P2.188: "Todos con Corazon, Hacemos Milagros": Engaging Stakeholders to Imagine a More Comprehensive and Compassionate System to Improve the Health of Arriving Immigrant Families with High-Risk Medical Needs

Background:

Background: There is no coordinated system to identify newly arrived immigrant families with high-risk medical needs at the Southern United States (US) border and connect them with appropriate medical care. Each region had to create its own system. We aim to describe the existing efforts that support new immigrants along the continuum from the border to their final destination cities, and to incorporate critical stakeholder experience to develop innovative solutions to create a more comprehensive system for identification, referral, and entry into health care for this at-risk group.

Methods:

Methods: In 2024, major non-governmental shelters were identified that received immigrant families after release from Customs and Border Protection (CBP). Purposeful sampling occurred via recruitment by these shelter leaders and the authorship team. Participants included local governmental officials, school and hospital administrators, CBP officers, social workers, shelter staff, physicians and mental health providers who work with immigrants. Two focus groups included Mexican immigrant shelter representatives. A virtual focus group was held with Pediatric Specialty Care Access Network (Pedi SCAN) Champions, a national network of pediatricians who facilitate access to care for newly arrived children with complex medical needs. Another virtual focus group was held with Migrant Clinician Network case managers, who provide medical care coordination for families with high-risk medical needs. Interviews were transcribed and coded using constant comparative analysis.

Results:

Results: Seven in-person border sessions and two virtual sessions with MCN case managers and Pedi SCAN Champions with total of 66 individuals were conducted. Critical needs were identified and innovative solutions proposed. Major themes include: 1) Immense violence and fear along migration journey, 2) Mental health needs are inadequately addressed, 3) Border policies must be improved 4) Once released from CBP, healthcare is often denied or delivery is insufficient and fragmented, 5) Social and procedural barriers impact care, 6) Improved coordination between organizations is needed, 7) Education for migrants and receiving communities would be beneficial, and 8) Health services must be accessible, culturally sensitive, and accountable.

Conclusion:

Conclusion: Many changes are needed to address high-risk medical needs in immigrant families new to the US. Successful interventions will require a multi-pronged approach with local, regional, national and international collaboration. Immediate and long-range strategies will be needed. Next steps include reporting the detailed ideas for change proposed by this experienced group, creating forward-facing community advisory boards in each region to define best practices, and conducting an analysis to determine which practices are effective and sustainable. Utilizing stakeholder wisdom, we can prepare for the day when asylum-seeking families will once again be welcomed at our borders.