PA Refugee Health Program Overview

Transcription

1 PA Refugee Health Program Overview Asresu Misikir, Dr.PH., MPH Epidemiologist & RHP COO Division of Infectious Disease Bureau of Epidemiology PA Department of Health September 21, 2011

2 PA Refugee Health Program 1. Introduction, Goals & Priorities 2. Key Partners 3. Source of Arrival Notifications 4. Flow of Information 5. Statistical Information

3 PA Refugee Health Program Goals Prevent communicable disease among, and resulting from, the arrival of new refugees by providing comprehensive health risk assessment, treatment, and referral Eliminate health-related barriers to successful resettlement and protect the health of the Commonwealth population. PA RHP, AM_2011

4 PA RHP PROGRAM PRIORITIES/TASKS Coordination of care Training and Health Education Collaborations Provide Technical Supports Site Review Identify of Potential health risks Public Awareness Documentations & Produce Reports

5 PROGRAM KEY PARTNERS PA Department of Public Welfare (DPW) Local VOLAGs and Community-Based Organizations State/Local School Districts Private Health Care Providers/Clinics

6 Data/information Source: Obtain Notifications Refugee Arrival from CDC, Division of Global Migration and Quarantine Services (DGMQS) daily. Office of Refugee Resettlement (ORR) Bureau of Population, Refugee, and Migrants (PRM) PA RHP_AM, 2011

7 ALGORTHIUM OF PA REFUGEE NOTIFICATIONS Refugee enters US Through CDC/Quarantine stations CDC notifies through EDN system PA DOH, IDE Refugee Health Program: Identify priority conditions; document notifications; comply & analysis data, report PA TB control Program (Class B1 & B2 cases) DPW, Refugee Resettlement Program Local Health Providers/Clinics: Initiate comprehensive health assessment and report to PA DOH, RHP State Health Centers - Initiate re-evaluation TB conditions (B1/ B2), Screening, STD, HIV, and Lead Testing, Treatment and referral VOLAGs/Community-Based Org.: initiate contact with SHC And LHP to schedule health Screening for all refugees

8 Who are served under Refugee Health Program? Refugees Asylees Cuban/Haitian Entrants Amerasians Victims of Human Trafficking Unaccompanied Alien Children Survivors of Torture PA RHP AM_2011

9 Primary Refugees - Foreign-born persons who arrive directly from overseas to resettle in PA Secondary Refugees Refugees who initially settled in any State in the USA, but have moved to another State

10 Methods of Implementation: Developed refugee Surveillance Form Used Participating Providers Agreement (PPA) Provide RHA protocol to Health Care Providers who signed PPA

11 PA Refugee Health Assessment Form Pennsylvania Department of Health Refugee Health Assessment Form FAX COMPLETED FORM TO THE PADOH AT (717) ATTN: REFUGEE HEALTH COORDINATOR

12 Refugee Health Assessment (RHA) Primary Components: Medical history and physical exam Immunization (children and adult) Tuberculosis (TB) Screening Sexually Transmitted Infection (STI)/HIV Screening Hepatitis B Screening Intestinal Parasite Screening Malaria Screening Childhood Blood lead Test Chronic diseases referral

13 Refugee Health Screening Protocol Model Use Three - visit model*: 1 st visit Pre-screening nurse visit 2 ND visit 3 rd Visit» Provider visit when labs / chest x-ray results are available» Complete physical exam; lab. & chest ray results

14 First Pre-Screening - Nurse Visit * Medical histories on all arrivals Check for documentation of pre-departure treatment of malaria and parasitic infection Screen for acute medical or social issues Plot children on growth charts Collect urinalysis Urine pregnancy test (females 13-45) Give stool containers with direction for collection or check absolute eosinophil count (per national guidelines) Administer Tuberculin Skin Test (TST) or draw QuantiFERON Obtain Labs: CBC, HBsAg, HBsAB, comprehensive panel, RPR (13 and older) and blood lead (6 mo -16 yrs) Collect stool containers for O&P Hearing and vision check Schedule return appointment in 2 to 3 days

15 Second Visit Provider * Read TST Obtain PA and Left Lateral CXR for all with positive TSTs/QFR Use medical interpreter Review test and lab results and treat or refer to the State Health Centers/ Local Health Department, based on findings Administer presumptive therapy for malaria for refugees from sub- Saharan Africa, as indicated Immunize, or refer to the State Health Centers/ Local Health Department Growth and Development Screening Mental Health Screening Perform physical exam, include vision, hearing, cursory dental assessment Make referrals if needed (hearing, vision, dental, family planning, WIC, peds, other specialties)

16 Third Visit Conduct physical examination: consists of general appearance and nutritional status, Height, weight measurement, and vital signs (B/P, heart and respiratory rate), visual acuity, hearing, cursory dental and mental status Review lab results and treat or refer to the State Health Centers/ Local Health Department, based on findings Administer presumptive therapy for malaria for refugees from sub- Saharan Africa, as indicated Immunize, or refer to the State Health Centers/ Local Health Department Growth and Development Screening Mental Health Screening Make referrals if needed (hearing, vision, dental, family planning, WIC, pediatrics, other specialist as determined Use interpreter if needed

17 Role of State Health Center/Community Municipal Health Department and Local Health Providers Provide health risk screening to newly arriving refugees using PA Refugee HRA Protocol Use Three Visits Model Provide interpretation service Provide health educate to all refugees on how to use the health care system appropriately Maintain active collaborative relationship with VOLAGs Provide follow-up immunization to children and adult, and TB screening and follow-up treatment Participate Periodical Conference on RHP

18 Health Care Providers Who provide Refugee Health Screening Hamilton Health Center, Harrisburg Dauphin County Lancaster General Hospital Lancaster County Multicultural Health Evaluation Delivery System (MHEDS), Erie County Neighborhood Health Center of the Lehigh Valley, Allentown, Lehigh County Southeast Lancaster Health Service Lancaster County Northern Area Multi-Service Center, Pittsburgh, Allegheny County Squirrel Hill Health Center, Pittsburgh Allegheny County Spectrum Health Services, Inc. Philadelphia

19 Health Care Providers Who are on Process to Sign PPA Welsh Mountain Medical & Dental Center Lancaster County Scranton Primary Health Care Center Lackawanna County Sacred Heart Hospital, Allentown Lehigh County The Wright center for Graduate Medical Education, Scranton Lackawanna County Lehigh Valley Health Network, Allentown Lehigh County

20 Health Care Providers and VOLAGs By Region Erie Warren McKean Potter Tioga Bradford Susquehanna Wayne Crawford Forest Elk Venango Cameron Mercer Clarion Lawrence Butler Armstrong Beaver Allegheny Jefferson Clearfield Indiana Cambria Blair Sullivan Wyoming Lycoming Clinton Luzerne Columbia Union Montour Centre Northumberland Snyder Mifflin Schuylkill Juniata Perry Dauphin Westmoreland Huntingdon Lebanon Washington Cumberland Somerset Fayette Greene Bedford Fulton Lackawanna Pike Monroe Carbon Northampton Lehigh Bucks Berks Montgomery Chester Lancaster Delaware Philadelphia Franklin Adams York Health CARE Providers Volunteer Agencies (VOLAGs)

21 Newly Arriving Refugees and Eligible Immigrants in PA, 2009 and PA RHP, PA AM_2011 RHP_AM 2011

22 Total Number of Newly Arriving Refugees by Country of Origin in PA, % 10% N = % 2% 65% Africa East_South Asia Ease_Europe Latine America/PI MiddleEast Note: Refugees came from 67 different countries; Source CDC EDN, 2010

23 Total Number of Newly Arriving Refugees and Eligible Immigrants by County in PA, 2010 Erie Crawford Mercer Lawrence Beaver Washington Greene JACKSON CENTER Allegheny PITTSBURGH Butler Venango Forest Westmoreland Fayette Northwest North-central Northeast Clarion Armstrong Warren Jefferson Indiana Somerset Elk Cambria McKean Cameron Clearfield Bedford Blair Huntingdon Fulton Juniata Mifflin Dauphin Potter Franklin Clinton Centre Perry Tioga Cumberland Adams Lycoming WILLIAMSPORT Snyder Union Columbia Montour Lebanon HARRISBURG York Bradford Sullivan Northumberland Wyoming Luzerne Lancaster Schuylkill Susquehanna Carbon Berks READING Lackawanna Lehigh Chester Wayne Monroe Allentow Delaware Northampton Bucks Montgomery Pike Philadelphia Southwest South-central Southeast Legend: < 10 Refugees Refugees >100 Refugees Note: Refugees and Eligible Immigrants reside in 32 Counties PA_RHP_AM, 2011

24 Health Conditions Commonly Observed during Health Screening Dental infections Hypertension, Heart Disease Congested Heart Asthma Diabetes Mellitus Chronic TB Hepatitis B & C, HIV positive Mental conditions Depression, Post Traumatic disorder (PTD), Anxiety, etc Intestinal Parasites Giardia, Hookworms Anemia

25 Refugees with TB Conditions Refugees who were Diagnosed with TB Conditions Overseas and Resettled in PA from June May 31, (16%) (19.4%) June - Dec.2010 January - May 2011 Total Arrival Refugees with TB Conditons PA_RHP_AM, 2011

26 THANKS YOU QUESTIONS & ANSWERS