P2.184: Exploring the Impact of the Humanitarian Migrant Crisis on a Safety-Net Hospital and its Frontline Staff: An Ongoing Mixed-Methods Advocacy Project

Background: Migrant families have been forcibly displaced due to global socio-political and economic instability, leading to influxes of families seeking refuge in the United States. Given the limited resources for navigating complex healthcare and housing systems, many families have presented to safety-net hospitals for support, where frontline staff (FS) face challenges in navigating public systems that have exceeded their capacity. Yet, few initiatives have centered the experiences and insights of staff across healthcare roles when looking for solutions. FS have unique perspectives on individual, institutional and structural changes that could strengthen care coordination and resource access for newly arrived families, however many also experience an emotional toll caring for this at-risk population.

Project Description: In this IRB-approved multimodal advocacy project, we characterize the perspectives of a diverse cohort of FS at a safety-net hospital using inductive thematic content analysis of semi-structured interviews, and present a report on opportunities for improvements in healthcare delivery for migrant families to hospital leadership. Using the validated Professional Quality of Life Scale, we also assess the prevalence of vicarious trauma, burnout and compassion satisfaction in our safety-net hospital’s FS. Qualitative interview analysis will be completed by May 2025. This project will culminate in a solutions-based advocacy-oriented briefing for our safety-net hospital centering the voices of FS who interact with both the systems at play, and the families affected the most.

Discussion: Of 196 FS who completed the survey, the majority noted high rates of compassion satisfaction (CS), a measure of job-place pleasure derived from helping others, with 33% noting high CS and 66% noting moderate CS. Meanwhile, about half of respondents noted moderate secondary trauma or burnout. These findings coupled with early analysis of qualitative interviews suggest that while burnout and secondary trauma are present, the satisfaction derived from providing care to migrant families may be protective from more severe burnout. Early findings from individual interviews highlight ideas for improving healthcare delivery and resource linkage, including health education by peer health navigators, patient literacy support, structural changes in flexibility for public insurance coverage when housing instability forces them to move far from previously covered health centers, and increased clinic-based social services.

Conclusion: Frontline staff from a variety of patient-facing roles within our safety-net healthcare system are impacted by burnout and secondary trauma, yet remain motivated to continue caring and advocating for recently migrated families. Upon conclusion of our interviews, we plan to synthesize suggestions from FS into major individual, institutional and structural themes, and ultimately present them to hospital leadership. We hope that this project serves as one example of how to minimize re-traumatization of migrant families by instead leveraging the diverse experiences and expertise of FS when advocating for possible improvements within institutions caring for migrant families.