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Overcoming the chilling effect: Identifying strategies for improving immigrant families’ acceptability and accessibility to health and social services that alleviate poverty

The project: In March 2017, a commentary in the New England Journal of Medicine (NEJM) by two physicians called for research on the potential “chilling effect” that increased immigration enforcement under the new presidential administration would have on immigrant’s willingness to seek healthcare or government services. Given that the timely receipt of health and social services can be a successful poverty-alleviation strategy, this barrier to health and social services for immigrant populations could exacerbate and prolong poverty. Because healthcare and access to other social services is critical for preventing and alleviating poverty, neighborhood Federally Qualified Health Centers are a vital resource for immigrants living in the surrounding community. This project aimed to identify new and promising strategies for how these health centers can provide healthcare and social services to undocumented immigrants and their families in this context of increased immigration enforcement.

The process: Investigators at Community Health and Social Service Center (CHASS) in Detroit, Washtenaw Health Plan in Ypsilanti, Packard Health in Ann Arbor and the University of Michigan conducted in-depth interviews with 28 frontline healthcare and social service providers in 2018 to better understand the barriers to and facilitators of healthcare for their immigrant clients.

Results: The researchers found undocumented clients encounter three phases of delay: delay in the decision to seek care, delay in identifying and traveling to healthcare facilities, and delay in receiving adequate and appropriate care at healthcare facilities. Given the current socio-political climate for immigrants, they recommend healthcare and social services organizations that serve undocumented clients should adapt existing services or introduce new services, including those that are not site-based like telemedicine, home visits by providers, and harnessing a workforce of community health workers.

More information: Barriers and facilitators to healthcare and social services among undocumented Latino(a)/Latinx immigrant clients: Perspectives from frontine service providers in Southeast Michigan

Paul J. Fleming, Ph.D., M.P.H., U-M Assistant Professor, Dept. of Health Behavior & Health Education, School of Public Health
William D. Lopez, Ph.D., M.P.H., U-M Postdoctoral Fellow, Dept. of Health Behavior & Health Education, School of Public Health
Richard Bryce, D.O., Chief Medical Officer, Community Health and Social Services Center (CHASS)