identified through PAC
Learning Objectives are reflected in the design, implementation, and
1. Understand the necessity of integrating objectives of our research projects.
patient-centered principles not only in
refugee healthcare delivery, but also in Conclusions/Discussion
the research principles and design that PAC is a framework that can be adapted to
inform and modify service delivery. various settings as an accessible tool to
2. Define Nominal Group Technique and its decolonize refugee health. By convening a
use in consensus-based healthcare virtual Patient Advisory Committee among
decision-making refugee patients to help decide research
3. Identify one overarching strategy for priorities, we are striving to ensure that refugee
evaluating the extent to which the output health research is expressly beneficial to those it
of a refugee health research program seeks to support.
reflects and serves patient needs.

Centering the needs of newly resettled refugees
is essential for delivering effective healthcare,
and failure to employ a patient-centered
approach in this process may result in
unintended harm done to an already vulnerable
population. Our objective is to ensure that the
clinical and research priorities of a specialized
refugee clinic and research program in Calgary
are equitably and intentionally shaped by the
lived experiences of refugee patients.
Methodology
We convened a Patient Advisory Committee
(PAC) of former and current patients of our
clinic in order to better understand refugee
patients’ complex intersectoral needs and
identify and prioritize future research directions.
We applied Nominal Group Technique, a
consensus-driven qualitative methodology for
exploring healthcare priorities, to ensure equal
and democratic participation among all PAC
members, including those whose voices may
otherwise have remained invisible. Leveraging
the opportunities that COVID-19 affords for
virtual gathering, PAC is held on Zoom. Finally,
we are evaluating all research output generated
Session: P78, Submission Number: 1047580 vaccine readiness by age, length of time in the
US, or level of education. There was a
Surveying COVID-19 Vaccine Readiness in a downward trend in the proportion of people
Culturally and Linguistically Diverse Refugee willing to accept the vaccine over time, from
and Immigrant Community in Upstate New York December (n= 47, 68.1%) to March (n= 14,
38.9%). Certain ethnic groups were more
Carlie Thompson; Megan Harris; Daniel Lichtenstein; Kathryn hesitant than others and trusted different
Anderson; Jana Shaw; Rachel Fabi; Christina Lupone; Donna
Bolourchi; Andrea Shaw sources for health information.

1. Describe COVID-19 vaccine readiness This study engaged diverse minority
and hesitancy in a culturally and communities at risk for COVID-19 infection to
linguistically diverse refugee and better inform equitable vaccine distribution and
immigrant community in Upstate New health promotion.
York.
2. Describe differences in sources trusted to
obtain health information among different
ethnic groups.
3. Understand how these findings can
inform equitable vaccine distribution.

The COVID-19 pandemic has disproportionately
affected individuals from minority populations,
including resettled refugees and non-refugee
immigrants. These linguistically and culturally
diverse populations carry a disproportionate risk
of acquiring COVID-19 and suffer more severe
consequences of COVID-19 infection. Better
understanding of the beliefs and attitudes
toward COVID-19 and vaccination will better
inform public health outreach to vulnerable
populations.
Methodology
From December 2020 to March 2021, 247
individuals from 31 countries, speaking 20
languages other than English, were surveyed at a
COVID-19 testing site located at a refugee
resettlement center in Syracuse, NY. Surveys
gauged vaccine-related thoughts and beliefs,
and were conducted by health navigators from
congruent immigrant communities.
Of 247 participants, 56.7% were ready to
accept a COVID-19 vaccine today, 17.4% were
unsure, and 24.7% said they would not accept a
vaccine. There was no significant difference in
Of the 113 affidavits composed by HRI, 54 have
Psychological Torture Among Asylum Seekers documented psychological torture. Of the
Aided by the Human Rights Initiative affidavits that contained the psychological
torture code, 52% were coded for death threats,
Yasmeen Mohammad; Andrea Alfonsi 37% for destruction of home/village, 46.3% for
killing of family member, 44.4% for threats
Learning Objectives against family, and 42.6% for witness beating of
1. Upon completion, participants will be family member.
able to describe the forms of
psychological torture endured by asylum Conclusions/Discussion
seekers. The asylum seekers aided by the HRI have
2. Upon completion, participants will be endured a varied spectrum of psychological
able to consider the long term impacts abuse that has the potential to result in
that psychological torture can have on the significant long-term consequences. It is
overall quality of life of asylum seekers. important to identify and address the impacts of
3. Upon completion, participants will be torture on asylum seekers in order to provide
able to discuss the importance of comprehensive care to this population.
identifying and addressing the
complications of psychological torture on
asylum seekers.

Psychological torture often contributes to an
individual’s decision to seek refuge in another
country. The Human Rights Initiative (HRI) is a
student run organization at the University of
Buffalo. HRI seeks to aid asylum seekers by
arranging their medical and psychological
evaluations by trained providers, and composing
the affidavits which serve to strengthen the case
of the asylum seeker. The majority of the asylum
seekers aided by HRI have endured
psychological torture before arriving to the
United States.It is the purpose of this
investigation to explore the prevalence and
nature of the psychological torture endured by
the clients of the HRI.
Methodology
HRI receives a final copy of asylum seeker
medical and psychological evaluations as they
are filed with the courts. The evaluations are
coded for a number of factors including mention
of psychological torture. All evaluations which
included the psychological torture code were
retrieved and reviewed for form of psychological
torture endured.
We identified six themes: 1) the challenges of
"Refugee Women Gardening: “Because We Plant living in the U.S.; (2) gardening as a coping
Things mechanism; (3) the satisfaction from growing
vegetables; (4) the physical benefits of
Community gardens served as a place of refuge, social gardening; (5) a connection with their home
connection and self-affirming identity for many women refugee
gardeners. Government and community agencies can adopt country; and (6) their gender role as a
programs and policies to expand access to community gardens woman.Gardening was not a panacea for all
and similar social engagement activities to assist refugees in challenges but it reduced stressors and the
their transition to living in a new country. Kari, Hartwig; St.
Catherine University Gao, Lee; St. Catherine University Raw, social isolation experienced by many women.
Raen; St. Catherine University
Learning Objectives
1. Gardening Makes Our Heart Feel Pleased.
2. Name at least 3 ways that gardening
facilitates adaptation and resilience for
refugees.
3. Describe unique gender benefits of
gardening for women refugees.

Identify structural interventions and policy
changes to impact population health for
refugees.
Methodology
Refugees’ experience of integration into a new
country and culture is often different from other
immigrants given the trauma or persecution that
led to immigration. One concept of resilience
refers to the ability to adapt and adjust to
physical, emotional, and psychological stressors.
The purpose of this qualitative research was to
explore the relationship between gardening and
resilience for refugee women living in the Twin
Cities of Minnesota.
This qualitative study design conducted in
summer 2018, combined focus groups and
face-to-face interviews with Bhutanese (14),
Karen (6), and Hmong (10) women gardeners.
Trained facilitators who shared the same
language and ethnicity, conducted one focus
group with each ethnic/language group followed
by individual interviews. A multi-ethnic research
team used the constant comparative method to
identify themes. The St. Catherine University
Institutional Review Board approved this study.
The TB follow-up data were obtained from the
Assessment of US Tuberculosis Follow-Up EDN system. The overall TB worksheet
Records for Immigrants and Refugees in the utilization rate was calculated based on
Electronic Disease Notification System, January completion of any field by US health partners.
2015-June 2020 We assessed all variables including date of first
US test or provider/clinic visit, evaluation
Amanda Dam; Raheem Smith; Deborah Lee disposition date in the US, and final diagnosis.

1. Upon completion, participants will be During January 2015-June 2020, of 109,943
able to understand how US health TB notifications, the overall worksheet
providers have reported findings in the utilization rate was 99.6%. The date of first US
Tuberculosis Follow-Up Worksheet in the test or provider/clinic visit was indicated in
Electronic Disease Notification system 91,430 (83%) records (81.4% for immigrants
during January 2015 - June 2020. and 93.1% for refugees). Over 95% of
2. Upon completion, participant will be able worksheets had the field for evaluation
to describe the training needs that the disposition date in the US completed, for both
Migration Health Information Nexus Unit immigrants and refugee records; median days
will address based on data quality from the first visit date to the evaluation
assessment of the US tuberculosis follow- disposition date was 35 days for refugees and
up records for Immigrants and refugees 28 days for immigrants. The final diagnosis was
entered in the CDC Electronic Disease missing for 11% of refugees and 23% of
Notification (EDN) system during January immigrants.
2015 - June 2020.
D R A W N
WITH Findings from the data quality assessment
to identify how specific fields on the
Tuberculosis Follow-up Worksheet are provide a roadmap for identifying improvements
calculated to ultimately determine to the TB worksheet, communication gaps, and
potential improvements to be made to the training needs.
Tuberculosis Follow-up Worksheet as well
as communication gaps that contribute
towards Worksheet completion.

The Centers for Disease Control and Prevention
(CDC) Division of Global Migration and
Quarantine (DGMQ) is responsible for providing
arrival notifications for immigrants with
tuberculosis (TB) classifications and all
refugees, and their records from the required
overseas medical examinations, to US state and
local health departments. CDC recommends US
health departments conduct TB follow-up
evaluations upon notification through the
Electronic Disease Notification (EDN) system,
and report their findings using the TB Follow-Up
Worksheet in EDN. We assessed the data quality
of these worksheets.
Session: P82, Submission Number: 1048216 the asylum seeker’s own process of LGBTQ+
self-actualization -- exacerbated their pre-
Considerations for LGBTQ+ Asylum-Seekers: A existing distress. We also observed protective
Qualitative Case Study effects when the applicant was able to gender-
express in a way that fit their identity.
Kaiz Esmail; Jennifer McQuaid, PhD, Yale Center for Asylum
Medicine, Yale School of Medicine; Katherine McKenzie, MD,
Yale University School of Medicine Conclusions/Discussion
We propose several unique considerations for
Learning Objectives LGBTQ applicants and possible treatment
1. Participants will understand the unique directions to address the mental health needs of
factors associated with the mental health LGBTQ asylum-seekers.
of LGBTQ+ asylum-seekers.
2. Participants will gain a greater
understanding of the importance of
LGBTQ+ self-actualization in the asylum
process to inform their own practice.
3. Participants will learn about future
considerations for working with LGBTQ+
asylum applicants and ways to
incorporate them in the forensic
evaluation process.

Asylum seekers demonstrate high rates of
psychopathology due to their experiences of
significant trauma and persecution in their
country of origin. Additionally, LGBTQ+-
identifying persons are at a greater risk than the
general population for developing
psychopathology, a phenomenon that has been
associated with stigma and discrimination.
Methodology
The case study presented herein attempts to
explore these two experiences in order to
investigate the unique risk factors associated
with LGBTQ+ asylum-seekers.
Through qualitative coding of an LGBTQ
declaration for asylum, we observed themes
consistent with existing research: targeted abuse
based on identity characteristics, consistent life
stressors associated with homo/transphobia, and
depression, suicidality, and substance abuse
associated with identity-discrepant gender
expression. Additionally, the need to document
one’s LGBTQ+ identity as a means of supporting
the applicant’s claim for asylum -- regardless of
Session: P83, Submission Number: 1048253 were more successful than didactic approaches.
Students were most engaged in modules about
Evaluating a Comprehensive and Functional mental health and understanding prescriptions.
Health Literacy Curriculum for Adolescent Data collection was complicated by
Refugees in a Cincinnati Public High School technological barriers: we were able to match
pre-post scores for only 11 students. There were
Mentalla Ismail; Shanna Stryker; Sonali Doshi; Adam Elzarka no differences in HL scores in this limited
sample
Learning Objectives
1. Demonstrate an understanding of barriers Conclusions/Discussion
to healthcare access for adolescent Adolescent refugees had poor HL but were
refugees motivated to learn about basic health topics. In
2. Identify institutional and systematic a limited sample our curriculum did not impact
problems that contribute to low health scores on validated measures of HL. In future
literacy levels in English language studies, the curriculum will be adapted to better
learners and adolescent refugees address students’ learning preferences, and our
3. List health literacy competencies that evaluation will be adjusted to better capture the
address both functional and impact.
comprehensive components of
intervention and content needed to
address competencies

Many refugee adolescents act as liaisons
between their families and the American
healthcare system. However, minimal health
education is provided to students who are
English learners. We aim to describe lessons
learned in a pilot study implementing a novel
health literacy (HL) curriculum for adolescent
refugees
Methodology
An eight-week HL curriculum was piloted among
high school students enrolled in three ESL
seminars in a Cincinnati Public School by
Refuge Collaborative volunteers. Using a pre-
post design, changes in scores on the English
version of the Swedish Functional Health
Literacy Scale (SFHLS-E) and the European
Health Literacy Survey Questionnaire (HLS-EU-
Q16) were assessed using a signed-rank test.
85 students from 16 countries participated. At
baseline, half of participants had inadequate,
and another third had problematic functional
HL; a third had inadequate and another third
had problematic comprehensive HL. Teacher
feedback suggested that activity-based modules
This was part of a mixed-methods international
Reproductive, Productive, and Community comparative study on the experiences of
Responsibilities: Shifting Patterns Among parenting in adversity across five countries. In
Migrant Mothers in the Thailand-Myanmar this analysis, 62 first-person qualitative
Border Region narratives that were shared by migrant mothers
were inductively analysed using the Qualitative
Lisa Wight, Queen's University; Nway Nway Oo, Child Protection Analysis Guide of Leuven (QUAGOL) method.
Unit at Mae Tao Clinic, Mae Sot, Thailand; Tee Tar Sway, Health
Information Systems Working Group, Mae Sot, Thailand;
Supaporn Trongsakul, School of Health Science, Mae Fah Luang Results/Impacts/Outcomes
University, Chiang Rai, Thailand; Eva Purkey, Department of The results highlight how migrant mothers
Family Medicine, Queen's University; Susan A Bartels,
Department of Emergency Medicine and Public Health Sciences; undertake significant reproductive
Heather M Aldersey, School of Rehabilitation Therapy, Queen's responsibilities, such as giving birth,
University; Colleen M Davison, Queen’s University Department of breastfeeding, and child-rearing, as well as
Public Health Sciences
productive responsibilities, including paid labour
in the agricultural, formal, and informal sectors.
Learning Objectives
Community responsibilities were less frequently
1. List the reproductive, productive, and
mentioned. Five overarching themes emerged:
community responsibilities undertaken by
the existence of many significant challenges for
female migrants living in situations of
migrant mothers in situations of protracted
protracted displacement in Mae Sot,
displacement, overlapping reproductive and
Thailand
productive responsibilities, mothers dispersing
2. Describe the challenges associated with
reproductive responsibilities amongst extended
assuming these responsibilities in
family members, mothers sharing reproductive
situations of protracted displacement and
and productive responsibilities with children,
the care strategies migrant mothers
and the complexity of mothers’ positions within
utilize to distribute their responsibilities
family networks in situations of protracted
amongst their children and extended
displacement.
family members within family networks
3. Understand how further research on
income-generating opportunities and
Income-generating opportunities and community
community activities specific to migrants
activities are needed that are able to be
living in the Thai-Myanmar border region
undertaken given these challenges. Further
could benefit migrant mothers
research directions specific to migrants living in
the Thai-Myanmar border region will be
discussed.
Conflicts between ethnic minorities in Myanmar
and the government and military have been
ongoing for the past fifty years. Enduring unrest
has caused thousands to flee to the region
around Mae Sot, a city on Thailand’s western
border. Women globally assume a combination
of reproductive, productive, and community
responsibilities, and during situations of armed
conflict and displacement, conditions for women
often worsen. This study sought to investigate
the parenting experiences of female migrants
from Myanmar living in situations of protracted
displacement in Mae Sot.
Session: P85, Submission Number: 1048507 asynchronous learning opportunities that deliver
practical tips to address communication
Prehospital Care for Refugee Families: Provider barriers. The lack of interpreters, unfamiliarity
Education Model for Trauma-Informed Care with trauma-informed care and absence of prior
training about the history and cultural of refugee
Sarah Cornell, Medical College of Wisconsin; Nathan Fleming, families creates an opportunity for high-impact.
Medical College of Wisconsin
Learning Objectives
Online learning modules designed to target bias
1. Participants will learn to how to assess
and increase provider cultural humility can be
awareness of refugee health needs among
effective tools to educate pre-hospital care
emergency medical teams.
providers. In cases where cultures are different,
2. Participants will understand the
miscommunication and misunderstandings may
advantages of human-centered design to
lead to patient harm. When providers do not
facilitate rapid development and
carefully traverse cultural obstacles, patients
implementation of focused educational
may not receive the full benefit of medical
content.
treatment. Co-developing educational
3. Participants will appreciate the
opportunities with refugees for prehospital
opportunities and limitations of delivering
providers will increase provider and community
trauma-informed care to refugee families
capacity for cultural responsiveness when
during a medical emergency.
interacting with migrant populations.
Pre-hospital care can be a life-saving service for
refugee families, but the experience of a
medical emergency after resettlement has the
potential to be re-traumatizing. Language
differences and cultural practices may present
barriers to the delivery of quality care. EMTs
benefit from education focused on health equity,
cultural humility, and trauma-informed care.
Methodology
A literature review and surveying local EMTs,
identified the need for cultural competency
training focused on refugee populations living in
Wisconsin. A human-centered approach was
used to tailor trauma-informed care best
practices to the pre-hospital setting. Feedback
was incorporated into a distance educational
module focused on reducing re-traumatization,
educating EMT about local refugee populations,
and modeling cultural humility during an
emergency situation.
The results of a needs assessment of EMTs
related to refugee awareness indicate a need for
education and tools to help reduce re-
traumatization. EMTs are open to online,
Session: P86, Submission Number: 1048560 two groups but trended toward lower mortality
rate for LEP patients.
Disparity in Length of Stay Between Limited
English Proficiency (LEP) Patients and English Conclusions/Discussion
Proficient Patients at a Single Medical The study revealed that LOS was significantly
Institution increased for LEP patients, but there were not
significant differences between other healthcare
Hannah Lee; Heri Lopez; Michael Shyne; Hope Pogemiller outcomes. Increased LOS raises concerns of
poor communication leading to delays in care
Learning Objectives that English proficient patients don’t
1. Learn best practices for working with an experience. Ensuring that providers follow best
interpreter practices of working with an interpreter and have
2. Understand disparities between Limited easy access to professionally trained interpreters
English Proficiency patients and English remain crucial in caring for our refugee LEP
proficient patients patient population.
3. Define areas of improvement for working
with Limited English Proficiency patients

It is well documented that Limited English
Proficiency (LEP) patients, including many
refugees, experience inequities in our healthcare
system. Interpreters play a crucial role in
mitigating disparities in healthcare outcomes.
We aimed to uncover an opportunity for
improvement at our hospital by comparing
healthcare outcomes for LEP patients who
worked with interpreters to English proficient
patients admitted to internal medicine.
Methodology
Retrospective chart data review obtained from
Regions Hospital from 2013-2019 was
analyzed. LEP patients were matched with
English proficient patients on age (+/- 5 years),
insurance type, gender, and APRDRG weight
(within 0.5). Descriptive statistics, logistic and
linear regressions were applied.
1139 LEP patients and English proficient pairs
were matched for a total N = 2278. LEP
patients had a longer length of stay (LOS) of
0.62 days compared to an English proficient
patient with a mean LOS of 5.93 days
(p=0.0171). The rates of ED visits and
readmissions within 30 days of discharge were
not significantly different (p=0.948 and
p=0.4896 respectively). Mortality rates were not
significantly different (p=0.0524) between the
Session: P87, Submission Number: 1048567 The motivations behind each decision were
analyzed using Bourdieu’s multiple forms of
Parental Decision Making Among Economic capital; economic, cultural, social and symbolic.
Migrants in the Thai-Myanmar Border Region: A
Qualitative Analysis Using Bourdieu’s Multiple Results/Impacts/Outcomes
Forms of Capital Six overarching themes focused on specific
decision-making emerged: parent leaving home
Katrina Streef, ; Sherri Dutton, ; Nway Nway Oo, Child for work while children live with other relatives,
Protection Unit at Mae Tao Clinic, Mae Sot, Thailand; Tee Tar
Sway, Health Information Systems Working Group, Mae Sot, parents asking children to leave school to work,
Thailand; Supaporn Trongsakul, School of Health Science, Mae parents sending child to Burmese schools
Fah Luang University, Chiang Rai, Thailand; Eva Purkey, instead of Thai schools, parents not letting their
Department of Family Medicine, Queen's University; Susan A
Bartels, Department of Emergency Medicine and Public Health children play with Thai children, parents
Sciences; Heather M Aldersey, School of Rehabilitation Therapy, discouraging sons from engaging in risky
Queen's University; Colleen M Davison, Queen’s University behaviour, and parents imposing heightened
Department of Public Health Sciences
protection over their daughters.
Learning Objectives
1. List six key parenting decisions made by
It was expected that parenting decisions made
economic migrant parents living in the
by economic migrants would primarily be driven
Thai-Myanmar border area.
by a desire to acquire more economical capital
2. Describe the motivation behind six key
for themselves, their family and their children,
parenting decisions using Bourdieu’s
but other types of capital were equally
multiple types of capital; economic,
important. Each decision related to Bourdieu
cultural, social and symbolic.
forms of capital in different ways. Further
3. Visualize the complexity of factors
research directions will be discussed.
involved in parental decision making
among migrants living in a situation of
protracted displacement in the Thai-
Myanmar border

Conflicts between ethnic minority groups in
Myanmar and the government and military have
been ongoing for the past fifty years. Enduring
unrest has caused thousands to flee to the
region around Mae Sot, a city on Thailand’s
western border. This study investigated
parenting decision-making among economic
migrants from Myanmar living in protracted
displacement in Mae Sot. This was part of a
mixed-methods international comparative study
on the experiences of parenting in adversity
across five countries.
Methodology
In this analysis, 69 first person qualitative
narratives shared by economic migrant parents
facing ‘a lot’ of or ‘extreme’ adversity were
inductively analyzed using the Qualitative
Analysis Guide of Leuven (QUAGOL) approach.
The authors, who work in clinics for adults with
Challenges Identifying and Providing Care for iDD and homeless shelters, report on 3 cases
Refugees with Intellectual or Developmental which address these challenges.
Disability (IDD)
Donna Lougheed, Faculty of Medicine University of Ottawa; Education of health care professionals
Paula Walsh-Bergin, Faculty of Medicine University of Ottawa;
Simon Hatcher, Faculty of Medicine University of Ottawa
Learning Objectives Without recognition of dual Diagnosis, and
1. Identify a group of refugees who are at supportive education and treatments, abuse,
high risk for mental illness. risk of family violence, hospitalization and
2. Identify and use the term 'dual diagnosis' homelessness in the country of resettlement
appropriately may be adverse outcomes for refugees with a
3. Understand the challenges that face dual diagnosis.
refugees with IDD which lead to
homelessness in the country of
settlement.

3% of the general population are estimated to
have an intellectual or developmental delay,
with cognitive and functional disabilities ranging
from mild to profound. They are at higher risk of
mental illness than the general population (1).
Literature on characteristics and needs of
refugees shows little attention to those with IDD
(2). Refugees with IDD likely accompany family
members, and are easily recognized if there is
severe or profound impairment, but not if mild
or moderate.Presentation of mental illness in
those with IDD (called Dual Diagnosis in
Canada) may be atypical due to developmental
factors (1) - sometimes identified as mental age
equivalent (MA). Living in a war zone with
instability in family and social life, the
uncertainty of life in a refugee camp with risk of
physical and sexual abuse, and relocation to a
new culture may result in mental health
problems (3, 4, 5). On relocation, challenges for
the adult with IDD and caretaking family
members such as adapting to a new culture,
coping with stigma around the dual diagnosis,
and accessing services that even helping
professionals may not know exist, can result in
worsening of symptoms.
95% (20/21) of Afghan women enrolled
Group Prenatal Care for Afghan Refugee Women received ≥ 9 prenatal visits, which is defined as
adequate per WHO Healthy People 2020. Using
Lauren Marcell; Amber Maratas; Shoshana Aleinikoff the CP definition of success (four completed
visits), there was 100% attendance. 95%
Learning Objectives (20/21) of women delivered at term. One infant
1. Upon completion, participant will be able was born preterm with a low birth weight. 100%
to understand the feasibility of group of participants “liked receiving prenatal care in
prenatal care as a model to address group sessions” and “felt prepared for labor.”
maternal and neonatal outcomes for There were 100% breastfeeding initiation rates
refugee communities in the US. postpartum.
to reflect on the benefits of group Conclusions/Discussion
prenatal care to address healthcare Group prenatal care is a feasible model to
disparities amongst pregnant refugee address prenatal and neonatal health outcomes,
communities in the US. as well socio-cultural barriers to care for Afghan
3. Upon completion, participant will be able refugee women in the US.
to define Centering Pregnancy as a model
of group prenatal care that can be
adapted for refugee communities in the
US.

There are approximately 2.9 million Afghan
refugees globally, with an estimated 50,000 of
whom have resettled in the United States as of
2016. Refugee status is associated with delayed
initiation of prenatal care and fewer prenatal
visits, contributing to disparities in maternal and
fetal health outcomes. The aim of our study is to
describe the feasibility and experience of
Centering Pregnancy (CP), a group prenatal care
model, for pregnant refugee women from
Afghanistan, and provide descriptive maternal
and neonatal outcome data.
Methodology
This retrospective cohort and qualitative analysis
uses pregnancy outcome data extracted from
EHR and post-participation surveys for
participants in two CP groups conducted in
2018 – 2019 (n=21) at a FQHC (HealthPoint,
Des Moines, Washington). Given limitations of
our family medicine community-based obstetrics
model, high risk patients were excluded. We
received approval from The Wright Center for
Graduate Medical Education IRB for our
retrospective analysis with waiver of consent.
Session: P90, Submission Number: 1048630
Seeking Asylum in the United States: A Preliminary results suggest high rates of gender-
Retrospective Qualitative Case Review based violence, family-based violence, and
violence inflicted by government sanctioned
Jennifer McQuaid, PhD, Yale Center for Asylum Medicine, Yale groups. Of particular interest are the high rates
School of Medicine; Michelle Silva, PsyD, Department of
Psychiatry, Yale School of Medicine; Kaiz Esmail; Kiara Tan, of interpersonal losses resulting from the
Williams College; Gigi Gamez, Williams College; Katherine incident of persecution: ostracism, forced
McKenzie, MD, Yale University School of Medicine; Mayali separation from children, and loss of
Hartman
professional and economic status. Participants
report an overwhelming burden of clinically
Learning Objectives
significant mental health outcomes.
1. Identify common experiences of
persecution and violence among asylum
seekers in the United States.
A comprehensive assessment of asylum-seekers’
2. Recognize variations in the manifestation
experiences pre, peri and post-migration is
of trauma among asylum-seekers.
critical. The understanding gained through this
3. Understand the value of community-
case review will aid those working with asylum
based resources and collaborations to
seekers to conduct culturally informed
meet the multiple needs of asylum
evaluations, interventions and referrals with this
seekers.
unique population.
Individuals seeking asylum in the United States
flee violence and persecution in their countries
of origin. The physical and sexual persecution
experienced is associated with PTSD,
depression, and insomnia, as well as symptoms
of grief and loss. Mental health professionals
provide evaluations of psychological sequellae to
document human rights abuses and the long-
term psychological consequences of persecution
and torture.
Methodology
The present study includes a retrospective
qualitative chart review of the de-identified
personal declarations and forensic psychological
evaluations of 25 adult asylum seekers seen at
the Yale Center for Asylum Medicine between
2017 and 2021. Using a Grounded Theory
approach, 5 independent coders used a series of
open and axial coding techniques to identify
themes behind asylum seeking and associated
experiences of psychological distress as reported
in the chart review. We sought to understand the
types of trauma and associated stressors pre and
peri-migration and indicators of mental health
and well-being among this group of asylum
seekers.
Session: P91, Submission Number: 1050223 57% of patients had a vaginal delivery, 37% of
patients underwent a C-section (55% emergent),
Single-centre Retrospective Cohort Study of Risk and 6% had a vacuum delivery. 5.6% of
Factors for Adverse Pregnancy Outcomes in deliveries were preterm and 8.2% of infants
Refugees in Toronto were admitted to the NICU. Bivariate analysis
suggested that maternal age was significantly
Lauren Clarfield; Darby Little; Anton Svendrovski; Leanne De associated with C-section (p=0.005) and
Souza; Mark Yudin
preterm delivery (p=0.048), greater gestational
age at first prenatal visit was associated with
Learning Objectives
large for gestational age infant (p=0.043), and
low pre-pregnancy BMI was associated with low
to describe the demographic, refugee-
birth weight (p=0.033) and NICU admission
related, and pregnancy related
(p=0.038).
characteristics amongst a diverse
pregnant refugee population in Toronto
Efforts are needed to expand psychosocial
to quantify and discuss adverse perinatal
support services, language-inclusive care, and
maternal and fetal outcomes among
increased access to first-trimester antenatal care
refugee patients in years 2013 to 2019
for pregnant refugees.
to identify areas for future research and
quality improvement

Pregnant refugees may be at increased risk for
poor obstetrical outcomes, however data
describing refugee-related risk factors and the
inherent heterogeneity of the refugee population
in Canada is lacking.
Methodology
Retrospective cohort study of all obstetrical
refugee patients covered under the Interim
Federal Health Program admitted to a tertiary
care hospital in Toronto, Ontario between
January 2013 and January 2019.
A total of 196 patients were included, with a
mean (standard deviation) age of 30.9 (5.5) and
pre-pregnancy BMI of 25.0 (4.8). Most patients
were from Sub-Saharan Africa (57%), East Asia
and the Pacific (16%), and Latin America and
the Caribbean (8%). From the Ontario Perinatal
Record, 57% of patients were identified to have
poor social support, 42% lived in a shelter, and
16% experienced family violence. The majority
of women (87%) had their first antenatal
appointment during their second or third
trimester. 48% of patients spoke fluent English.
To provide culturally acceptable patient-centred
Health Peculiarities of Refugee and New care we must understand the peculiarities of the
Immigrant Sub-Saharan African Women in patient population we serve; review the
Canada immigration policies that keep families apart,
fast-track relicensing for health professionals
Peter Emelike; Ekene John that are refugees and asylum claimants, early
mental health assessments and more inclusion
Learning Objectives of refugee and immigrant health modules in the
1. List the health peculiarities of refugee training curriculum of health professionals.
women from sub-Saharan African in
Canada
2. List recommendations that could improve
the health challenges of refugee women
from sub-Saharan Africa.
3. Understand the importance of culturally
patient-centred communication

Africa has been plagued by prolonged ethnic
and religious wars, civil wars, criminality and
widespread violence and as a result, a good
majority of the refugees in North America come
from African countries. This has led to a marked
diversity in the patient population in countries
like Canada. It is therefore important for
Physicians and health professionals to be aware
of the common health issues peculiar to these
women.
Methodology
A search was conducted for articles in English
with no methodological restriction that had the
keywords refugee, Africa, women, health,
surgery and Canada on PubMed and Google
scholar electronic databases. The date range
was from 2010 to 2021.
The main health peculiarities of refugee women
from sub-Saharan Africa were in the areas of
maternity and obstetric care, issues around
female genital circumcision, reduced
compliance with screening for cervical cancer
and breast cancer, poor mental health and low
socioeconomic status.
Session: P93, Submission Number: 1051771 by participants, evaluation consultants, and
folks working within the settlement sector.
Evaluating the Utility of Mixed-methods
Curriculum Model to Engage ACB, Women, Results/Impacts/Outcomes
LGBTQ+, and Substance User Newcomers in a Preliminary findings show increased capacity
Photovoice Project among newcomers. Newcomers reported that the
curriculum topics were relevant to their
Yoshith Perera; Kaminda Musumbulwa; Ruchit Shah migration experience and general satisfaction
with project was high. Opportunities to engage
Learning Objectives with facilitators and other newcomers during
1. Identify unique social determinants of project sessions was regarded highly.
health that impacted newcomer
communities in Peel region. Conclusions/Discussion
2. Explore the impact of co-occurring Ongoing feedback from participants continue to
epidemics (syndemics) on the health of inform the development of our capacity building
newcomers with intersectional identities modalities.
(those who identify as queer, trans,
racialized, substance users etc.)
3. List strategies that support a syndemics
approach to curriculum development.

Newcomers to Canada experience challenges
related to immigration status, income,
employment, health and accessing health care,
education, race, gender, and support networks.
The interactions between these social
determinants of health and lived experiences
(those living with a chronic illness such as
HIV/AIDS, those who identify as LGBTQ+,
African, Caribbean or Black, substance users,
and trans and cis women) suggest the need for a
syndemics approach to educational curriculum
development.
Methodology
For this newcomer Photovoice project, Moyo
HCS created an 8-week curriculum aimed at
providing education and support for newcomers
residing in Peel by granting them the
opportunity to share their experiences of
settlement through photography. The project
gave access to settlement services in the region
and integrated activities to help build local
social networks. The curriculum used both
subject-based and experience-based approaches
covering topics on nutrition (Canada’s food
guide, food security), impacts of racism,
employment and mental health. Curricula was
developed using an iterative process, informed
Session: P94, Submission Number: 1051954 and how to respond to psychological concerns,
3. financial support needed for long-term aid
Challenges Faced by Humanitarian Aid Workers workers, and 4. ethical dilemmas. Barriers to
Providing Support to Asylum Seekers and meaningful work included: 1. difficulty gaining
Refugees in Greece trust, 2. futility and limitations, 3. language
barriers and challenges with interpreters, 4.
Natalie Colaneri, Northwestern Feinberg School of Medicine; difficulty assisting people with multiple,
Essam Daod, Humanity Crew; Jess Ghannam, UCSF School of
Medicine; Hrayr Attarian, Northwestern Feinberg School of complex needs, 5. difficulty identifying needs of
Medicine; Shannon Galvin, Northwestern Feinberg School of refugees, and 6. limited resources.
Medicine
Learning Objectives This study shows the many complex challenges
1. Identify three systemic challenges facing facing aid workers, and highlights the need for
aid workers in Greece systemic changes, increased training and
2. Describe two ways in which aid workers in support for aid workers, and more attention
Greece need more support toward improving the situation in Greece.
3. List three challenges faced by aid workers
in providing meaningful support to
refugees

Greece is facing a continued humanitarian
crisis. More than 50,000 asylum seekers and
refugees currently reside in Greece, and aid
workers work in an increasingly complex system.
This qualitative study explores challenges faced
by humanitarian aid workers in Greece.
Methodology
The study involved semi-structured interviews
with 28 international aid workers. Responses to
the question “What challenges do aid workers
face in providing support to refugees?” were
analyzed using thematic analysis.
Three major themes included: systemic
challenges, lack of support and training for aid
workers, and barriers to conducting meaningful
work. Systemic challenges included: 1. lack of
coordination and cooperation among NGOs, 2.
instability of NGOs and frequent turnover of aid
workers, 3. changing laws/policies, 4. increased
regulations, 5. lack of consistent, specific
pathways for assistance, and 6. conflict with the
Greek state. Respondents noted a lack of
support and training for aid workers including:
1. a need for psychological support for aid
workers with concerns of secondary
traumatization, 2. a need for training on culture
Among 129 eligible patients, 86 (66.7%) were
Factors Associated with Missed Appointments diagnosed with LTBI and 24 (26.4%) failed to
and Incomplete Therapy in Pediatric Latent complete therapy. 83 (20.6%) of the 402
Tuberculosis Patients appointments scheduled were missed.
Significantly higher rates of missed
Nirali Butala; Angela Zhao; Thomas Murray; Richard Feinn appointments and incomplete therapy were seen
in non-English and non-Spanish speakers
Learning Objectives (p=0.013, p=0.031) and patients who lived
1. Upon completion, participant will be able within 5 miles of the clinic (p=0.026,
to identify factors associated with missed p=0.029). Self-referred patients or those
appointments in pediatric patients with referred from an immigration office or school
LTBI. clinic as opposed to a pediatric office were more
2. Upon completion, participant will be able likely to miss appointments (p=0.086). More
to identify factors associated with missed appointments was associated with failure
incomplete therapy in pediatric patients to complete treatment.
with LTBI.
to recommend interventions that improve Language and lack of a primary provider are
appointment attendance and LTBI main contributors to missed LTBI appointments
treatment adherence. and poor treatment adherence. Interventions
that improve communication with non-English
Background and Purpose/Rationale and non-Spanish speakers and patients not
Pediatric patients in the U.S. with latent referred by a primary care provider are currently
tuberculosis infection (LTBI) often fail to planned to improve appointment attendance.
complete therapy and are at risk of disease
reactivation and spread later in life. TB studies
often address barriers to treatment completion,
but rarely review factors associated with missed
appointments. The aim of this study was to
identify factors associated with higher rates of
missed appointments and incomplete therapy
for pediatric LTBI patients.
Methodology
We performed a retrospective chart review of
pediatric patients referred to Yale Pediatric
Winchester Tuberculosis Clinic from 2016-2019
with primary outcome measures of missed
appointments and LTBI therapy completion.
Associations between demographic and clinical
variables with missed appointments and therapy
completion were analyzed using generalized
estimating equations and bivariate chi-square
tests.
Session: P96, Submission Number: 1052653 COVID tests were distributed to farms and 196
samples have been processed resulting in the
Protecting Immigrant Dairy Workers from COVID early identification of 10 cases of COVID. The
by Partnering an Academic Medical Center with continued contact within the agriculture
Rural Agriculture Educators and Local Health community regarding COVID and workforce
Departments protection has resulted in successful on-farm
vaccination drives. For example, one county
Katheryn Wood; Patrick Ames; Jolene Munger; Nathaniel vaccinated 164 farmworkers across 14 farms in
Meuser-Herr
a well coordinated mobile effort spanning only 2
days.
Learning Objectives
1. List preferred means and characteristics
of communication when responding to
Trusted community relationships with direct
the COVID pandemic on the agriculture
communication proved to be both valued and
workplace.
successful as public health needs evolved.
2. Describe barriers to COVID testing among
Innovation at an academic medical center in
agriculture workers.
COVID testing was made accessible to a
3. Identify potential community partners in
vulnerable population.
responding to public health threats.

SUNY Upstate, Cornell Cooperative Extension,
and 3 local health departments in Northern New
York partnered to bring COVID education,
supplies, and self-collected saliva COVID testing
to large dairy farms to help sustain a safe
workplace during the pandemic for valued and
vulnerable immigrant farmworkers.
Methodology
A concise project narrative was delivered directly
to farms from their known farm educator.
Supplies, educational content, and testing
available were clearly outlined along with
standards of health information protection.
Grant funding was secured for direct purchase of
both preventative equipment and testing
supplies. A surveillance agreement was
established with the local health departments
allowing for COVID tests to be distributed
universally to participating farms and later
directly mailed to the lab as needed. This
removed conventional testing access barriers.
44 farms were directly contacted. 33 (75%)
participated with a total workforce of 979
workers. 2,237 reusable cloth masks were
distributed. 6 education sessions were provided
in english and spanish. 1,165 self-collect saliva
Session: P97, Submission Number: 1052516 (74/253) of nurses had ever completed a patient
admission with an interpreter, 17.8% (45/253)
Nursing Across Languages: The Experience of had ever attended a ward round with an
Nurses Working with Interpreters in a Paediatric interpreter, and 7.4% (18/243) reported
Hospital Setting interpreter assistance for daily nursing care most
of the time. Onsite and telephone interpreting
Katrina Sangster; Karen Kiang; Fiona Newall; Tony, Stratford; were the primary forms utilised. Informal
Sharon Smith; Catherine Matthews; Georgia Paxton
interpreting was commonly engaged by nurses
(49.2%, 125/254). Although 59.0% (148/251)
Learning Objectives
of nurses reported no prior training in
communicating with interpreters, most nurses
able to describe the general experience of
(81.6%, 199/244) felt confident and supported
nurses caring for LOTE-I background
(73.3%, 184/251) in working with interpreters.
patients in a paediatric hospital setting.
Themes arising from commentary included:
accessibility/availability, lack of interpreting for
able to list the five themes arising from
daily nursing care, and workflow issues.
nursing commentary relating to the
experience of caring for LOTE-I
background patients and families in a
Findings suggest substantial challenges for
paediatric hospital setting.
nurses in caring and communicating with LOTE-
I patients. Recommendations include training,
able to list some key recommendations
embedding assessment of language needs
that may improve access to language
during care planning, and incorporation of
assistance for LOTE-I background
interpreter assistance into daily nursing care.
patients in a hospital setting.

To examine the experience of nurses caring for
patients and families with a language other than
English background who require an interpreter
(LOTE-I) in a tertiary paediatric hospital.
Methodology
An electronic survey of all nursing staff in
September 2018 at the Royal Children's
Hospital, Melbourne, Australia. Data collated
and analysed in REDCap, and nursing comments
thematically analysed.
295 nurses responded, predominantly from
inpatient areas (85.1%, 251/295). Overall,
31.5% (92/292) of nurses were born overseas
and 24.0% (70/292) identified as having
additional language/s to English.Nurses reported
infrequent access to interpreters when caring for
LOTE-I patients. When describing cumulative
experience, only 31.8% (68/214) of nurses
reported that their LOTE-I patients had access
to interpreters most or all of the time. 29.2%
Session: P100, Submission Number: 1024395 ECP appointment than non-refugees (p=0.016).
The time from diagnosis to referral was
Eye-care Utilization Among Newfoundland and significantly longer for refugees than non-
Labrador’s Diabetic Refugee Population: A Pilot refugees (p=0.0498). A trend towards a longer
Study time from referral to appointment attendance for
refugees than non-refugees was noted
Stuti Tanya; Bonnie He; Christine Aubrey-Bassler, Memorial (p=0.9069).
University
Learning Objectives
Our findings are aligned with studies from
Canadian refugee-focused clinics, which show
able to recognize variations in measures
higher rates of health services utilization within
of eye-care utilization among refugees
primary care. However, the longer time to access
and non-refugees in Newfoundland and
vision care among refugees suggests the
Labrador.
presence of barriers to accessibility; specialist
care is also known to be more challenging to
an understanding of the pathway to
access for vulnerable populations. Future
diabetic vision screening among resettled
studies should better characterize dynamics of
refugees in Newfoundland and Labrador.
eye-care utilization among a larger refugee
cohort.
an understanding of future directions for
research in this domain.

Diabetic retinopathy (DR) is a leading and
preventable cause of blindness. DR screening
lies at the intersection of many documented
challenges in access to care for refugees.
Additionally, vision screening is determined to
be an important health need and a critical locus
for underutilization of health services among
refugees resettling in Canada. Our objective was
to identify patterns of eye-care utilization among
refugee and non-refugee patients with type 2
diabetes mellitus (T2DM) in Newfoundland and
Labrador (NL).
Methodology
We conducted a retrospective comparative
cohort study at the Memorial University Family
Medicine clinic, which includes a dedicated
refugee clinic. All patients with a new T2DM
diagnosis between 2015-2020 were included.
This study received full ethics approval.
73 (18 refugee, 55 non-refugee) patients were
included. Refugees had a significantly higher
rate of referral to an eye-care provider (ECP)
(p=0.0475) and were more likely to attend their
Session: P101, Submission Number: 1051771 by participants, evaluation consultants, and
folks working within the settlement sector.
Evaluating the Utility of Mixed-methods
Curriculum Model to Engage ACB, Women, Results/Impacts/Outcomes
LGBTQ+, and Substance User Newcomers in a Preliminary findings show increased capacity
Photovoice Project among newcomers. Newcomers reported that the
curriculum topics were relevant to their
Yoshith Perera; Kaminda Musumbulwa; Ruchit Shah migration experience and general satisfaction
with project was high. Opportunities to engage
Learning Objectives with facilitators and other newcomers during
1. Identify unique social determinants of project sessions was regarded highly.
health that impacted newcomer
communities in Peel region. Conclusions/Discussion
2. Explore the impact of co-occurring Ongoing feedback from participants continue to
epidemics (syndemics) on the health of inform the development of our capacity building
newcomers with intersectional identities modalities.
(those who identify as queer, trans,
racialized, substance users etc.)
3. List strategies that support a syndemics
approach to curriculum development.

Newcomers to Canada experience challenges
related to immigration status, income,
employment, health and accessing health care,
education, race, gender, and support networks.
The interactions between these social
determinants of health and lived experiences
(those living with a chronic illness such as
HIV/AIDS, those who identify as LGBTQ+,
African, Caribbean or Black, substance users,
and trans and cis women) suggest the need for a
syndemics approach to educational curriculum
development.
Methodology
For this newcomer Photovoice project, Moyo
HCS created an 8-week curriculum aimed at
providing education and support for newcomers
residing in Peel by granting them the
opportunity to share their experiences of
settlement through photography. The project
gave access to settlement services in the region
and integrated activities to help build local
social networks. The curriculum used both
subject-based and experience-based approaches
covering topics on nutrition (Canada’s food
guide, food security), impacts of racism,
employment and mental health. Curricula was
developed using an iterative process, informed
Session: P102, Submission Number: MP2101 availability for immigrant, refugee and asylee
communities within Philadelphia.
The African Cultural Alliance of North American:
the value of local efforts in promoting equitable
vaccine access
Fatima Rizvi, Anshel Kenkare, Lauren Posego, Nahyun Kang,

Eugene Mensah, Nanette Johnson
Summary
The coronavirus disease (COVID-19) pandemic

has magnified the health disparities asylee,
refugee, and migrants experience. Studies
suggest that refugee and immigrant
communities specifically have higher incidence
and death rates from COVID-19. Although
current vaccination rates of immigrant and
refugee communities within the United States
are not readily available, previous trends and
evidence of low vaccination rates within other
historically marginalized communities suggest
that there is most likely a vaccination gap. The
African Cultural Alliance of North American
(ACANA) serves African refugee, asylee, and
immigrant communities throughout the
continent, working to bridge gaps and provide
access to healthcare and social resources. On
June 3rd 2021, the ACANA Philadelphia branch
hosted a vaccination clinic of which 58
members of the community were given the
Pfizer vaccine. Of this population, 42 responded
to a survey addressing their motivations for
getting vaccinated, as well as factors that
prevented them from previously getting
vaccinated. 47.5% reported accessibility as an
issue and 20% reported hesitancy as a concern.
The compiled data highly suggests that reduced
availability of and accessibility to the vaccine
was a significant driving factor in not being able
to get vaccinated for members of the community
served by ACANA. Furthermore, using the
logistic regression model, trends in the data
provide evidence that availability of vaccination
centers closer to underserved communities,
increase the likelihood of vaccination. In
conclusion, to confront the disparities
exacerbated by this pandemic there is a
significant need for increased vaccination
Session: P103, Submission Number: MP2102
Social Determinants of Health Screener for

Human Rights Asylum Clinic
Odette Zero, BA, MD-ScM ‘22; Alizeh Shamshad, BS, MD ‘24;

Liana Lum, BA, MD ‘24; Elizabeth Toll, MD Warren Alpert
Medical School of Brown University, Providence, Rhode Island;
Departments of Pediatrics and Medicine
Learning Objectives
Present a novel pilot intervention for addressing
the social determinants of health for non-citizen
immigrants seeking legal status in the U.S.

The Brown Human Rights Asylum Clinic (BHRAC)
conducts pro-bono medical and psychological
evaluations and writes affidavits for immigrants
seeking legal status in the U.S. Non- U.S citizens
are prohibited from most federally funded benefits
related to education, housing, food, employment,
healthcare, and financial assistance. Furthemore,
factors related to language, lack of knowledge,
discrimination, and fear of legal ramifications
prevent immigrants from accessing the limited
services and resources available.
Methodology
We created a Social Determinants of Health (SDoH)
screener and intervention program to identify and
address resource needs of non-citizen clients. After
the medical evaluation, clients receive a resource
brochure and support from a Community Resource
Navigator.
Between May 2020 and July 2021, 61% of clients
were screened and of those, 58% were contacted by
a Community Resources Navigator. The most
common needs were for mental health services and
health insurance.
This pilot intervention addresses the social
determinants of health for a population that has
limited access to resources and support. We aim to
improve our intervention by expanding our list of
resources, quantifying utilization of offered
resources, and improving communication strategies
Treatment of Intestinal Protozoa in Pregnancy: A

Systematic Review of Maternal, Fetal and Infant
Outcomes.
Poster details not available at time of

publishing.
An Update on the Role of Imaging in the Care of
Patients with Genitourinary Treatment of Schistosomiasis in Pregnancy: A
Systematic Review of Maternal Outcomes
publishing.
publishing.
Schistosomiasis: A Systematic Review Session: P112, Submission Number: MP2111
Poster details not available at time of Validation of a Multiplex real-time PCR

publishing. Gastrointestinal Parasite Panel
Session: P107, Submission Number: MP2106 Poster details not available at time of
publishing.
Accuracy of Diagnostics in New World
Tegumentary Leishmaniasis: A Systematic
Review Session: P113, Submission Number: MP2112
Validation of a multiplex real-time PCR

Poster details not available at time of gastrointestinal helminth panel
publishing.

Session: P108, Submission Number: MP2107 publishing.

publishing. Session: P114, Submission Number: MP2113
Session: P109, Submission Number: MP2108 Epidemiological Update on Fever in Returning

Travelers to Ontario
An Update on the Role of Imaging in the Care of
Patients with Schistosomiasis
Poster details not available at time of publishing.
publishing.
‘Rapid Assessment of Febrile Travelers’ (RAFT)
Treatment of Schistosomiasis in Pregnancy: A Programme
Systematic Review of Fetal and Infant Outcomes
Poster details not available at time of Poster details not available at time of
publishing. publishing.
Session: P116, Submission Number: MP2115 had been receiving LPG. In-depth interviews and
focus-group discussions with refugees and
Large-scale distribution of LPG in a refugee implementers explored the experience of fuel
camp improves child and maternal health and collection, effective distribution strategies, and
well-being opportunities to improve program
implementation.
Laura Kwong, University of California, Berkeley; Chris LeBoa,
University of California, Berkeley; Nuhu Amin, International
Centre for Diarrheal Disease Research, Bangladesh; Mahbub
Rahman, International Centre for Diarrheal Disease Research, Results/Impacts/Outcomes
Bangladesh; Steve Luby, Stanford University School of Medicine Receipt of free LPG resulted in exclusive use
when LPG was available. Families receiving LPG
Learning Objectives experienced reductions in airborne particulate
1. We evaluated the human and matter PM2.5 to below WHO-recommended
environmental costs and benefits of levels, a 15% increase in expenditure on food,
distributing liquid propane gas for reduced harassment, and a reduction in the
household cooking to 1 million prevalence of suicidal thoughts and burning of
households in the Rohingya refugee camp plastic as a cooking fuel. Time previously spent
gathering firewood or cooking was reallocated to
Background and Purpose/Rationale education, childcare, employment, or rest. 100
Humanitarian organizations typically provide % of households received training and 81% of
refugees with shelter and food, but not cooking households had a safety visit following stove
fuel. To cook, many refugees harvest firewood, distribution. Over half of households said they
resulting in deforestation, indoor and ambient would pay $5.80 for a 12.5 kg LPG tank
air pollution, loss of animal habitat, and conflict (approximately the cost of LPG production). Re-
with host communities. UNHCR and IOM began sale of LPG tanks was minor due to the unique
distributing liquid propane gas (LPG) to all nature of the aid -- tanks had to be brought back
200,000+ households in the Rohingya refugee to the distribution center to be refilled. LPG
camp following the loss of nearby firewood distribution continued throughout the COVID-19
supplies and pressure from the Bangladeshi pandemic, allowing for a more thorough
government to reduce the impact of the refugee lockdown of the camp because refugees did not
crises on that country’s natural resources. need to leave the camp to harvest firewood.
Deforestation returned to levels experienced
Methodology prior to the influx of refugees.
We used sensors and households surveys to
assess stove usage, indoor air pollution, self- Conclusions/Discussion
reported respiratory symptoms, food security, Large-scale, multi-year distribution of LPG is
expenditures, harassment and violence, mental feasible and can improve refugee health and
health, deforestation, and costs though a well-being. Distribution of LPG as part of a basic
difference-in-difference study among households humanitarian response package could reduce
that, at baseline, were about to begin receiving exposure to harmful particulate matter, prevent
LPG (n = 600) or had been receiving LPG for at large-scale deforestation and associated impacts
least 12 months (n = 600). Endline was on animal habitat and climate change, and
conducted 12 months later, when all households reduce refugee-host tensions.
Sponsors
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Access Alliance
Multicultural Health and Community Services
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Sept 9-11, 2021

Welcome Letter from Conference Chair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Aniyizhai Annamalai MD Jose Debes, MD

Nina Marano DVM MPH Dipl ACVPM

Paul Spiegel MD MPH

Mike Woodman MD MPH DTM&H

European Union for Medical Specialists (EUMS) ECMEC® Credit

0900 Opening remarks Anna Banerji Anna Banerji

1040 Health Break

1055 Concurrent Workshops - Session 1 Presenters Stream Submission# Moderator

W1 Improving opportunities for Health Gayathri Kumar

W2 Clinician Advocacy to Support Refugees, Katherine

W3 Gender Based Violence During Rahel

W4 Talking about Stress: Mental Health Kate Yun Mental

W5 Canada’s Refugee Health Clinics Amidst Gabriel

W6 Addressing the impact of family loss and Huda El-Zein

W7 Splenomegaly in refugees: Etiology, William Infectious Hassan

W8 COVID-19 Response Perspectives of Elizabeth

W9 Advancing the centers of excellence in Emily Jentes

W10 Strategies for Publishing Your Work in Paul Geltman Paul

1155 Lunch visit the poster & exhibit halls

Refugee and Immigrant Patients (I-Care) Vatanparast

Syrian Refugees in Lebanon

O6 Coordinating IOM Resettlement Activities in the Context of Alexander 1043238

O7 SARS-CoV-2 Pandemic Information and Healthcare Disparities Steven Repas 1043344

O9 Suicide Prevention Subgroup of Cox’s Bazar: A coordinated Ariel Zarate 1048562

response approach to community-centered suicide prevention in

O10 Explaining Variation in Refugees’ Post-Traumatic Stress and Shannon 1046867

O11 Survivors of Daesh: Characterization of Health Conditions Nour Hassan 1048297

O13 Reproductive Health of US-Resident Women from Countries Lillian 1043754

Minority Asylum Seekers Loo

Sensitive VR Educational Platform to Improve Vaccine Streuli

O20 Perceived Barriers and Facilitators of COVID-19 Vaccination of Elizabeth 1041845

O24 Exploring and Addressing the Healthcare Challenges of Patricia Li 1048481

0225 Health Break

0245 Concurrent Workshops - Session 2 Presenters Stream Submission# Moderator

W18 Publishing Workshop Paul Geltman Education Paul Geltman

Plenary Session 2 Presenters Moderators

0445 Closing remarks day 1 Anna Banerji

0450 End of Day

0450 Society’s Research Committe Meeting

0700 A new Twin Cities PBS documentary: Trusted Messenger

Program Friday, September 10, 2021

0900 Opening remarks Anna Banerji Anna Banerji

Keynote Address: The impact of COVID-19 on refugees: a Global Mike

Keynote Address: Pregnant Mothers and Powerless Children: Outdated Marsha

1040 Health Break

1055 Concurrent Workshops - Session 3 Presenters Streams Submission # Moderators

W25 Recommended Travel Vaccinations in Aisha Khatab Travel MW2107 Patricia

1155 Lunch visit the poster & exhibit halls

0100 Concurrent Keynotes Presenters Moderator

3. Tuberculosis James Mahli Brindamour

0200 Oral Abstracts - Session 2 Presenters Submission # Moderators

Primary Care: The NYC Care Outreach Model

Experiences and Perspectives of Community Health Workers

O32 A Collaboration to Harmonize COVID-19 Health Messaging Megan 1041428

O35 Navigating Barriers to Access Higher Education: Academic Zachary 1044139

O39 Development of a Story Map as a Clinical Decision-Making Laura Smock 1037796

O47 Evaluation of a Newcomer Navigator Program for Newly-arrived Patricia Li 1048550

Prescription Drugs in Ontario Antonipillai Vatanparast

0300 Health Break

0315 Concurrent Workshops - Session 4 Presenters Streams Submission # Moderators

W32 Fever in new refugees Andrea Refugee MW2106 Paul

0415 Health Break