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November 2023

The Minnesota Center of Excellence in Newcomer Health (MN COE) is dedicated to developing tools to support health care providers, public health professionals, and resettlement partners in their efforts to better serve immigrant and refugee families. We build on existing infrastructure and partners’ extensive experience to identify and monitor newcomer health issues and needs, contribute to evidence-based policies and guidance, and ultimately improve continuity of care and health outcomes for newcomers.

• Pop quiz
• Thank you for participating in our Needs Assessment Survey!
• "Ask Where?" resource
• Immigrant Health Matters
• ECHO Colorado Newcomer Health Series
• CDC guidance updates
• Office of Refugee Resettlement updates
• Colorado COE in Newcomer Health
• Contact

Pop quiz

1. How many refugees arrived in the U.S. in the 2023 federal fiscal year? A. 1,355 B. 25,465 C. 60,014 D. 73,612 For our clinical audience… 2. You have an unvaccinated 8-year-old patient who recently traveled (past few weeks) presenting with fever, pink eye, runny nose with cough, and rash starting on the face. What disease do you suspect? A. Varicella (Chicken Pox) B. Measles C. Conjunctivitis (Pink Eye) D. Mild allergies Answers at the bottom of this newsletter

Thank you for participating in our Needs Assessment Survey!

We received 393 survey responses and wanted to share with you some of our preliminary findings!

Who took the survey?

• Physicians (27.2%)
• Public Health Nurses (23.2%)
• Other Nurses (19.3%)
• Public Health Professionals (7.4%)
• Nurse Practitioners (6.9%)
• Clinical Psychologists, Community Health Workers, Dentists, Pharmacists, Physician Assistants, State Refugee Health Coordinators, Social Workers in Health Care Settings (<10%)
• Other (7.6%)
  Student, resident, trainee, intern (5.1%)

How long have the participants worked with newcomers?

Where are the participants from?

Responses as of 10/27/2023

What were the top requested trainings we should consider for next year?

1. Management of patients with latent TB infection (LTBI) (41.7%)
2. Vaccine catch-up (36.5%)
3. Mental health care (35.9%)
4. Caring for unaccompanied refugee minors (29.7%)
5. Interpreter-mediated communication skills (26.8%)
6. Care Coordination/Specialty Care Referrals (26.8%)
7. Children with special healthcare needs/complex chronic conditions (26.0%)
8. Developmental delays in children (18.2%)
9. Failure to thrive, stunting, and malnutrition in children (17.7%)
10. Management of patients with hepatitis B (16.9%)

"Ask Where?" resource

Children and adolescents living in the U.S. come from all over the world. To ensure the
best possible health for all children, primary care clinicians should offer country-specific screening for conditions that are asymptomatic initially but, if untreated, can cause health problems later.

Our refugee health partners at Children's Hospital of Philadelphia created a guidance document to support conversations with newcomers when needing to ask where they were born or where they came from in a culturally sensitive way to improve health outcomes.

Ask Where: Communication Guidance for Clinicians Implementing Immigrant Child Health Screening in Primary Care (PDF)

Immigrant Health Matters

Immigrant Health Matters is a quarterly series of brief vignettes focused on immigrant health and health equity. Articles are designed to be read in three minutes and to provide an immigrant’s perspective of challenges in achieving health equity. 

Read the latest installment of our Immigrant Health Matters series, following a nurse and the steps she took to transition her clinic to a refugee health clinic: Starting a clinic for newcomers: Central Indiana.

ECHO Colorado Newcomer Health Series

In partnership with ECHO Colorado, the Minnesota Center of Excellence in Newcomer Health has been hosting a monthly training on newcomer health since Oct. 25, 2022; the final 2023 training was held on Nov. 28, 2023. As of the end of August (the tenth session), we had reached 460 unique participants from 40 states and Washington, D.C. On average, 148 people attended each session.

Access recorded sessions and resources at Newcomer Health ECHO Resource Page and keep an eye on the Newcomer Health: ECHO Colorado webpage as we plan and get ready for our 2024 series!

ECHO completed a mid-series evaluation and compiled the information to present at the MetaECHO 2023 Global Conference earlier this year.¹ They presented the following information:

Participants who completed the mid-series survey and indicated they provide direct patient care reported significant changes (p ≤ 0.001) in current use of CareRef when caring for Newcomers compared to before this ECHO series (n=70).

CAREREF UTILIZATION WHEN CARING FOR NEWCOMERS

Participants reported significant changes (p ≤ 0.001) in current use of CareRef when caring for newcomers compared to before this ECHO series:

Most participants who provide direct patient care indicated that the Newcomer Health ECHO series has provided new and relevant information that has potential to impact (43%) or definite impact (47%) to their professional performance (n=70).

RELEVANCE AND IMPACT TO PROFESSIONAL PERFOMANCE

Most participants indicated that the Newcomer Health ECHO series has provided new and relevant information that has potential to impact (43%) or definite impact (47%) to their professional performance (n=70):

Reference:
“Newcomer Health ECHO Series – Ongoing Collaboration for Sharing Clinical and Cultural Recommendations to Improve Provider Care of Newcomers in the U.S.” Kristen A. Young¹, AD Sanchez¹, Shuyuan Tan¹, Jessica Deffler², Lily Rubenstein³, Blain Mamo³, Janine Young⁴, Sarah Kuech³
ECHO Colorado, CO¹, Thomas Jefferson University Hospital, PA², Center of Excellence in Newcomer Health, MN³, University of California San Diego School of Medicine, CA⁴

CDC guidance updates

Intestinal parasites

CDC issued an update to the CDC Overseas and Domestic Presumptive Intestinal Parasitic Treatment Guidance for Refugees on Oct. 5, 2023. The key changes include:

• Single-dose treatment of Strongyloides with ivermectin 200 mcg/Kg orally.
• Recommendations for management of Strongyloides in refugees from Loa loa endemic areas emphasize a screen-and-treat approach and de-emphasize a presumptive high dose albendazole approach.
• Presumptive use of albendazole during any trimester of pregnancy is no longer recommended.
• Updated treatment table.
• Latin American and Caribbean refugees are now included, in addition to Asian, Middle Eastern, and African refugees.

Read more about the CDC Overseas Parasite Guidelines (PDF) or the CDC Intestinal Parasite: Domestic Guidance.

Cancer screening

CDC updated the guidance for cancer screening for newly arriving refugees and immigrants. The updated guidance emphasizes the need to consider additional risk factors or exposures when conducting cancer screening in newcomers, as well as the application of special considerations for cancer screening in immigrants outlined by the U.S. Preventive Services Task Force.

The guidance also highlights the National Breast and Cervical Cancer Early Detection Program, a resource through which some newcomers may be eligible for free or low-cost breast and cervical cancer screening and diagnostic services.

Clinicians providing health care for newcomers and/or conducting the domestic medical screening should use the interactive tool, CareRef, for customized screening recommendations based on the Guidance for the Domestic Medical Screening for Newly Arrived Refugees.

Office of Refugee Resettlement updates

We are working to update our MN COE website to reflect the recent Dear Colleague Letter 24-01: Eligibility for Refugee Resettlement Program benefits and services: Parolees from Afghanistan or Ukraine (PDF) regarding changes to eligibility for benefits and services recently issued by the Office of Refugee Resettlement. Keep an eye on our Afghan Clinical Guidance and Ukrainian Clinical Guidance pages for these changes in the coming weeks.

Colorado COE in Newcomer Health

Did you know that we are one of two centers established by support from the Centers for Disease Control and Prevention? Visit our partner site: Colorado COE in Newcomer Health! The Colorado team leads data/epidemiology and public health navigation initiatives through partnerships with states and sites across the country. Their primary goal is to maintain a data repository to identify and respond to the changing landscape of newcomer health, with a focus on domestic medical exams and long-term health follow-up data. Additionally, they support public health teams in ensuring that all populations are included in public health responses, regardless of culture or language. They develop best practices, toolkit resources, and capacity-building trainings for navigators and public health teams.

Contact

You are receiving this email because you are subscribed to MDH's COE or CareRef updates, Refugee Health Quarterly, or you have attended a past training. Please subscribe now if you are not already subscribed to Center of Excellence in Newcomer Health Updates and wish to receive future editions.

For more information or questions, please contact the Minnesota Department of Health Refugee Health Program at refugeehealth@state.mn.us or 651-201-5414.

The Center of Excellence in Newcomer Health is supported by NU50CK000563 (MN) from the U.S. Centers for Disease Control and Prevention.

Pop quiz answers
#1: C. 60,014 | #2: B. Measles