HEALTH PLANNING FOR IMMIGRANTS

Health Progress, Jan/Feb 2005 by Cameron, Karen, Hansen, Eletta

Bon Secours Richmond Sponsors a Community-Wide Needs Assessment

Increased security efforts since September 11, 2001, may have reduced the flow of documented immigrants entering the United States, but the overall flow continues. Most new immigrants do not have health insurance or other resources with which to address their health-related needs. And, unfortunately, many of the communities they move into are not prepared to help immigrants with interpreters, transportation, health care, and other services they need.

Since the mid-1990s, communities in and around Richmond, VA-like those in other parts of the South-have seen an explosion in the number of immigrants, particularly Hispanic people. Responding to this quickly growing immigrant population has become a high priority for the leaders of Bon secours Richmond Health System (BSR). BSR, a member of Bon secours Health System (BSHS), Marriottsville, MD, consists of four hospitals, a nursing school, outpatient and diagnostic facilities, physician groups, and the Care-a-Van, a mobile clinic that carries primary care sendees to underserved populations.

In August 2002, BSR's Community Health Services office invited representatives of local health and human service providers and community groups to meet to discuss the needs of local refugee and immigration populations and the resources available for them.* BSR's leaders hoped that the meeting would give birth to a plan for serving the area's quickly growing immigrant populations, which were affecting community health resources. The meeting's participants, constituting themselves as a steering committee for the effort, discussed a number of topics, including the services available, fiscal and legal restrictions on those services, the importance to immigrants of neighborhoods, and immigrants' need for interpreters and bilingual health care professionals.

The two authors of this article were delegated to meet to develop a list of stakeholders and an interview protocol to be used to gather more detailed information about the issues identified. I am executive director of the Central Virginia Health Planning Agency (CVHPA), a not-forprofit health planning organization whose primary service area comprises 27 cities and counties, covering about a fifth of the state. The CVHPA's mission is to facilitate accessible, cost-effective, and high-quality health services to communities through planning and collaborative efforts.

In January 2003, BSR, using funds from a BSHS grant, contracted with the CVHPA to conduct a comprehensive needs assessment to quantify the immigrant population, identify health care needs according to various demographic groups, and develop strategies for meeting high-priority needs. BSR was especially interested in identifying the groups that appeared to be having the greatest impact on the area's health care resources, in terms of their locales, ethnic or racial backgrounds, and lengths of residence in the United States. Specifically, the needs assessment was to "assess the health needs of the Hispanic and Asian populations in the greater Richmond area, with particular focus on those living in the Counties of Chesterfield, Hanover and Henrico and the City of Richmond and the members of these populations who have lived in the area for three years or less."

PLANNING THE ASSESSMENT

The CVHPA, in consultation with BSR's Community Health Services' staff, developed a plan for the needs assessment. The plan, intended to ensure that sufficient quantitative and qualitative information was gathered, contained 14 steps. The project partners would:

* Conduct an initial meeting with immigrant health and service-provider representatives (the steering committee) to solicit their opinions about the needs of and services available to refugees and immigrants in the greater Richmond area, potential barriers to planning for these populations' health needs, and the work already being done. This was the meeting held in August 2001.

* Gather available 2000 census data from the U.S. Citizenship and Immigration Services (formerly the Immigration and Naturalization Service) and Virginia's Department of Education, Department of Health, inpatient level database, and any other sources.

* Analyze data to determine trends, concentrations of Hispanic and Asian people, the likely number of recent immigrants, and the inpatient and general health needs of these populations.

* Using the protocol developed, interview those health and service providers who offer services to a significant number of immigrants in the greater Richmond area.

* Summarize the findings of these interviews.

* Develop a questionnaire for three 10-person focus groups (two of recent Hispanic immigrants, one of recent Asian immigrants).

* Translate the questionnaire into Spanish for the Hispanic groups (the Asian group did not need a translation).

* Conduct and summarize the results from the focus groups.

* Compile a report of preliminary findings, including a list of three to five salient needs.