Learning How to Support and Improve Healthcare Delivery to Immigrant Patients at Health Centers in Massachusetts
Sullivan, Margaret M.
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CitationSullivan, Margaret M. 2019. Learning How to Support and Improve Healthcare Delivery to Immigrant Patients at Health Centers in Massachusetts. Doctoral dissertation, Harvard T.H. Chan School of Public Health.
AbstractImmigrant communities are foundational to the social and economic success of the United States. Health is an important factor in the ability to achieve and maintain success, but numerous barriers to equitable health access, quality and outcomes persist for many immigrants in Massachusetts. These longstanding barriers are compounded by restrictive immigration policies, creating new uncertainties about eligibility for health-promoting benefits, hamper individuals’ willingness to seek care, increase mental health concerns, and thwart the ability of healthcare providers to deliver care. Federally Qualified Health Centers (FQHCs) play a vital role in healthcare delivery to immigrants. With their unique mandate to serve all-comers, regardless of ability to pay, insurance, or immigration status, FQHCs disproportionately care for patients with low-income, lack insurance, and who prefer receiving healthcare in a language other than English. This DELTA (Doctoral Engagement in Leadership and Translation for Action) addresses the challenges and needs FQHCs in Massachusetts face in delivering healthcare to immigrant patients. In collaboration with the Massachusetts League of Community Health Centers, this work sought to understand the specific challenges and opportunities health centers face when caring for immigrant patients. The objective was to identify how the League can improve support of health centers experiencing challenges with delivery of services to immigrant patients. Between December 2018 and June 2019, 53 staff members across five FQHCs and the League participated in discussion groups about challenges and opportunities. Responses were analyzed thematically and formulated into recommendations and tools for the League. A second component of this DELTA was the launch of an immigrant-friendly clinic at one FQHC, Boston Health Care for the Homeless. Since March 2019, 23 clinic sessions have taken place, serving 201 unique patients from over 13 countries who speak more than six languages. The process of developing the new clinic has shed light on one health center’s existing challenges in immigrant healthcare delivery, constructive opportunities for improvement, and necessary core organizational components. Improvements at the organizational level of health centers have the potential to facilitate and promote individual staff capacity. However, new uncertainties, confusion and growing fears compound existing barriers and health centers require additional support.
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